Debate swirls about safety, public health effects of nicotine trend

by: TRIBUNE PHOTO: JONATHAN HOUSE - Ben Arboleda blows a cloud of vapor into his hand after taking a puff from his electronic cigarette at Escape Vapor Lounge. E-cigs helped Arboleda quit smoking cigarettes. There’s something in the air at Escape Vapor Lounge and it’s not cigarette smoke.

Clouds of fruity vapors fill the room, from customers puffing on electronic cigarettes that deliver mists of nicotine-laced liquid into their lungs. Some customers hover near a display case to check out the latest electronic cigarette models — essentially battery-operated nicotine delivery devices — while others sample liquid “juices” used to add nicotine and flavor.

Escape Vapor Lounge, on Northeast 82nd Avenue near Madison High School, could be the first of many “vaping parlors” in Portland. Use of electronic cigarettes or “e-cigs” is growing swiftly here and around the world, and many predict they’ll eventually surpass regular cigarettes in popularity.

by: TRIBUNE PHOTO: JONATHAN HOUSE - Ben Arboleda concocts his own flavored juice to use in his e-cigs, such as his Crazy Dutch blend.  E-cigs can be cheaper and come in alluring flavors like hazelnut, mango, peanut butter, strawberry, coffee and chocolate. Perhaps more importantly, some of the “vapers” at Escape Vapor Lounge say e-cigs helped them quit smoking cigarettes.

Matt Freeman, a 38-year-old from Portland, says he started smoking at age 15 and had been trying to quit for 10 years. After a month of vaping, Freeman says he lost the desire to smoke, and now finds the smell of cigarettes repulsive.

“I’m still addicted to the nicotine,” Freeman says. But his health has improved now that he’s not inhaling all that tar, carbon monoxide and other cigarette additives into his lungs.

“I can taste food,” he says. “I can exercise. I don’t smell like cigarettes.”

Friends say he smells like cookies.

by: TRIBUNE PHOTO: JONATHAN HOUSE - A battery-operated coil inside the e-cig heats up liquid juice that enables the user to inhale the flavored nicotine. But the rapid spread of e-cigs alarms public health experts, who fear they could undo gains from the decades-old battle to reduce smoking in this country. So far, governments of all levels have been slow to respond, leaving e-cigs unregulated while Big Tobacco companies move in to dominate the fledgling industry.

In Oregon, there’s no minimum age to buy e-cigs. They’re not taxed, making them cheaper than cigarettes and other tobacco. They don’t fall within the Oregon Indoor Clean Air Act, so people can vape indoors unless it’s barred by the property owner.

Some say that’s a recipe for tobacco companies to attract a new generation of customers at a time when cigarette smoking is declining.

“It’s going to be a Frankenstein monster,” says state Rep. Carolyn Tomei, D-Milwaukie, the Oregon Legislature’s leading anti-tobacco voice.

“I think the frightening part is young people can be addicted,” Tomei says. “People who smoke cigarettes now, they wouldn’t be interested in something that tastes like mango and bubble gum. Kids would go in and use that, especially if there’s no law against it.”

Eighty-eight percent of regular adult smokers started smoking by the age of 18, and the use of e-cigs among middle- and high-school students doubled in the past year, according to the U.S. Centers for Disease Control and Prevention.

In the 2013 Oregon Healthy Teens Survey, 5.2 percent of 11th-graders reported using e-cigs or the equivalent in the prior month — three times the number tracked in the 2011 survey.

The battery in an e-cig heats a coil, which turns the flavored juice into a vapor that’s sucked through a tube often resembling a cigarette. Nicotine is added to the juice in a mix of propylene glycol and vegetable glycerin, says Thang Truong, who opened Escape Vapor Lounge in April.

Truong managed to kick his pack-a-day cigarette habit by switching to e-cigs, and liked them so much he opened his own vaping parlor. Truong says he knows of four other vaping businesses in the works in Portland, Beaverton and Hillsboro, in addition to the kiosk selling e-cigs at Lloyd Center.

A Nielsen report for Oct. 26 found e-cig sales at U.S. convenience stores the prior month were up 118 percent from a year earlier. A Wells Fargo Securities analyst recently projected $1.8 billion in e-cig sales this year, and that they’ll surpass cigarette sales within a decade.

by: TRIBUNE PHOTO: JONATHAN HOUSE - Smoke N Vape salesman Mark Pittman lets customers try out some of the dozens of flavors (at right) available for e-cigs. Pittman predicts cigarettes will go the way of the dinosaurs.

Drive-through e-cigs

A new owner just bought The Smoke Shack on Southeast Foster Road near 50th Avenue, and converted it to a new business called Smoke 'N Vape. The inventory shifted to highlight e-cigs and juice, which are sold alongside cigarettes, pipes, bongs, hookahs and other products.

Smoke 'N Vape is promoting a $25 e-cig starter kit offer between now and year’s end. That provides the equivalent of a carton of cigarettes that would cost $40 to $50, says Mark Pittman, a Smoke ‘N Vape salesman. Many customers are switching to e-cigs, he says. They can walk inside the store to try out flavored juices, or buy at the drive-through window.

Cigars and cigarettes “will go the way of the dinosaurs,” Pittman predicts. E-cigs can be used inside a restaurant, a hospital or even a funeral parlor, where people are stressed out and feel the need to smoke, he says.

Emily Pittman, the store manager and Mark’s ex-wife, says one of the beauties of e-cigs is people can buy juices with different levels of nicotine, using it as a way to gradually get off smoking and nicotine entirely. “They can start at 24 milligrams of nicotine and work all their way down to zero,” she says. “It’s kind of like the patch.”

by: TRIBUNE PHOTO: JONATHAN HOUSE - Escape Vapor Lounges marketing manager Darlene Gorgonia takes a puff on her e-cig. Gorgonia, a former cigarette smoker, enjoys the hobby and culture of vaping as a safer alternative.

Mixed views

Dr. Bruce Gutelius, deputy state epidemiologist with the Oregon Health Authority, worries that e-cig prices are falling, and minors are getting exposed to ad campaigns and store promotions. The tobacco products growing in use among Oregon teens, Gutelius says, are the ones that come in flavors: hookahs, cigars and e-cigs.

And many youths start smoking with menthol cigarettes, because they’re not as harsh, he notes.

New CDC data revealed that of the 1.7 million middle and high school students who have tried e-cigs, 160,000 had never used conventional cigarettes before. That suggests that sweet and savory e-cig flavors are luring young people to nicotine addiction who otherwise wouldn’t smoke cigarettes.

E-cigs may turn out to help some people quit smoking and be a useful cessation device, Gutelius says, thus reducing the harm tobacco causes to their bodies. More studies are needed to confirm that, he says.

But experience shows smokers who try alternatives such as chewing tobacco and snus continue “dual use” with cigarettes, he says. E-cigs also could cause more ex-smokers to relapse. If e-cigs are used to get around indoor smoking bans, that could lead to more addicts, not less, he says.

“It’s sort of a public-health policy conundrum,” says Dr. Don Austin, a trained doctor and professor emeritus at the Department of Public Health at Oregon Health & Science University.

“If you are not a smoker, then this is a good way to become addicted,” Austin says.

Yet e-cigs may cause less physical harm than smoking. “It’s probably better for smokers to switch to them than it is to keep smoking,” Austin says. “So far as we know, it doesn’t increase your risk of cancer.”

There’s no long-term studies of e-cigs’ health effects, since they were only introduced here in 2007. But early studies haven’t found health hazards in the same magnitude as those from smoking, Austin says.

There’s no dispute that nicotine from cigarettes or e-cigs is highly addictive — more addictive than heroin. It’s known to cause damage to a fetus in a mother’s womb, physiological changes to the brain, especially among developing adolescents, and it’s not good for the cardiovascular system, Austin says.

And there’s no scientific evidence yet showing e-cig users are more able to shake their nicotine addictions, he says.

Here comes Big Tobacco

Some observers say big U.S. cigarette makers have been slow to enter the e-cig field, perhaps fearing they’d cannibalize sales of cigarettes. But now they are going all-in.

Lorillard Tobacco Co., which makes Kent, Newport and other cigarettes, bought the Blu e-cig brand last year, and has since used its marketing clout to propel Blu to No. 1 in e-cig sales. The Altria Group, parent company of Philip Morris, is testing its MarkTen e-cig in Indiana.

R.J. Reynolds Tobacco is selling its Vuse e-cig in Colorado, and expects to go national “very soon,” says Richard Smith, lead communications manager for R.J. Reynolds Vapor Co. in Winston-Salem, N.C.

“We intend to be the dominant player in the category,” Smith says. The company has already prepared TV, radio and print ads, and other marketing.

“There’s going to be some cannibalism,” Smith says, but the company wants smokers to switch to e-cigs.

Unlike Blu, which comes in multiple flavors, Vuse will only come in tobacco and menthol flavor. It could be that R.J. Reynolds expects the U.S. Food and Drug Administration to ban flavors in e-cigs, as it did with cigarettes.

Regulators also face an e-cig conundrum. Last month, the European Parliament rejected a proposal to tightly regulate e-cigs as medical devices, opting for a more permissive approach to their use.

In this country, the FDA has declared an intent to regulate e-cigs as tobacco products, which generally face a much lower level of regulatory scrutiny than medical devices. The FDA hasn’t actually issued any e-cig regulations yet, but is expected to soon.

Until then, vapers won’t know the ingredients in their e-cig juices. Some studies found the vapors include hazardous substances such as benzene, formaldehyde and volatile organic compounds.

Twenty-eight states have passed laws restricting e-cig sales to those 18 and older — with 13 of those states acting this year, Smith says. Oregon is not among them.

Escape Vapor Lounge and Smoke ‘N Vape staff say they require patrons to be 18 or older, though. Oregon, which has no sales tax, figures to have among the lowest e-cig prices in the country. E-cig sales likely are trimming revenue to Oregon’s state and local governments, as people switch from heavily taxed cigarettes.

Oregon legislative committees held two hearings on e-cigs in September, though Tomei says it’s unlikely any bills will be introduced in the February 2014 session. It’s no use, she says, because the Oregon chapters of the cancer, heart and lung associations are deferring to their national leaders, and those groups aren’t ready to push state legislation.

“I can’t go forward unless I have a lot of support from the people who would normally support the anti-tobacco issues,” Tomei says.

That means no bill will be considered here until at least the 2015 regular session. Often bills don’t pass the first session they’re introduced in Oregon, so it could take several years for the state to begin regulating or taxing e-cigs.

by: TRIBUNE PHOTO: JONATHAN HOUSE - Robert Lippert enjoys an e-cig at Escape Vapor Lounge while employee Sopon Muanprasitivej shows customers various e-cigs for sale.

Narrow window?

Chuck Tauman, a Portland attorney who has litigated several cases against tobacco companies, fears the window to enact state e-cig regulations could close in a year or two. The three big tobacco companies will have more control of the industry by then, he reasons, and they already have significant clout in Salem. Anti-smoking groups are still smarting from the 2007 defeat of an 84.5-cents-a-pack state cigarette tax increase, due to a record $12 million advertising campaign by tobacco companies.

“Once Big Tobacco gets into the game, then Katie bar the door,” Tauman says. “If the legislative issues aren’t addressed soon, there’s going to be a critical mass of lobbying in favor of e-cigs that will be difficult for the Legislature to overcome.”

Jason Parks, a lobbyist for The American Cancer Society Cancer Action Network in Portland, understands that frustration, but says groups such as his are awaiting guidance from their national leaders. “For my organization, we kind of take our time on a lot of these issues,” Parks says.

Some bills being debated in other states are now originating from the tobacco industry, he says. “This is an opportunity for us to get out in front of it that we’re not taking full advantage of.”

Slim chances for statewide actions any time soon has put more pressure on cities and counties to act. Gutelius notes there’s nothing preventing counties from enacting their own regulations. County commissioners in Clark County, Wash., barred sales of e-cigs to minors younger than 18, for instance. The state of Oregon, Multnomah and Washington counties, TriMet and some private employers such as Fred Meyer have barred the use of e-cigs on their grounds. But that’s as far as government regulators have gone here.

Multnomah County is studying the e-cig problem and “best practices” to address it, says Adele Adams, communications and policy lead coordinator for the county Health Department. Would-be regulators likely will face a growing constituency of e-cig users who swear by the products, as European regulators recently discovered.

Ben Arboleda, a customer at Escape Vapor Lounge, says he smoked cigarettes for 25 years but managed to quit in one day after discovering e-cigs. “I tried the patches and gums,” he says. “It makes me sick.”

Arboleda no longer has to duck outside for smoking breaks during the day, and says he sometimes uses nicotine-free juice in his e-cig. “Right now, if I don’t want to vape, I can do it. I can go for a week without doing it.”

Usually, he says, a few puffs in the morning will last him all day. “It’s like coffee.”

Rising e-cig use

• 5.2 percent of Oregon 11th-graders reported used electronic cigarettes* in the prior month, in an 2013 survey

• That’s up from 1.8 percent in 2011

• 1.8 percent of Oregon eighth-graders used e-cigs* in the prior month, in the 2013 survey

• That’s up from 1.3 percent in 2011

• Nationally, 1.8 million middle schoolers and high schoolers — 10 percent of them — tried e-cigs in 2012

• That’s up from 4.7 percent in 2011

• Nationally 23.3 percent of high schoolers regularly used tobacco in 2012

• Most common forms: cigarettes: 14 percent; cigars: 12.6 percent; smokeless: 6.4 percent; hookahs: 5.4 percent; pipes: 4.5 percent; e cigs: 2.8 percent

• Nationally, 6.7 percent of middle schoolers regularly used tobacco in 2012

• Most common forms: cigarettes: 3.5 percent; cigars: 2.8 percent; pipes: 1.8 percent; smokeless: 1.7 percent; hookahs: 1.3 percent; e-cigs: 1.1 percent

* Question was expanded in 2013 to include newer electronic cigars and electronic hookahs

Sources: Oregon Health Authority, Centers for Disease Control and Prevention

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