Plan B Forum

S.F. Supervisor Eric Mar crafts plan to regulate e-cig use
By Marisa Lagos
Updated 6:36 am, Tuesday, March 4, 2014

Thirty-one years ago, UCSF researcher Stanton Glantz helped push a San Francisco law to curb smoking in the workplace, pioneering legislation that set the stage for some of the strictest antitobacco laws in the nation.

Now, he's hoping to expand those laws to electronic cigarettes.

Glantz stood alongside health advocates and Supervisor Eric Mar at City Hall on Monday to talk about the supervisor's proposal to treat e-cigarettes like their combustible counterparts in San Francisco, legislation that would severely limit where the relatively new tobacco product can be used and sold. Supporters said the ban will help limit children's use of the e-cigarettes and protect the public from the secondhand aerosol emitted by the devices, which are unregulated by federal authorities.

"I feel like I'm in a time machine," said Glantz, a vocal antismoking advocate and head of UCSF's Center for Tobacco Control Research and Education. "I was here and participating in 1983 when San Francisco passed a smoking law ... and it was the same arguments - that it would destroy freedom, that it would destroy America, that it would ruin everything. That there was no evidence secondhand smoke is dangerous. It was not true when we were talking about secondhand smoke in 1983, and it's not true when we are talking about e-cigarettes now."

Under Mar's proposal, which is co-sponsored by Supervisors John Avalos and David Chiu, electronic cigarettes would be banned in the same places regular cigarettes are, including inside businesses, at city parks, and on buses and trains. It would require sellers of e-cigarettes to secure a tobacco permit, and prohibit their sale in pharmacies and other businesses where tobacco sales are banned.

If passed by the Board of Supervisors and signed by the mayor, the legislation would join a growing list of policies limiting their use and sales in a number of cities and counties, including Contra Costa County.

Mar said that while tobacco use among young people remains low, the number of youths experimenting with e-cigarettes is on the rise. He cited a 2013 Centers for Disease Control and Prevention survey which recorded a significant jump in the number of high school students who had tried e-cigarettes: 4.7 percent in 2011, and 10 percent in 2012.
'This is about ... health'

"This is about the health of our children and our communities," Mar said, noting that e-cigarettes come in flavors, such as berry, Skittles and bubble gum, that are apparently intended to appeal to kids. "I have a 13-year-old daughter who is in eighth grade, and she has told me stories about people smoking in class when the teacher turns their back. ... This would just allow smoking e-cigarettes where regular cigarettes are allowed, and prohibit them where cigarettes are prohibited."

Little is known about the long-term health effects of e-cigarettes, but Glantz said he believes they have become a "gateway" device for young people who then will move on to smoking real cigarettes. While they have been characterized by tobacco companies as a smoking-cessation device, he said most smokers don't use them to quit, but simply for situations where regular cigarettes are banned.

"One of their big marketing messages is that you can smoke them anywhere - they are marketed as a way around smoking bans," he said. "Right now, I think the most dangerous thing about e-cigarettes is that they keep people smoking."

While state law prohibits their sale to minors, Malaysia Sanders, a San Francisco City College student, said she and a group of teenagers went out in the Tenderloin neighborhood last week and found it incredibly easy to buy e-cigarettes.

"Most of the time we weren't IDd or even asked for our age," she said.

E-cigarettes are battery-operated devices that contain cartridges filled with nicotine, flavors and other chemicals. Glantz said that while their emissions are billed as vapor, they are actually aerosol, because in addition to vapor they emit small particles and gases including metals and dangerous chemicals.

"The amount of toxic stuff in e-cigarettes is less than cigarettes - they have about 10 percent of the bad stuff. But the fact is that cigarettes are so ridiculously toxic, even something one-tenth as bad is still quite toxic," he said.

If the law is passed, said Department of Public Health educator Derek Smith, the city will undertake a campaign to educate business owners about their responsibilities and rights.

Officials at the Consumer Advocates for Smoke-free Alternatives Association, a group that supports access to electronic cigarettes, and Lorillard, which manufactures one of the most popular brands of e-cigarettes, could not immediately be reached for comment.

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Daisy wrote:"...

"They are not marketed or sold to under 18's ... No teen is ever going think e-cigs are cool.... ".

So based on the current evidence: e-cigarettes sound like a substantial improvement over cigarettes, at least on some key dimensions. This is the sort of tradeoff known in public-health circles as “harm reduction.”

While adult smokers trying to quit certainly drove the growth of the vaping industry, another demographic was getting hooked at the same time. Vaping usage in the U.S. today is highest among people aged 18 to 24. Again, keep in mind e-cigarettes only came into existence 12 years ago. Roughly 20 percent of high-schoolers now vape regularly — more than double the share that smoke cigarettes. Which means that a lot of them didn’t smoke before e-cigarettes came along.

Now, this isn’t to say that plenty of smokers didn’t take up vaping; they did. A recent analysis in the Annals of Internal Medicine found that 54 percent of e-cigarette users also smoke regular cigarettes, but that 30 percent of vapers had quit smoking. At least for now. But if you are an e-cigarette company and you can’t market your product as a safer alternative to existing smokers, who might you market to instead? Especially if your product comes in flavors like mint and mango and cucumber?

DUBNER: So the British government took pretty much exactly the opposite approach of the U.S. Federal Government. And they basically looked at it years ago and said e-cigarettes are probably not the greatest thing in the world for people, but we believe that as a substitute for smoking, they could save a lot of lives. And the British government and their cancer and anti-smoking institutions offer evidence to argue that they have been correct.

o Michael Siegel’s argument is pretty interesting: public-health officials in the U.K. developed a regulatory plan for e-cigarettes that was meant to maximize smoking cessation among adults while limiting youth uptake. In the U.S., meanwhile, an early attempt at a ban led to a murky regulatory environment that didn’t further either those goals. It also left a company like Juul free to make and market a product that many people now agree is too powerful and too popular with too many young people. But the lack of regulation around vaping did more than just that. It also paved the way for a public-health tragedy that seemed to come out of nowhere.

Actually, as of this recording, the death total is 42, with more than 2,000 injuries, across nearly every state, all attributed to EVALI — “e-cigarette, or vaping, product-use-associated lung injury.” The condition involves chest pain, shortness of breath, and vomiting; and it’s been overwhelmingly concentrated among young people — nearly 8 in 10 were under 35.

SIEGEL: So far, I don’t know of any cases of respiratory failure that have been reported in the U.K. And that’s important because it tells us that it can’t be traditional e-cigarettes because those products have been sold in the U.K. and in other countries for a decade or more, and they haven’t had any problems. Something different is going on here.

SIEGEL: I think what is going on different is that we have a huge black market, especially for THC products. And I think it’s those products that are predominantly responsible for the outbreak.

SIEGEL: The CDC has reported that approximately 89 percent of the cases are attributable to THC or black-market vaping oils, whereas 11 percent of the cases did not admit to using THC.