Tuesday, December 17, 2013

CASAA's Testimony to the New York City Council regarding proposed ordinance to include e-cigarettes in NYC Smoke-Free Air Act


December 17, 2013

Re:  Proposed Int. 1210-A

Dear Members of the New York City Council:

On behalf of its members in New York City and surrounding cities, The Consumer Advocates for Smoke-free Alternatives Association (CASAA)[1] urges you to reject Proposed Int. 1210-A that would include electronic cigarettes (“e-cigarettes”) in New York City’s Smoke-Free Air Act. 

While we appreciate the City Council’s desire to protect the health of the citizens of New York City, CASAA respectfully submits that not only would banning the use of e-cigarettes in public places not further public health, it would actually work against the interests of public health by discouraging smokers from using smoke-free e-cigarettes that, like smokeless tobacco products, pose an estimated 1% of the risk of smoking.[2]  Given that e-cigarette use poses no hazard to bystanders[3] and is unquestionably low-risk for the user, CASAA urges the City Council to reject the proposed ordinance as seeking a solution to a problem that does not exist.

Simply stated, e-cigarettes are one of the most promising public health innovations of the last half-century and have already been shown to help smokers quit smoking cigarettes.[4]  Restrictions seeking to treat e-cigarettes exactly the same as smoking are more about politics and ideology than about science and genuine health concerns. 

I. E-cigarettes do not produce smoke and pose no risk to bystanders and, as such, should not be included in smoking bans.

Smoke-free laws were passed ostensibly to protect bystanders from the effects of second-hand smoke.  However, because there is no combustion involved in their use, e-cigarettes do not produce smoke.  Rather, liquid is gently heated to the point where a vapor is formed.  Various studies have examined the composition of the vapor produced by e-cigarettes, and none have found any reason to believe that bystanders are at any risk.

The vapor, which contains no products of combustion or harmful quantities of any toxic substances, begins to dissipate almost immediately, and there is typically little or no detectable odor.  (If there is an aroma, bystanders usually describe it as pleasant and smelling not at all like smoke.) 

Professor Igor Burstyn of the Drexel University School of Public Health recently published a review of 9,000 observations about the chemistry of the vapor and liquid in e-cigarettes.[5]  Dr. Burstyn performed this review to determine the potential risk that e-cigarettes pose to users and bystanders. He concluded that e-cigarette users are exposed to levels of chemicals far below those that would create any health concern. Most importantly for present purposes, Dr. Burstyn also determined that that the levels of chemicals in e-cigarette vapor were so trace so as to present no measurable risk to bystanders.

Even the American Cancer Society, the American Lung Association, and the American Heart Association acknowledge that smoke-free laws do not require a ban on e-cigarettes.  Last year, those three organizations agreed to specifically exempt smoke-free e-cigarettes from a smoking ban in Springfield, Missouri so as to avoid any confusion over their legal status.[6] 

Including e-cigarettes in smoking bans when there is absolutely no proof of appreciable risk to bystanders is not only inappropriate, it represents legislative overreaching.

II.  Unintended Consequence of the Proposed Ordinance:  Discouraging smokers from switching to lower-risk alternatives.

Banning the use of smoke-free e-cigarettes in public places may actually work against the New York City Council’s stated purpose of promoting the health of its citizens.

The concept of Tobacco Harm Reduction (THR)—replacing tobacco cigarette smoking with far less hazardous sources of nicotine—is becoming increasingly recognized as a valid strategy in combating the crippling health problems associated with smoking.  

As noted by the Royal College of Physicians, a large percentage of smokers may never be able to give up all use of nicotine.[7]  For those who feel they are unable or unwilling to completely quit nicotine use, switching to a smokeless alternative can achieve substantial health benefits, with many such products carrying only about 1% of the risk posed by smoking.  Low-risk products embraced by THR include smokeless tobacco products, e-cigarettes, and long-term use of nicotine replacement therapy (NRT) products.[8] Smoke-free e-cigarettes are proving to be one of the most promising of the THR products.

Rather than treat all tobacco products as equally dangerous, politicians and health care advocates should embrace THR.  In fact, both Indiana and Nebraska have passed proclamations embracing the concept of THR, recognizing that current strategies simply are not effective enough. 

Sound public health policy surely would encourage smokers to replace or reduce their cigarette consumption—not create obstacles to it. Banning the use of e-cigarettes where smoking is prohibited sends a message to smokers that they may as well continue to smoke, whereas allowing e-cigarette use indoors provides an incentive to switch to a far safer alternative.

III.  As a practical matter, a ban on e-cigarette use would be largely unenforceable.

As noted above, whereas cigarette smoke has an unmistakable odor and smoke lingers in the air, e-cigarette vapor is practically odorless and visible vapor begins to dissipate almost immediately.  When a person using an e-cigarette chooses to hold the vapor in for several seconds, there is typically no (or very little) visible vapor upon exhale.  Furthermore, unlike cigarettes, no evidence of a violation is left behind (i.e., a cigarette butt or a lingering smell).

IV.  Allowing e-cigarette use where smoking is prohibited will not pose any problems with enforcing existing smoking bans.

Forty-seven states do not ban e-cigarette use where smoking is prohibited, and yet there are no reports of authorities in these states having had problems with enforcement. Just as the innocuousness of e-cigarette vapor, as compared to cigarette smoke, makes a ban difficult to enforce, it makes it impossible to not recognize the difference.  Smokers who see an e-cigarette used indoors do not light up—they ask, “What is that?” and “Where can I get one?”

There are visible clues that are obvious to anyone tasked with enforcement, including how the devices are held, where they are placed after puffing, and the blue or other colored electronic lights on many e-cigarettes that contrast clearly with a glowing burning cigarette.  If the City Council feels there is a genuine issue of possible confusion, the more reasonable response would be to ban the use of e-cigarettes with orange or yellow glowing LED tips in areas where smoking is prohibited.

V.  Allowing e-cigarette use where smoking is prohibited will not "normalize" smoking.

E-cigarette use does not "normalize" smoking.  To the contrary, it sends a clear signal that smoking is becoming less-and-less the norm.  It normalizes an alternative that is magnitudes of order safer than smoking and which poses no measurable risk to bystanders.   The solution is not to treat e-cigarette use exactly like smoking, but, rather, to educate the public about the differences.


CONCLUSION

For the foregoing reasons, CASAA urges the New York City Council to reject the extension of New York City’s Smoke-Free Air Act to include e-cigarettes.  

Thank you for your consideration. 


Sincerely,

Julie Woessner, Legislative Director
The Consumer Advocates for Smoke-free Alternatives Association
7481 Huntsman Blvd, #420
Springfield, VA 22153
jwoessner@casaa.org
(202) 241-9117





[1] CASAA is a non-profit 501(c)(4), all-volunteer organization with a grassroots' membership of thousands of individuals from all walks of life. We are a consumer-focused organization, not a trade association. We are dedicated to ensuring the availability of reduced harm alternatives to smoking and to providing smokers and non-smokers alike with honest information about those alternatives.

Since CASAA's founding in 2009, we have educated the public and increased awareness about the benefits of reduced harm alternatives to smoking, including e-cigarettes. We also encourage responsible legislative policy designed to improve public health by recognizing that smoke-free nicotine-containing products are inherently far less dangerous than smoking.

[2] Phillips CV, Rabiu D, Rodu B. Calculating the comparative mortality risk from smokeless tobacco versus smoking. Am J Epidemiol 2006;163:S189.

[3] Burstyn, I.  Peering through the mist:  What does the chemistry of contaminants in electronic cigarettes tell us about health risks?  Drexel University.  2013 http://publichealth.drexel.edu/~/media/files/publichealth/ms08.pdf

[4] Polosa R, Caponnetto P, Morjaria J B, Papale G, Campagna D, Russo C: Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation: A Prospective 6-Month Pilot Study. BMC Public Health 2011, 11:786. http://www.biomedcentral.com/content/pdf/1471-2458-11-786.pdf 

[5] Burstyn, I.  Peering through the mist:  What does the chemistry of contaminants in electronic cigarettes tell us about health risks?  Drexel University.  2013 http://publichealth.drexel.edu/~/media/files/publichealth/ms08.pdf

[7] Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2007.

[8] Rodu B. The scientific foundation for tobacco harm reduction, 2006-2011. Harm Reduct J. 2011 Jul 29;8:19. The scientific foundation for tobacco harm reduction, 2006-2011

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