Tuesday, December 3, 2013

New York City - Don't make the same mistake that New Jersey did

Dear Member of the New York City Health Committee:

While we appreciate the City Council’s desire to protect the health of the citizens of New York City, CASAA [1] 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 a smoke-free product that, like smokeless tobacco, poses an estimated 1% of the risk of smoking [2]. Given that e-cigarette use poses no hazard to bystanders [3] and is unquestionable low-risk for the user, CASAA urges the Health Committee to reject the proposed ordinance as seeking a solution to a problem that doesn’t exist.

Information has and will be presented to the Health Committee both in support of, and in opposition to, restricting the use of e-cigarettes in public places. Unfortunately, much of the information being presented by e-cigarette opponents in support of the ordinance is speculative, and, in some cases, is not only misleading, but demonstrably false. CASAA hopes that the Health Committee will carefully examine the evidence and conclude that e-cigarette use is not a problem, nor is it a threat to public health, and, in fact, placing roadblocks to e-cigarette use is not in the best interests of the citizens of New York City.

For example, proponents of the ordinance claim that e-cigarette use “may interfere with smokers’ attempts to quit.” It would be just as accurate to say that making e-cigarette use more difficult and less attractive for adult smokers “may interfere with smokers’ attempts to replace (“quit”) their smoking habit with e-cigarettes.” In fact, one might ask that if using e-cigarettes “may interfere with smokers’ attempts to quit,” why are smoking rates going down?

The number of adult smokers in the U.S. hovered right around 46 million from 1990 through 2009. E-cigarettes first became readily available in the U.S. in 2009. By 2010, the number of adult smokers had dropped to 45.3 million. By 2011, the number had adult smokers dropped again to 43.8 million.

Adult current smoking prevalence rates for the state of New York were 18.1% in 2011, and declined to 16.1% in 2012. Things are going in the right direction.

Please don't make the same mistake that New Jersey did.

New Jersey outlawed indoor use of e-cigarettes in 2010. In 2011, New Jersey's adult smoking rate was 16.8%. By 2012, that rate rose to 17.3%. In contrast, the Virginia Attorney General issued a legal opinion in 2010 stating that use of an e-cigarette is not included in the definition of smoking in Virginia's Clean Indoor Air Act. Seeing e-cigarettes in use has not served to renormalize smoking in Virginia. In fact,Virginia's adult smoking rate was 20.9% in 2011, but dropped to 19.0% in 2012.

By reducing the odds that New Jersey smokers would see e-cigarettes in use, New Jersey may have missed an opportunity to lower the state's smoking rates and to reduce the health risks of hundreds of thousands of its citizens.

If use of a smoke-free e-cigarette in locations where smoking is prohibited creates "fear and confusion and interferes with the enforcement" of Clean Air laws, why have there been no wide-spread enforcement problems in New York City...and in all the states that do not ban the indoor use of e-cigarettes?

It's not difficult at all to tell when someone has lit a real cigarette. Smoke has a distinctive odor. Smokers are not lighting up in droves after they witness someone using an "un-cigarette." Yes, that's right, an e-cigarette is not a real cigarette, and using an e-cigarette is not smoking--it's a low-risk replacement for smoking.

If using an electronic cigarette (e-cigarette) may cause children and youth to become addicted to nicotine and then "switch to smoking cigarettes," why are youth recent smoking rates going down, and why are youth smoking initiation rates going down?

Data Sources:
* CDC Morbidity and Mortality Weekly Report, Tobacco Product Use Among Middle and High School Students — United States, 2011 and 2012, November 15, 2013 / 62(45);893-897. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6245a2.htm?s_cid=mm6245a2_e
** Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables, Figure 4.4 Past Month Cigarette Use among Youths Aged 12 to 17, by Gender: 2002-2012. http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#fig4.4
*** Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables, Figure 5.8 Past Year Cigarette Initiation among Youths Aged 12 to 17 Who Had Never Smoked Prior to the Past Year, by Gender: 2002-2012. http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#fig5.8

Is nicotine a "highly addictive" substance without the smoke?

Researchers at Virginia Commonwealth University explored the question of whether use of an e-cigarette would lead to physical and/or psychological dependence. They determined that the slower rate of nicotine delivery makes it appear that e-cigarettes have a lower potential for triggering chemical dependency than traditional tobacco cigarettes. (See: Vansickel AR, Weaver MF, Eissenberg T. Clinical laboratory assessment of the abuse liability of an electronic cigarette. Addiction. 2012 Jan 9.http://www.ncbi.nlm.nih.gov/pubmed/22229871)

When the FDA found "toxins and carcinogens" in some e-cigarette samples, was that the whole truth?

There's a reason why witnesses are asked to swear to tell the whole truth when they testify in court. Leaving out pertinent information can mislead the audience. Should we be concerned that Tobacco-specific Nitrosamines (TSNAs) were detected by the FDA in a few samples tested? The rest of the story is FDA-approved "Nicotine Replacement Therapy" (NRT) products have never been shown to cause cancer. The quantity of TSNAs in a day's supply of e-cigarette liquid is equivalent to the quantity contained in a nicotine patch, or in just two pieces of nicotine gum. E-cigarette liquid is made with the same pharmaceutical grade nicotine as NRT products, a fact that opponents of e-cigarettes often conveniently neglect to mention.

As far as toxins go, Professor Igor Burstyn, Drexel University School of Public Health conducted a comprehensive review of over 9,000 observations about the chemistry of the vapor and the liquid in e-cigarettes, Dr. Burstyn was able to determine that the levels of contaminants e-cigarette users are exposed to are insignificant, far below levels that would pose any health risk. Additionally, there is no health risk to bystanders. Proposals to ban e-cigarettes in places where smoking is banned have been based on concern there is a potential risk to bystanders, but the study shows there is no concern. The study is available at http://publichealth.drexel.edu/~/media/Files/publichealth/ms08.pdf.

In addition, the FDA has awarded a research grant to the University of Maryland to conduct toxicology testing on e-cigarette liquids and vapor. The results should be available this spring. Prince George's County in Maryland was considering a law similar to NYC's 7248 but decided to postpone the issue, pending the results of the University of Maryland testing.

While it is true that e-cigarettes are currently unregulated by the FDA, the rest of the story is that the FDA has submitted a proposed regulation to the Office of Management and Budget (OMB) and FDA action is expected within the month.

On behalf of millions of consumers who have switched to this low-risk alternative and experienced health improvements as well as the millions of lives that remain to be saved, The Consumer Advocates for Smoke-free Alternatives Association (CASAA) urges you to vote against T2013-7248.


Elaine Keller, President
The Consumer Advocates for Smoke-free Alternatives Association

[1] CASAA is The Consumer Advocates for Smoke-free Alternatives Association. 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? DrexelUniversity. 2013 http://publichealth.drexel.edu/SiteData/docs/ms08/f90349264250e603/ms08.pdf


brainyfurball said...

First class article.

Unknown said...

so excellent.. Kudo's to you Elaine Keller, and thank you too.!!!

illinoisvapors said...

We Need a Plan people. The Information MUST be in the Committee's hand and we have to be Focused on what we Can do. they will rule on something this meeting is where we can Change there wording to Let Shops operate and Just maybe we can stay away from the Smokers OUTSIDE please Tweet and Email these Officials and lets win one of these battles!!

john walker said...

Elaine Good article!
I am an Australian and no expert on US law . However there seems to be an obvious legislative process, problem re the banning of ecigs; If you 'deconstruct' a ecig you get :vegetable glycerine , propylene glycol , flavorings , a rechargeable battery , a small low watt heating coil, some strands of fibre and some sort of small tank and ,optionally, some pharmaceutical grade nicotine. All of these ingredients (bar the nicotine) are used for many other quite lawful purposes. And possession of nicotine , by a adult, is quite legal. And these devices do not emit any kind of smoke at all.

Therefore it is hard to see what exactly a law against ecigs , as a product ,would be banning -think it would be open to legal challenge, as in Common law terms being a "unreasonable" arbitrary treatment.
Also think that using anti smoking laws to regulate the use of things that do not emit Smoke , looks unsound.