Americans are becoming more familiar with e-cigarettes, which are beginning to appear in restaurants, bars and coffeehouses where regular cigarettes have long been banned. An e-cigarette is, in effect, a battery-operated nicotine delivery system that works by heating a mixture of water, nicotine and other chemicals. The user inhales and exhales the resulting vapor rather than smoke.
E-cigarettes look like regular cigarettes and, for many people, substitute for them. But enormous questions remain. Are they a relatively harmless tool that helps people quit, or are they an attractive gateway into smoking for young people? If they're substantially less dangerous than regular cigarettes but substantially more dangerous than not smoking at all, should they be subject to the laws that govern cigarettes on TV advertising, sales to minors and restrictions on smoking?
E-cigarettes became a sales phenomenon so quickly that they left scientists as well as local, state and federal governments scrambling to catch up. To date, there is little in the way of definitive, evidence-based answers to the many questions that have been raised.
Many cigarette smokers who have switched from smoking to "vaping" swear they could never have beaten their tobacco habit without the e-cigarette, which provides both the nicotine and some of the experience of smoking. Not that nicotine is safe; in addition to being addictive, it raises the heart rate and is one of the components of smoking associated with heart disease. But e-cigarettes don't have the tar that is the main cause of smoking-related cancers.
It seems reasonable to assume that e-cigarettes are, if not harmless, at least more benign than tobacco. But scientists warn that such assumptions could be mistaken. A Greek study last year found e-cigarettes almost immediately inflamed and constricted the users' airways at the same time, but another Greek study — a relatively limited one — found no heart damage from the e-cigarette, which would be a significant advantage over regular cigarettes.
According to the FDA, e-cigarettes contain many chemicals and ultrafine particles that can become embedded in the lungs, just as regular cigarettes do. The effect on people sitting nearby — in other words, people inhaling secondhand vapor — isn't known. The mist certainly isn't as smelly, cough-inducing or annoying as tobacco smoke. One German study found that toxins were still a problem in secondhand vapor, but at about 20% of the level from tobacco cigarettes. And a report this year by the German Cancer Research Center concluded that harm to secondhand inhalers couldn't be ruled out because of metals and carcinogenic chemicals. The paper also cited the substances that irritate people's airways as a reason not to assume that "vaping" indoors harms no one other than the person puffing on the e-cigarette.
Are we all thoroughly confused yet?
In the absence of extensive research, policymakers must rely on common sense while committing to research to learn more. In some ways, e-cigarettes are markedly different from regular cigarettes. For example, they don't result in toxic trash on the beach (partly because most are reusable and because they don't need to be stubbed out). Nor do they create smoke — and the vapors they do create dissipate quickly outdoors. So restrictions on their use at beaches, parks and near the entrances of buildings seem like overkill.
In contrast, there is a good argument for policies to prevent minors from taking up an e-cigarette habit. The U.S. Centers for Disease Control reported in September that use among middle and high school students more than doubled from 2011 to 2012. Unlike regular cigarettes, which under federal law cannot be candy-flavored, e-cigarettes come in a variety of flavors, such as bubble gum and cherry, that draw minors. The devices are heavily advertised on TV. In only half of states are sales to minors banned (California is one of them).
The FDA has indicated that it will propose some e-cigarette regulations this month, and these are the fronts it should hit hard. We don't need to help more adolescents develop a nicotine habit, and it's logical to think that vaping could lead more teens to smoking.
The more difficult question is the one that is most important to the e-cigarette industry and its customers: Should the devices be considered virtually the same as cigarettes when it comes to secondhand inhalation indoors? At the moment, we lack the knowledge to decide this with confidence.
Still, New Jersey and various municipalities have banned e-cigarettes in all the places where regular cigarettes are prohibited. A bill to do the same in California was held over to the next legislative session.
The U.S. Department of Transportation moved early, banning e-cigarettes on airlines in 2011. Amtrak also prohibits them. Of course, planes and trains are particularly tight, enclosed quarters where the mist alone could be an annoyance. But when is an indoor area spacious enough to say that e-cigarettes should be allowed? A tiny bar? A spacious, airy hospital waiting room?
Because of the scientific concerns raised about the safety of secondhand vapor, the prudent course for now would be to keep them out of public buildings, restaurants and the like. Though the users and makers of the devices act as though this is an unconscionable trampling on vapers' rights, the fact is that former cigarette smokers — who make up a good portion of e-cigarette users — already are used to having their habit excluded from such spaces.
The restrictions should be temporary, pending the outcome of better research. It's quite possible that scientists will conclude that the amount of toxic material in secondhand vapor is minute. If so, then perhaps restrictions will not be necessary in the future. E-cigarettes should not be targeted for regulation solely because they look like something that so many people rightly abhor.