E-cigarettes and other 'vaping' methods grow in popularity, controversy

The Fresno BeeDecember 14, 2013 

Eric Long takes a drag on an electronic cigarette and exhales a white mist at his Royal Vapes store in southeast Fresno.

With each puff, the cloud spreads above Long's head. The plume of water vapor rises like smoke, but only a faint, sweet smell hangs in the air.

Long, 24, is among a growing number of "vapers" in the central San Joaquin Valley — people who use e-cigarettes and other electronic nicotine-delivery systems. The devices use a battery to vaporize a solution of nicotine and additives — mostly with fruity or candy-like flavors.

Long began vaping about a year ago and says he has given up his half-pack-a-day cigarette habit for strawberry-pomegranate nicotine e-cigarettes.

He and a partner opened Royal Vapes about five months ago to sell e-cigarettes and the refill vials of flavored nicotine. Theirs is one of a handful of "vape" shops that have opened in Fresno in the past year or two.

Electronic cigarette proponents say the devices help smokers kick the cigarette habit and don't foul the air with secondhand smoke. The growing popularity of e-cigarettes and other nicotine vaporizers, however, has sparked a public-health debate, including whether their use should be banned in public places that are smoke-free and whether there may be long-term health concerns.

But the key debate is their increasing appeal to children and whether inhaled nicotine vapor is a gateway drug to smoking.

Youth appeal

Vaporizers loaded with candy-like flavors from bubble gum to chocolate-cherry fuel the youth appeal, say tobacco-control advocates.

Many young people don't realize that nicotine, which is highly addictive, is in the devices, says Daisy Lopez, marijuana prevention project director at the California Health Collaborative in Fresno. "They think it's just a vaporizer with air coming out of there," Lopez says.

Under California law, selling e-cigarettes to minors is illegal, but public health officials say children can obtain them easily. Kids can buy them over the Internet or have older people purchase for them.

A report released last month by the federal Centers for Disease Control and Prevention said e-cigarette use among middle-school students rose from 0.6% in 2011 to 1.1% in 2012. Among high school students, the rate increased from 1.5% to 2.8%.

E-cigarettes and hookah pens are small enough to slip into backpacks, and a quick puff can go unnoticed. Hookah pens typically don't contain nicotine or tobacco, but they vaporize a liquid and are "smoked" like a cigarette.

"If an adult isn't paying attention, they would have no idea, it looks so much like a regular pen," says Leila Gholamrezaei-Eha, who coordinates the Fresno County Tobacco Prevention Program at the Fresno County Department of Public Health.

School officials in Fresno and Clovis say only a couple of students have been caught with e-cigarettes on campuses — a violation of school policies.

Clovis Unified bans tobacco or related products and treats e-cigarettes as "tobacco related." The district, however, is "staying abreast of the nationwide conversation about e-cigarettes and if necessary will consider revising our policy language," spokeswoman Kelly Avants says.

At Fresno Unified, the use of cigarettes is prohibited on school grounds, and using an electronic cigarette is considered a violation of the policy, says spokeswoman Susan Bedi.

While it's unknown if teenage use of e-cigarettes will lead to higher numbers of young smokers in years to come, "we don't want these young people using this device that teaches them how to smoke a cigarette," Lopez says.

Cigarette smoking is the leading cause of preventable death and disease in the United States, killing more than 1,200 Americans every day, according to the CDC. Each day, more than 2,000 youths and young adults become daily smokers, the agency says.

And allowing e-cigarettes to be smoked in public places sends a mixed message, Gholamrezaei-Eha says.

For the past 20 years, smoking use has been made less accessible and desirable and it's not the societal norm. Now, with e-cigarettes gaining popularity, she says, "there's a potential to make tobacco use the social norm again in California."

Controlling use

Local governments, school districts and universities have imposed restrictions on the use of electronic cigarettes, but there is no federal control over them — yet.

The federal Food and Drug Administration regulates cigarettes, other tobacco products and smokeless tobacco. An FDA spokesperson says the agency intends to propose a regulation that would extend the agency's "tobacco product" oversight to other categories.

But the proposed rule has yet to be released to the public, so it's unclear what it would do.

In Fresno, vape shop owners say they are careful to check IDs before selling electronic cigarettes and the liquid refills, and they disagree with claims that e-cigarettes could be a gateway drug to smoking tobacco.

The Smoke Free Alternatives Trade Association, a Florida-based organization representing the interests of the electronic cigarette industry, says it supports efforts by local and federal agencies and organizations to keep electronic cigarettes and other vaporizing devices out of the hands of underage consumers.

"These products are intended for and should only be available to adults," executive director Cynthia Cabera says.

The association, however, objects to electronic cigarettes being lumped together with tobacco products, Cabera says.

"Grouping e-cigarettes with tobacco products misclassifies these devices, subjecting them to regulations intended for a very different category, while stifling adult access and negatively impacting local small businesses that offer them."

In California, 44 cities and counties prohibit the use of e-cigarettes in some outdoor and indoor areas by including the devices in their smoke-free laws. Fresno is not one of them.

At California colleges and universities, policies for e-cigarettes are hit-and-miss. All 10 of the University of California campuses, including UC Merced, have tobacco-free policies that include electronic cigarettes.

But only one California State University — CSU Fullerton — bans electronic cigarettes, according to Kimberlee Homer Vagadori, project director at the California Youth Advocacy Network, an agency funded by the state to work with tobacco-control projects.

California State University, Fresno doesn't include e-cigarettes in its tobacco policy, but there are plans to review the use of e-cigarettes on campus, says Lisa Kao, administrator in charge of the campus smoking policy.

"I do consider the indoor use of e-cigarettes to be confusing because it looks like a regular cigarette," Kao says.

Electronic cigarettes so far have not been a problem at the Fresno State dorms, where smoking and e-cigarette use is confined to designated areas, says Erin Boele, director of housing.

The policy is adequate — for now, Kao says. E-cigarettes have yet to be popular among the dorm students.

Price could be tempering the use among college students. Vaporizers can cost $45 to more than $100, depending on the design. Some include digital readouts of nicotine content. Liquid refill vials cost $10 to $12.

Why they vape

Youths who vape say there is a "cool" factor to e-cigarettes not awarded to tobacco, with its smelly smoke and risk of cancer.

Nicotine flavors available at Royal Vapes carry names with a youth slant: Air Headz, Flatline and Curious Jorge.

Kenny Hammon, 19, says he likes that the smell from vaporized nicotine isn't offensive like cigarette smoke. He smokes about half a pack daily and wants to quit.

Last week, he bought his first vaporizer at Sublime Vape, a shop in central Fresno that opened this year. His first pick for a nicotine flavor: sour candy. It tastes "like a Popsicle," he says. His second choice: sweet honeydew.

The white vapor billowing from the e-cigarettes is another draw. Elaborate "smoke rings" made from the mist become "tricks" to be perfected.

"I just smoke it to do the tricks with it," says Sergio Alvarez, 20, who recently was at Royal Vapes with two friends. "And they sell juices with no nicotine."

Alvarez's friend, Gerardo Vivanco, 18, says more of his friends smoke cigarettes than vape. Using e-cigarettes is better than smoking, he says, but the attraction to vaping escapes him. "I don't think it's good or bad, I see it more as a pastime."

Other young adults, however, say they vape to keep from smoking.

Johnny Phean, co-owner of Royal Vapes, says he used to smoke four or five cigarettes a day until he switched to vaping two years ago. After vaping, the taste of cigarettes disgusts him, says Phean, 24. "I don't want to touch a cigarette." Watermelon is his favorite e-cigarette "juice" flavor.

Jacob Brossard, 19, says vaping has done what nothing else could — break his pack-a-day cigarette habit.

He began vaping a couple of months ago and hasn't smoked since, he says while puffing on an e-cigarette with friends at Sublime Vape. "I tried cold turkey and that just didn't work," he says.

Matt Cook, a part-owner of Sublime Vape, says vaping ended his two-pack-a-day smoking habit. Cook, 37, began smoking when he was 16 and wishes e-cigarettes had been available when he was a young adult.

Tobacco-control advocates aren't convinced vaporized nicotine is a cure-all for smoking cessation.

"I do know some people have decided to use electronic cigarettes as a way to stop smoking," says Gholamrezaei-Eha. "For some people it works and for some people it doesn't."

Safety is another question. Electronic cigarettes became available about six years ago, and "we just don't know yet how it's going to affect people down the road," Gholamrezaei-Eha says.

Research on the health effects of e-cigarettes also is relatively new and there is no agreement on potential hazards.

Studies by researchers at the University of California at Riverside have found metals present in e-cigarettes and concentrations of toxic chemicals in the flavorings.

Prue Talbot, a UC Riverside professor of cell biology who is leading the e-cigarette research, says the toxicity varied by flavoring and manufacturer.

For example, cinnamon flavors were high in toxicity, she says. "We felt this is a flavor maybe users would want to be careful with."


The reporter can be reached at (559) 441-6310, banderson@fresnobee.com or @beehealthwriter on Twitter.

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