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August 1, 2014

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Health:

As more young people get down with e-cigarettes, health officials’ concerns rise

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Paul Takahashi

Planet Hollywood employee Bronson Espinueva, 27, vapes an e-cigarette on Friday, Oct. 11, 2013, at the Vapery, a vapor shop at 8060 S. Rainbow Road. The rise in e-cigarette use among young adults is a growing concern among health officials, who have long waged a public-health campaign against smoking.

E-cigarettes

CSN student Kaitlyn Chandler, 21, Launch slideshow »

Shelby Gibbs takes a puff from a thin plastic pipe, cocks her head slightly and blows a plume of white vapor that quickly shrouds her face.

An ephemeral kiwi scent permeates the air inside the Vapery. Gibbs visited the posh central valley “vapor” shop on a recent Friday evening to purchase her first electronic cigarette.

“What do you think?” her friend Kaitlyn Chandler, 21, asks as Gibbs tries a new flavor, dubbed “Kwikee.”

“I like it,” the 21-year-old College of Southern Nevada student replies, nodding her head. “I’m down with the kiwi.”

Gibbs is among a growing number of young adults and teenagers across the country who are experimenting with e-cigarettes. Their surging use, particularly among youths, is prompting new concerns among health officials who have long waged campaigns against smoking.

E-cigarettes are battery-operated devices that vaporize liquid nicotine into an aerosol mist that can be inhaled, or “vaped.”

Proponents claim e-cigarettes are a healthier alternative to smoking, one that can help tobacco smokers quit. They argue e-cigarettes use more “natural” ingredients than traditional cigarettes, which contain dozens of harmful chemicals, including tar.

Public health officials, however, say e-cigarette health claims cannot be substantiated because there isn’t enough research yet on this relatively new device. The federal Food and Drug Administration doesn’t consider e-cigarettes to be a sanctioned smoking-cessation device, however.

Despite the relative lack of information about the effects of e-cigarettes, their use has surged among American youths.

A national survey released in September by the Centers for Disease Control and Prevention found that 1.8 million high school and middle school students had tried e-cigarettes in 2012 — double the number of student users in 2011.

Clark County officials say they haven’t noticed e-cigarettes being a problem, but health officials are concerned e-cigarettes can serve as a gateway for young adults and teenagers to try conventional cigarettes.

Maria Azzarelli, the tobacco-control program coordinator for the Southern Nevada Health District, believes e-cigarettes are threatening decades of anti-smoking campaigns that have changed social norms and perceptions about smoking.

In 1965, 42 percent of American adults were smokers. Today, it's less than half that figure, at 19 percent.

Azzarelli fears e-cigarettes could reverse the public’s views about smoking. After decades of anti-smoking commercials featuring emphysema patients breathing out of air tubes and poison signs on cigarette packs, e-cigarettes just might make smoking nicotine cool and glamorous again.

“People who may have never used a tobacco product are now using e-cigarettes,” Azzarelli said. “We’re very concerned that what’s becoming passe — smoking — is now coming back.”

• • •

E-cigarettes were invented in the mid-2000s in China, but they have become popular in the United States only over the past couple of years.

E-cigarettes range in size from a traditional tobacco cigarette to a small metal pipe — called a “mod” — that resembles the tip of a hookah pipe.

These devices can cost between $30 for a starter kit, which includes an e-cigarette and battery, to more than $200 for a stainless steel “mod” used by vapor enthusiasts. E-cigarettes are manufactured around the world, predominantly in China and the Philippines.

E-cigarette users purchase vials of “juice,” which contain from 6 milligrams to 32 milligrams of liquid nicotine costing between $6 and $20 a pop. Vapor shops sell non-nicotine versions, but all juices come in various flavors, from cherry, watermelon and peach to chocolate and bubble gum.

The vials generally contain propylene glycol, a preservative used in food and tobacco.

E-cigarettes have been found to contain diethylene glycol, an ingredient used in antifreeze, as well as traces of toxic chemicals, heavy metals and carcinogens, according to early studies. However, it’s still unclear how prevalent these chemicals are.

Regardless, nicotine — e-cigarettes’ chief ingredient — is an addictive vasoconstrictor that tightens and hardens blood vessels, which could lead to cardiovascular disease.

“At the end of the day, we want people not to get addicted to nicotine,” Azzarelli said. “No one can say right now whether e-cigarettes are a healthier alternative to cigarettes or hookah.”

• • •

At first, e-cigarettes were expensive novelties, sold only at mall kiosks.

However, with their price falling and popularity rising, e-cigarettes have become more commonplace.

Users can be found “vaping” at concerts, restaurants and on college campuses. E-cigarettes are seen as a recreational and social activity for users, who sometimes hold friendly competitions to see who can produce the biggest vapor cloud.

“A lot of people on (CSN’s) campus vape,” Gibbs said. “It’s all the hype right now.”

The popularity of e-cigarettes among youths doesn’t come as a surprise to Susan VanBeuge, a nurse practitioner and assistant professor at UNLV.

E-cigarettes are flavored, their taste a stark contrast to the harsh tobacco taste of regular cigarettes. E-cigarettes give off a sweet smell, and leave no yellowed fingernails, teeth or stained clothes — tell-tale signs that could tip a parent off to a smoking habit.

The “mods” and pipes also are customizable with different colors and accessories, like putting flashy rims on a car. Such modifications accentuate e-cigarette users’ personalities, unlike a pack of Parliaments.

For a generation that grew up with the Internet and experienced the rise of smartphones, e-cigarettes are the digital counterpart to the analog cigarettes.

“It’s popular because it’s cool and new and electronic,” VanBeuge said. “Everyone’s fascinated by their iPhones and Androids.”

• • •

E-cigarettes once were manufactured and promoted by startup companies that peddled their wares at specialty shops.

However, lured by potential lucrative profits from the youth market, major tobacco players are getting into the e-cigarette business, which is projected to approach $1.7 billion this year:

• Philip Morris, the maker of Marlboro and the nation’s largest tobacco company, has the “MarkTen” e-cigarette.

• R.J. Reynolds, the maker of Camel and the country’s second-largest tobacco company, has the “Vuse” e-cigarette.

• And Lorillard, the maker of Newport and America’s third-largest tobacco firm, acquired “Blu” e-cigarettes, which make up a third of all e-cigarettes sold in U.S. convenience stores.

Unfettered by marketing, age and flavor restrictions that hamper traditional cigarettes, tobacco giants have been able to promote e-cigarettes freely. Companies are spending millions of dollars on celebrity endorsements and sports sponsorships, harkening back to Big Tobacco’s heyday 50 years ago.

“The tobacco industry is taking everything out of their playbook and recycling it because it works,” Azzarelli said. “After lying for decades about carcinogens in cigarettes, are we going to trust the tobacco industry when they say e-cigarettes are safe?”

Much of the advertising around e-cigarettes seems to target youths, VanBeuge added. Young adults, ages 18 to 25, historically have been the ideal market for tobacco companies, she said.

“If you can get kids addicted and hooked between 18 and 21, you’ve got a user for life,” VanBeuge said. “That’s well demonstrated in the literature on smoking addiction.”

• • •

To meet the growing demand for e-cigarettes, vapor shops have cropped up across the valley, seemingly overnight.

The Vapery, which opened in July, is one of more than 70 smoke and vapor shops selling e-cigarettes in Las Vegas, according to Yelp.com.

Three Filipino brothers who saw a business potential in e-cigarettes and a calling to help tobacco smokers started the Vapery.

Elmer John Yumul, the middle brother, said he used to smoke up to two packs of cigarettes a day for decades.

In February, Yumul, 45, began using e-cigarettes at the urging of his younger brother. Yumul incrementally stepped down from 24 milligrams of nicotine, the equivalent of one pack of Camel cigarettes, to 6 milligrams of nicotine every two weeks.

Now, Yumul says he’s on the verge of kicking his tobacco habit.

“This is heaven’s gift for smokers,” Yumul said. “There are a lot of advantages. My food tastes better, I don’t have shortness of breath and my closet smells good.”

Although it has a steep upfront cost with batteries, pipes and coils, e-cigarettes are cheaper than purchasing $4 cigarette packs daily, Yumul said. A 6-milligram vial of nicotine, which costs about $6, lasts about two weeks for Yumul, who acknowledges that mileage varies from user to user.

Since opening four months ago, the Vapery has seen more than 1,000 customers, many of them first-time e-cigarette users, Yumul said. About a third of them are younger than 25, although increasingly vaping has become popular among adults and seniors, he said.

The Vapery demonstrates to customers how to maintain their “mods” and introduces them to new “juices,” which they say are made from high-quality, food-grade substances.

In the coming months, Yumul plans for the Vapery to distill juices on its own in a laboratory-grade facility in the shop’s backroom.

• • •

Like many smoke and vapor shops, the Vapery treats e-cigarettes the same as regular cigarettes: The shop doesn’t sell them to minors.

However, that’s only at Yumul’s discretion.

There are no regulations to compel Yumul and other vapor shops to card and turn away minors, who by law cannot purchase tobacco cigarettes.

Nevada law does not mention e-cigarettes or vaping, only the “smoking of tobacco.” The Silver State also does not prohibit minors from possessing or using cigarettes or e-cigarettes.

Last month, Nevada Attorney General Catherine Cortez Masto joined 38 other attorneys general in urging the FDA to place regulations on the advertising and ingredients of e-cigarettes, and prohibit their sale to minors.

The FDA is expected later this month to release new regulations on e-cigarettes.

States also are considering adding e-cigarettes to their public smoking bans. Currently, e-cigarettes skirt Nevada’s ban on indoor smoking in most public places.

In 2006, Nevada passed the Clean Indoor Air Act, which prohibited smoking in airports, supermarkets, stores and restaurants — even those with slot machines. The law doesn’t apply to casinos, both downtown and on the Strip, however.

The law was seen as a major victory for Nevada’s anti-smoking advocates, who worked for years to ban smoking in public places to combat the negative effects of secondhand smoke.

However, e-cigarettes technically are not tobacco, and so users can vape anywhere property owners allow it.

Increased e-cigarette use in public locations has prompted numerous calls to the Southern Nevada Health District. Residents are concerned about the health effects of e-cigarettes, Azzarelli said.

Five years ago, the health district received no calls about e-cigarettes. Now, the district receives calls several times a week, Azzarelli said.

Consequently, the health district has started to compile fact sheets and train schoolteachers on ways to educate Clark County high school and college students about e-cigarettes.

“Right now, there needs to be more research,” Azzarelli said. “We need legitimate studies on these things to see if they have fewer chemicals and carcinogens than cigarettes. We need to know more.”

In the meantime, students like Gibbs will continue to experiment with e-cigarettes.

Gibbs, a nonsmoker, plans to use only the non-nicotine vials. She hopes to introduce vaping to her brother and father, who are both smokers.

“I want people close to me to stop smoking,” Gibbs said. “That, and it makes my car smell good. It’s the bomb.”

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