FINALIZED MASTERS PAPER

1Running Head: E-CIGARETTE ORDINANCE IS NECESSARY.

“Clean Indoor Air? Why Electronic Cigarette Ordinance is Necessary to Promote Public Health.”

Jason McCoy

North Dakota State University

Adviser: Mary Larson

2E-CIGARETTE ORDINANCE IS NECESSARY.

Abstract

Electronic cigarettes (e-cigs) pose a unique threat to public health. Currently, more than 263,000

youth in the United States use electronic cigarettes. This is a three-fold increase in just two

years. 43% of youth utilizing electronic cigarettes indicate intent to smoke traditional cigarettes.

Created to look like cigarettes, they are marketed as cessation devices while not being approved

through the FDA. Utilizing a vast variety of flavorings, many of which are youth-centric such as

gummy bears and cotton candy, e-cigs threaten to renormalize smoking in a population who are

finally smoking less than their parents.

Currently there are zero federal laws regulating the manufacture, use, marketing, or

safety of electronic cigarettes and the refillable liquids utilized. This allows for marketing to

youth by tobacco companies, who currently own 49% of the electronic cigarette market. These

companies have a proven track record in selling tobacco products. Personal vaporizer units and

electronic cigarettes along with the refillable liquids ship are shipped without safety standards.

These devices are causing explosions resulting in fires and loss of property as well as personal

harm. Science is racing to determine the health effects of utilizing electronic cigarettes.

Tobacco funded research is clouding the matter with biased data while public health research is

providing health concerns.

Expanding state & local ordinances that include electronic cigarettes will provide clarity

for government officials and law enforcement needing to deal with these devices. Until the FDA

creates official regulations for electronic cigarettes and their refills, it falls on both state and local

governments to create laws and ordinance that regulate the use of e-cigs. They must be banned


from public areas in which traditional cigarettes have already been banned. The only way to

ensure safe, clean air for everyone is to create policy that will change all of our environment for

the healthier


“Clean Indoor Air? Why Electronic Cigarette Ordinance is Necessary to Promote Public

Health.”

Electronic cigarettes pose a unique threat to public health. Created to look like cigarettes,

they are marketed as cessation devices while not being approved through the FDA. Utilizing

a vast variety of flavorings, many of which are youth-centric such as gummy bears and

cotton candy, e-cigs threaten to renormalize smoking in a population who are finally smoking

less than their parents.

A lack of federal guidance places the onus for regulation on states and local governments

who are being lobbied by traditional tobacco companies who own 49% of the current e-cig

market as well as smaller “vape” companies who make up for their size with technological

savvy and wide market appeal to college and school age constituents. Research is being

funded by tobacco and vape organizations muddying the waters for legislators to make a

health-conscious decision for their state.

Lack of regulation on the federal level also allows marketing tactics to reemerge that

were banned in 1999. Electronic cigarettes and their e-juice refills may currently advertise

on television and billboards, as well as in magazines and point of sale locations. Advertising

agencies are bringing back versions of old tobacco advertisements that had great success in

the past.

Until the FDA creates official regulations for electronic cigarettes and their refills, it falls

on both state and local governments to create laws and ordinance that regulate the use of e-


cigs. They must be banned from public areas in which traditional cigarettes have already

been banned. The only way to ensure safe, clean air for everyone is to create policy that will

change all of our environment for the healthier. (Fairchild, Bayer, & Colgrove, 2014)

Tobacco: Still a Threat in America?

Nicotine is still the most deadly preventable threat in the United States. Claiming

480,000 lives in the United States alone last year, cigarette smoking is the leading

preventable cause of death. Add another 48,000 deaths from second hand smoke and we

have a public health emergency. Beyond mortality, nicotine leads to addiction, along with

countless wasted years of productivity & health. (CDC, 2015)

According to the CDC “Life expectancy for smokers is at least 10 years shorter than for

non-smokers.” (Fairchild, Bayer, & Colgrov, 2014) What about those who do not experience

mortality from smoking related causes? Smoking damages nearly every organ in the body. It

also causes disease and reduces the quality of health in smokers as well. (U.S. Department of

Health and Human Services, 2014) Despite the fact that smoking increases the risk of a great

many diseases, nearly 18 of every 100 U.S. adults aged 18 years or older (17.8%) currently

smoke cigarettes. This means in the United States there are currently an estimated 42.1

million adults who currently smoke traditional cigarettes. (CDC, 2015)

Smoking prevalence is falling in America. However in 2013, an estimated 17.8% (42.1

million) U.S. adults were current cigarette smokers. Of these, 76.9% (32.4 million) smoked

every day, and 23.1% (9.7 million) smoked some days. (U.S. Department of Health and

Human Services, 2015) These numbers become even more alarming when broken down by

ethnicity and socio-economic status.


American Indian/Alaska Natives (AI/ANs) have the highest prevalence of current

smokers than most other racial/ethnic groups in the United States. There are many factors

that affect smoking prevalence including sacred tobacco’s ceremonial, religious, and

medicinal roles in Native culture, which may affect attitudes, beliefs, and behaviors toward

commercial tobacco use. Also, tobacco sold on tribal lands is typically not subject to state

and national taxes, which reduces costs. (Caponnetto, et al, 2012)

Race/Ethnicity Prevalence

American Indian/Alaska Natives (non-

Hispanic)26.1%

Asians (non-Hispanic) 9.6%

Blacks (non-Hispanic) 18.3%

Hispanics 12.1%

Multiple Races (non-Hispanic) 26.8%

Whites (non-Hispanic) 19.4%Figure 1- CDC 2013 Smoking Prevalence by Ethnicity

Smoking rates are higher in men than women, highest amongst ages 25-44, and rates

reduce with higher education. (CDC, 2015) However it is also found that when a population

is below the poverty level, the smoking rates increase to 29.2%. The population at or barely

above poverty level are found to still have smoking rates at 16.2%. Clearly ethnicity,

education, and income highly influence the prevalence of smoking in our population.

Tobacco, and its addictive component, nicotine, are still a threat in the United States.

The continued education from public health which began back in 1972 with the Surgeon

General’s first warning that smoking was related to lung cancer has created a gradually

changing healthier environment. However, we have a new fox in the henhouse. A new


product threatens to renormalize smoking in our most vulnerable of populations, our youth.

(Fairchild, Bayer, & Colgrove, 2014)

Electronic Cigarettes

An electronic cigarette (e-cigarette) or personal vaporizer is a battery-powered

vaporizer that mimics the motions and appearance of smoking a cigarette. (U.S.

Department of Health and Human Services, 2015) E-cigarettes come in many variations

on shape and size. This often makes it difficult to even recognize the device.

(Caponnetto, et al, 2012) The original e-cigarettes were produced to resemble traditional

cigarettes, complete with an LED chip that “glows” like tobacco embers on traditional

cigarettes.

Most of the least expensive models of e-cigarettes today (average cost $10) are still

produced to mimic traditional smoking. (Grana, Benowitz, & Glantz, 2014) These less

expensive versions are also disposable, usually pre-loaded with two hundred “puffs” of

vapor. This is well calculated to mimic smoking as well; a pack of cigarettes averages

out to 200 puffs.

The more expensive reusable vaporizer units can range in price from $20 up into the

hundreds of dollars. (Pepper & Brewer, 2013) These units share in common the ability to

purchase refillable liquids. The more expensive models allow the user to regulate the

amount of vapor that is produced by the unit. The user, known as a “vaper,” then inhales

an aerosol, commonly called vapor, rather than cigarette smoke. (Ebbert, Agunwamba,

Rutten, 2015)


E-cigarettes are comprised of several elements, and these vary by manufacturer. All

e-cigarettes contain a heating element that reduces a liquid solution known as e-juice into

an aerosol. (Cheng, 2014) No two e-juice brands or flavors have identical ingredients.

All of them do contain a base liquid comprised of either propylene glycol or glycerin.

Common ingredients are then nicotine, which comes in various strengths, and a plethora

of different flavors. (U.S. Department of Health and Human Services, 2015)

Figure 2: Diagram of an Electronic Cigarette

The first e-cigarette was created by Herbert A. Gilbert. In 1963, Gilbert patented "a

smokeless non-tobacco cigarette" that involved "replacing burning tobacco and paper

with heated, moist, flavored air". This device produced flavored steam without nicotine.

He was granted a patent in 1965.

While Gilbert’s e-cigarette was ahead of time, it received little attention and was

never commercialized. Smoking was still fashionable, and as such no one wanted to pay

more for an electronic version of a cigarette. (Weaver, Breland, Spindle, & Eissenberg,

2014)


Hon Lik, a Chinese pharmacist and inventor, is given the credit for commercializing

the e-cigarette. Hon Lik was a research pharmacist for a company producing ginseng

products. He had quit smoking after his father, also a heavy smoker, died of lung cancer.

In 2003, Lik thought of using a high frequency, piezoelectric ultrasound-emitting

element to vaporize a pressurized jet of liquid containing nicotine. His design created a

smoke-like vapor. The main trouble he ran into was scaling down the device to a small

enough size. It is significant to note that Lik intended his e-cigarette to be an alternative

to smoking. (P.H. ,2014)

The modern e-cigarette design was patented in 2003. Lik was given the credit for

developing the first commercially successful e-cigarette. The e-cigarette was then

introduced to the Chinese domestic market in 2004.

Many versions of the e-cigarette made their way to the U.S., where they were first

sold via the Internet. From there it has grown into a $1.5 billion industry by 2014. This

industry is estimated to grow 25% by 2018.

Public Health Issues

Toxic Chemicals

The benefits and risks of electronic cigarettes are hotly contested between public

health organizations and what has become known as the “vaping” community. There are

a wide variety of both vaporizers and e-liquids making research a slow process. Tobacco

funded research correctly points out that there is no combustion when using an e-

cigarette, but they fail to prove the contents of the e-liquid, or e-juice, are safe for

consumption or inhalation. (Goniewicz, 2014)


Distributors of e-cigarettes promote the product as completely free of harmful

substances. The basis for this claim is that they do not deliver toxic doses of nicotine and

the nicotine solution lacks harmful ingredients. E-cigarettes are relatively new to the

market and, as such, require further testing to assess their toxic properties. Currently, the

scientific evidence on the lack or presence of toxic chemicals in the vapor generated from

e-cigarettes, and inhaled by their users is very limited. (World Health Organization,

2008)

Scientists are researching how much heavy metal, formaldehyde, and other toxic

substances are produced in the vapor from e-cigarettes. The vaping community assures us

that lower levels of toxins indicate a triumph of e-cigarettes over traditional cigarettes.

Meanwhile, public health advocates are wondering why we need any level of toxins added to

the air we all breath.

E-cigarette vapor contains toxic compounds. Research shows that the levels of toxic

compounds are 9 to 450-fold lower than those produced by a traditional cigarette. These

causes some researcher to point out that the levels of some of the toxins in e-cigarette vapor

are comparable to the trace amounts present in pharmaceutical nicotine replacement therapy.

(Goniewicz, 2014)

A conflicting study found that while the toxins inhaled from e-cigarette vapor do

preclude those inherent in combustible materials the e-juice provides an entirely different

matter. Thirty-six liquids were exposed to cytoplasm for toxicity, and it was found that

fifteen samples were moderately cytotoxic and twelve samples were highly cytotoxic.

(Farsalinos, & Polosa, 2014)


Nicotine Exposure

Nicotine exposure is one of the largest issues with e-cigarettes and e-juice. Due to the

lack of FDA regulation, there are currently no inspections, or at best they are self-reported, of

nicotine levels in e-cigarettes. Vaping devices have a variety of ingredients and nicotine

levels with anything revealed at the discretion of the manufacturer.

Tobacco and/or vaping companies currently report nicotine strengths in several

ways. They may choose to utilize the number of milligrams in a solution. More often they

self-report the percentage of nicotine in their e-juice. Less likely is the use of descriptors

such as low, medium, and high. As each company chooses how and what to report to the

public, there is little correspondence between descriptors and milligrams or percentage of

nicotine across brands, which makes standardization impossible. Instead, researchers have

created a strength testing in order to report. Complicating this is the sheer volume of brands

and flavors. There are currently 466 e-cigarette brands and 7764 unique flavors. In addition

to this number there are “mix charts” that many companies are promoting now. Furthermore

independent “vape shops” can order their own chemicals and create their own unique

mixtures. (Zhu, 2014)

Older brands* (N=251)Newer brands† (N=215)

Older vsnewer brandsp value

Top-5 brands (N=5)

Other brands (N=246)

Top-5 vs othersp value

Older brands combined (N=251)

Newer brands (N=215)

# of flavors per brand

Mean 30 32 0.93 32 49 <0.01

Median 8 15.5 15 33

# of nicotine strengths

Mean 5.4 4.4 0.13 4.5 4.4 0.65

Median 5 4 4 5


Older brands* (N=251)Newer brands† (N=215)

Older vsnewer brandsp value

Top-5 brands (N=5)

Other brands (N=246)

Top-5 vs othersp value

Older brands combined (N=251)

Newer brands (N=215)

Zero nicotine offered 80.0% 84.1% 0.85 84.1% 81.9% 0.55

Figure 3: A comparison of flavors and nicotine strengths offered by the 466 e-cigarette

brands, 2014

Goniewicz, et al (2012) found significant differences between labeled and true levels of

nicotine in cartridges and refill solutions. Traces of nicotine were also detected in one of two

cartridges labeled as containing no nicotine. These findings indicate that information about

nicotine levels provided on product packages may be misleading to customers. (Goniewicz,

Kuma, Gawron, Knysak, & Kosmider, 2012)

With no truth in advertising, the buyer must beware. When a product is being touted as a

cessation device and there is no regulation, who ensures that the consumer is actually not

harmed by the product? Several studies are already looking into the efficacy of e-cigarettes as

cessation tools.

False Advertising as Cessation Devices

A review of the literature related to e-cigarettes being used as smoking devices shows

that most individuals who use them are attempting to quit smoking traditional cigarettes.

(Grana & Ling, 2014) Science is not backing them up however. So far studies of their

effectiveness for cessation have been unconvincing. (Bullen 2013 & Caponnetto, 2013) One

randomized trial comparing e-cigarettes with and without nicotine with a nicotine patch

found no differences in 6-month quit rates. (Bullen, 2013)


Population-based, longitudinal studies have also not shown associations between e-

cigarette use and quitting. (Adkison, 2013 & Vickerman, et al, 2013) One longitudinal study

found that, although 85% of smokers who used e-cigarettes reported using them to quit, e-

cigarette users did not quit more frequently than nonusers (P = .52). Additionally, data from

US quit line call centers shows that e-cigarette users were less likely to have quit at 7 months

than nonusers. (Vickerman, et al, 2013)

Unfortunately, many smokers, turning to e-cigarettes for cessation help, become dual

users. In a study consisting of 19,441 participants, it was found that 3682 participants were

in this category. All of them managed to reduce their cigarette use from 20 or more to 4, but

their use of e-cigarettes compensated for the amount of nicotine they were consuming.

Participants utilized the e-cigarettes in public and around family members with the

assumption that it was a healthier alternative. (Farsalinos, Romagna, & Voudris, 2015)

The variability of nicotine in e-juice also complicates smoking cessation through e-

cigarettes. While some e-juice purportedly has little to no nicotine, many exceed the amount

found in a traditional cigarette. For smokers used to a certain level of nicotine, this can cause

increased nicotine addiction rather than aiding in a quit attempt. With no current regulatory

services provided, the use of e-cigarettes as a cessation tool is far from fool-proof. (Cobb,

Hendricks, & Eissenberg, 2015)

Additionally, e-cigarettes are not approved by the FDA as a smoking cessation device at

this time. The FDA is currently deliberating on how to classify e-cigarettes and e-juice.

However, as there is no standardized ingredients in e-juice and science has not yet proven the


efficacy of e-cigarettes as a cessation tool, it is completely unreliable to state that e-cigarettes

are a cessation tool at this time. (FDA, 2013)

Second-hand Vapor

The use of electronic devices to inhale e-juice provides a vapor that is exhaled much like

traditional cigarettes. This vapor has been proven to contain nicotine and other toxic

contaminants (Czogala, et al 2014 & Ballbè, et al 2014) though at a lower level than

traditional cigarettes. However, recent e-cigarette studies showing that there are substantial

levels of nanoscale particles in addition to detectable levels of metals with toxic materials

(e.g., aluminum, copper, magnesium, zinc, lead, chromium, manganese, and nickel) in e-

cigarette vapors brings this view into question (Williams, Villarreal, Bozhilov, Lin, & Talbot,

2013). At the nanoscale size, particles may reach the alveolar epithelium and mediate

oxidative stress and inflammation.

Studies continue to analyze the affect that second and even third-hand vapor have on

bystanders. The vaping community meanwhile not only purports the vapor to be safe, but is

creating a sensationalized sport around it. (Mickle, 2015) Called “cloud chasing” by

participants, the sport encourages the largest vapor cloud possible to be released with prizes

going to the winner.

Nicotine Poisoning in Children

Poison control centers have been receiving an increasing number of calls related to

nicotine poisonings from e-juice exposure. The majority of those harmed have been under

the age of six years. (American Association of Poison Control Centers, 2015) In 2015, as of


May 31, 2015, the AAPCC has received 1,499 e-cigarette devices and liquid nicotine

reported exposures.

Sixty milligrams of nicotine is enough to kill a 150-pound adult. This causes great

concern because some e-juice formulas pack as much as 72 milligrams per refill. (Lazutka,

Vasilyauskene, & Gefen, 1969) Nicotine poisoning does not require much exposure in

youth. Due to their smaller weight and size, toddlers can suffer poisoning at approximately 1

mg/kg in children. (Dart, 2004) These products can contain fatal levels of nicotine for

children, who may mistake the e-juice for candy or a drink.

Nicotine has been theorized to harm adolescence brain development. Pregnant women

should also be concerned due to evidence that nicotine can harm fetal brain and lung

development. According to the Minnesota Department of Health, “The teen years are a

critical time for brain growth and development. As a result, adolescents are especially at risk

from the harms caused by nicotine exposure. Evidence suggests that exposure to nicotine

during adolescence may have long-term effects on brain development. This could have

negative implications for human adolescent learning, memory, attention, behavioral problems

and future addiction.” (England, 2015)

Electrical Mishaps

Electrical fires are possible when using e-cigarettes. Electronic cigarettes and vaporizers

are mainly composed of lithium batteries. There have been reports of explosions of batteries,

caused either by prolonged charging and use of improper chargers or by design defects.

These have been linked to house fires as well as personal injuries in many national

newspapers. (ABC Eyewitness News, 2015)


Renormalizing of Smoking

Perhaps the greatest public health concern in e-cigarettes is the potential for

renormalizing smoking in a new generation. (Stanwick, 2015) Currently, the first generation

are growing up that never had to sit in a non-smoking section when visiting a restaurant.

They will also never have to deal with clouds of second hand smoke when they reach the age

to legally enter a bar.

Years of education and the normalization of smoking as an unhealthy activity have given

rise to the first National Adult Tobacco Survey (NATS) in which the 18-24 segment was the

lowest in the nation. (CDC, 2015) This trend continued in middle- and high-school age

students. However, the use of e-cigarettes escalated dramatically.

Burnell, et al (2014) synthesized the 2013 National Youth Tobacco Survey data and

found that between 2011-2013, the number of teens who used e-cigarettes even one time

increased three-fold, from 79,000 to over 263,000. Amongst those teens who had tried or

were current users of e-cigarettes the intention to transition to conventional cigarettes was

43.9%. (38)

The 2014 National Youth Tobacco Survey reveals that current e-cigarette use among high

school students increased from 4.5 percent in 2013 to 13.4 percent in 2014. This shows an

astronomical rise in use from approximately 660,000 to 2 million students. Middle school

students had similar numbers, tripling from 1.1 percent in 2013 to 3.9 percent in 2014

(increasing from 120,000 to 450,000 students.) This was the first time collecting that current

e-cigarette use has surpassed current use of any other tobacco product, including

conventional cigarettes. (CDC, 2015)


Combining this data shows that an increasing number of middle-and high-school students

are using e-cigarettes. 43.9% of those using e-cigarettes are self-disclosing an intent to

utilize traditional cigarettes. The path from e-cigarette use to traditional smoker becomes

very plain.

Marketing to Youth

A distinct lack of regulation has allowed e-cigarette vendors and vaping companies to

advertise through every medium as long as they do not claim them as cessation aids. (These

claims come through news articles, personal testimonies, and other social media sites.)

Using Neilson data, Duke, et al (2014) found that youth exposure to television e-cigarette

advertisements increased 256% from 2011 to 2013. Young adult exposure increased by more

than 300% as well. Additionally, more 3/4 of all youth e-cigarette advertising occurred on

cable networks frequented by teens and young adults. (Duke, 2014)

Having access to television advertising, e-cigarette companies reach 24 million youth

with their products. Unfortunately, there currently exists little evidence-based public health

messaging. This allows e-cigarette television advertisements to promote harmful beliefs and

present behaviors that pose harm to the public health.

A report published in 2014 by eleven members of Congress investigated the targeted

marketing of e-cigarettes to youth through written responses provided by nine popular e-

cigarette companies. It was concluded that marketing to adolescents is prevalent, although e-

cigarette manufacturers claim they are not targeting this population. Other findings of this

report included:


Eight e-cigarette companies promote their products through sponsored or

sampling events, many of which appear to be youth-oriented. In 2012 and 2013

alone, six of the surveyed companies sponsored or provided free samples at 348

events.

Seven e-cigarette companies air television and radio advertisements during events

and programs, including those with youth viewership. Blu’s commercials “have

aired thousands of times at various times of the day and night on 48 networks,”

and NJOY has advertised during programs including the Super Bowl, an event

that reaches a substantial audience of youth under age 18.

Six e-cigarette companies market e-cigarettes in flavors that could appeal to

children and teens. For example, e-cigarette manufacturers are marketing flavors

like Cherry Crush, Chocolate Treat, Peachy Keen, and Grape Mint.

E-cigarette manufacturers have significantly increased marketing spending, more

than doubling expenditures between 2012 and 2013. In total, six e-cigarette

companies spent $59.3 million in 2013 to market e-cigarettes. (Williams, &

Knight, 2015)

E-cigarette manufacturers are using the same strategies to market their product as tobacco

companies have used for traditional cigarettes in decades past prior to regulations on

marketing, including associating vaping with sports and cultural sponsorship, obtaining

celebrity endorsement, and through social networking, online advertising, Point of Sale

(POS) displays, pricing strategies, and product innovation (See example in Figures 4).

(Bunnell, 2014)


Figure 4: Comparison of Traditional Tobacco Advertisement with Current E-Cigarette

Advertisement.

This advertising is backed by stylish design, glamour, and association with celebrity and

fashionable venues and events (such as the Academy Awards), and sponsorship at sporting

events (such as the Super Bowl) where free samples are often given out. Major e-cigarette

manufacturers are targeting young people by giving away free samples at music and sporting

events and running radio advertisements during youth-oriented programs. (Tavernise, 2014)

E-cigarette manufacturers may claim that e-cigarettes are a safer and cheaper method to

satisfy a nicotine addiction; a “healthier alternative,” and “harmless.” E-cigarettes may also

be promoted as “an indispensable tool in the pathway to quitting smoking.” Marketing of this

product promotes long term use as a permanent alternative to tobacco and “the freedom to

enjoy the personal pleasures associated with smoking in places where conventional smoking

has been banned. (Bunnell, 2014)

The Need for Laws, Ordinance, & Policy surrounding E-cigarettes


E-cigarettes are currently not regulated by federal law. Many states have begun

regulating e-cigarette sale, taxation, and use through state law. Additionally, cities are also

free to create their own ordinance to further regulate the sale and use of e-cigarettes.

Passing legislation regarding e-cigarettes must include a detailed look at how they are

defined under said law. Current state and city legislation have successfully included e-

cigarettes under existing laws that regulate cigarettes. Legal considerations for e-cigarettes

include sales and marketing restrictions, youth access, smoking restrictions and taxation.

Opponents to regulation often push for exceptions to be made in e-cigarette legislation.

Public health officials oppose these understanding that exceptions for e-cigarettes in smoke-

free laws may encourage dual users of e-cigarettes and conventional cigarettes. Totally

exempting e-cigarettes from smoke-free laws exposes the public to e-cigarette vapor and

exposes youth to the norming effect of witnessing “smoking” indoors.

Crafting e-cigarette law is complicated by the wide variety of terms the industry utilizes.

Similar devices may be called e-cigarettes, e-hookah, vape-pens, hookah pens and personal

vaporizers. Adding to this confusion are the hundreds of types and brands of e-cigarettes

and the ability of users to modify or build their own products. (Grana, Benowitz, & Glantz,

2014)

In 2010, a court case found that e-cigarettes could not be regulated by the FDA unless

they are ‘marketed for therapeutic purposes.’ Further, the FDA could not regulated e-

cigarettes or e-juice as tobacco products unless the FDA eventually finds them to be ‘tobacco

products’ under the Family Smoking Prevention and Tobacco Control Act (FSPTCA).

(Kirshner, 2011) To date the FDA is still investigating the matter.


In April 2014, the FDA issue a preliminary ruling to bring e-cigarettes under their

tobacco authority. This ruling did not come to fruition however. Currently there exists no

federal ruling or stance on e-cigarettes. Many states and local communities have been

enacting legislation to regulate the use and sale of e-cigarettes. (FDA, 2014; National

Conference of State Legislatures, 2014; &- American Nonsmokers’ Rights Foundation,

2014)

Since they arrived on the market, e-cigarette and tobacco companies have been actively

promoting legislation designed to serve industry interests. (Family Smoking Prevention and

Tobacco Control Act, 2009; Eggert, 2014; McGrory, 2014; Bandyk, 2013) Lobbyist push for

laws that exclude e-cigarettes from the definition of ‘tobacco product’ or create new

definitions for e-cigarettes in order to purposefully separate them from current legislation

surrounding other tobacco products This forces new law-making for e-cigarettes, which is a

more lengthy process.

Public health advocates and health conscious lawyers seek laws that explicitly define e-

cigarettes as ‘tobacco products’ or define ‘smoking’ to include e-cigarettes. These laws will

better protect health as they automatically subject e-cigarettes to the same laws and

regulations as conventional cigarettes without additional legislation. Future laws need to

broadly define e-cigarettes to include future modifications and terminology that will come

from the industry as well.

Conclusion

E-cigarettes and their corresponding e-juice present a clear public health hazard. The

best arguments for their use include justifications including “acceptable limits of toxicity”


and raise questions regarding how much carcinogens are acceptable in children. Legislation

is the only way to ensure the tobacco and vaping companies adhere to whatever is agreed

upon by the FDA as acceptable use.

Just as traditional cigarettes were regulated at the federal level, e-cigarettes need

guidelines for production. Current e-cigarettes have exploded due to faulty wiring and

batteries causing physical harm and property damage. E-juice can be created in the back of a

vape shop allowing for untold numbers of contaminants to be included. The refillable

liquids shipped from manufacturers has been found to contain varying amounts of nicotine.

Public safety demands a legal definition that can be used to uphold the citizens’ right to

health. If legislation does not get out in front of e-cigarettes, history will follow that of

American anti-smoking laws. How many died of lung cancer and other disease before the

Surgeon General’s first report on smoking? What percentage of our youth is an acceptable

loss to nicotine addiction before e-cigarettes are regulated?

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Core CompetenciesCourses, Conferences, Master’s Paper (MP), Practicum (P)

Narrative

1.1 Biostatistics: Distinguish among the different measurement scales and the implications for selection of statistical methods to be used based on these distinctions.

MPH 731, P Hands-on training with SPSS software. Coursework provided the basis of understanding. My practicum included a survey in which I had to calculate the appropriate statistics for use in developing effective policy.

1.2 Biostatistics: Interpret results of statistical analyses found in public health studies.

MPH 731, 751, MP, P Interpreting the data from my survey allowed for policy work to be done. Researching my paper required effective interpretation of population statistics regarding health markers and harmful behavior.

2.1 Epidemiology: Describe a public health problem in terms of magnitude, person, time and place.

MPH 751, MP Readings; weekly assignments; In my paper I researched heavily how e-cigarettes are affecting youth in an escalating manner over the last three years.

2.2 Epidemiology: Calculate basic epidemiological measures.

MPH 751 Outside of classwork I was able to utilize either SPSS or other software to calculate needed epidemiological data that I input. Learning about GIS during our class helped me with this.

3.1 Health Policy and Management: Identify the organization, financing, and delivery issues of the health service system in the US.

MPH 710, HNES 725, 745

Through my classes I learned how US health care is primarily reactionary and how we can work towards becoming a prevention



Narrative

model of health care.

3.2 Health Policy and Management: Describe the legal, ethical, historical, and philosophical bases for the health service delivery system in the U.S.

MPH 704, 710, HNES 725, MP

Through classwork and research in those classes I explored the legality and ethics of health services. In my MP I narrowed that down to researching current tobacco and e-cigarette law.

3.3 Health Policy and Management: Discuss the policy process for improving the health status of populations.

MPH 704, HNES 721, 725, 745, P, MP

All of my classes discussed this to a degree. In my practicum and MP I address how e-cigarettes affect the health status of all, particularly youth.

3.4 Health Policy and Management: Apply “systems thinking” for resolving organizational problems.

MPH 704, 710, P, HNES 721, 725, 745, P, MP

Developing my practicum and MP I looked at the big picture of laws and ordinance, how we can change the environment as well to promote healthy changes.

3.5 Health Policy and Management: Analyze public health challenges within appropriate ethical and legal frameworks

MPH 704, HNES 725, 745, MP

My MP really dives into the ethics surrounding legislation of e-cigarettes.

4.1 Social and Behavioral Sciences: Identify basic theories, concepts and models from a range of social and behavioral disciplines that are used in public health research and practice.

MPH 741, HNES 725, P, MP

The social ecological model is used in both my P and MP. Educating the individual is good, but I move up the scale to community, state, and national change.

4.2 Social and Behavioral Sciences: Identify and analyze the social and behavioral factors that affect health of diverse populations.

MPH 741, P, MP, HNES 721, 725, 724, 727, 745

My classwork laid the groundwork for this method of thinking. I do address it in my P and MP, but I feel in



Narrative

my position as Tobacco Coordinator for Clay County I address these issues every day.

4.3 Social and Behavioral Sciences: Describe the role of social and community factors in both the onset and solution of public health problems.

MPH 741, HNES 721, 724, 725, 745, P, MP

I delve deeply into social factors such as the media targeting youth to promote e-cigarette use in my MP.

5.1 Environmental Health: Describe the direct and indirect human, ecological and safety effects of major environmental and occupational agents.

MPH 720, HNES 725, MP Classwork covered traditional environmental concerns. In my HNES classes we blew up the concept of environment to include social norms as environment. I discuss these greatly in my MP.

5.2 Environmental Health: Discuss various risk management and risk communication approaches in relation to issues of environmental and occupational justice and equity.

MPH 720, HNES 725, P Continuing from above, in my practicum I conducted a survey of business owners in which I speak to the justice of environmental harms (e-cig vapor) being allowed in both their place of business and their city.

6.1 Communication: Develop effective communication skills in writing and speaking, in person, and through electronic means.

MPH 704, 731, 741, 751, P, MP, HNES 721, 725, 745

Every class I have taken included written communication. Most of those listed also required presentations. My practicum included creation of video presentations.

6.2 Communication: Solicit community-based input from individuals and organizations.

P I have created and conducted a survey in a community in Minnesota.

6.3 Communication: Participate in MPH 704, 731, P, MP, My classwork prepared me



Narrative

the development of demographic, statistical, programmatic and scientific presentations.

HNES 721, 725, 745 for my practicum and MP in which I had to gather these forms of data and present them.

6.4 Communication: Demonstrate written and oral communication skills that express sensitivity to diverse socioeconomic, cultural, and demographic subgroups.

MPH 710, 720, P, MP, HNES 721, 725, 745

Cultural sensitivity and competency is a component of public health work and as such was practiced in all of my classes.

Health Promotion Competencies

HP 1. Comprehend and apply the principles of behavioral change models, theories, and practices throughout the process of needs assessment, program development, implementation, and evaluation to improve the health of populations.

HNES 721, 724, P, MP Weekly readings and discussion papers; weekly discussion/focus groups on the topics. Semester based projects allowed application of the material. Beyond my classroom work, I apply this knowledge in developing my practicum’s survey and deliverables. This work is part of a plan that will develop into a meeting with the city council advocating for Clean Indoor Air policy for their city.

HP 2. Utilize interdisciplinary public health information, including epidemiology and biostatistics to analyze and explain health problems and issues facing communities.

HNES 721, 727, P, MP Weekly readings and discussion papers; weekly discussion/focus groups on the topics. Semester based projects allowed application of the material. My practicum work has this being done behind the scene and involves gathering some of this data for future work. My MP utilizes this information to



Narrative

direct a narrative on why legislation and/or policy is the best way to change the environment and provide a system of change in the community, state, and nation.

HP 3. Develop and evaluate comprehensive, evidence-based strategies to improve individual health by promoting health through policy, system, and environmental change at organizational and community levels.

HNES 721, 725, 727, P, MP, Day at the Capitol (Tobacco Policy)

Weekly readings and discussion papers; weekly discussion/focus groups on the topics. Semester based projects allowed application of the material. Including the previous statements, my work with this material in class led to my appointment in Clay County Public Health. Daily I use the work that I learned here. Part of my position is the development of PSE changes in 4 MN counties and the advocating for the same at the State level.

HP 4. Explain and utilize leadership skills to build collaboration with the purpose of improving the health of the community.

HNES 724, 725, 745, P, MP

Weekly readings and discussion papers; weekly discussion/focus groups on the topics. Semester based projects allowed application of the material. Group projects also allowed leadership within peers. My practicum will lead to conversation with the city council of a MN community. My MP will be read and possibly utilized by all of the anti-tobacco agencies in MN



Narrative

from MDH down to the county level. My position as Tobacco Coordinator allows me to use the skills I learned through my MPH program to create partnerships in the cities and counties that I serve.

Documents

FINALIZED MASTERS PAPER