They look often like cigarettes, producing a cloud of vapor resembling cigarette smoke. But it’s not cigarette smoke. E-cigarettes are gaining ground on their tobacco predecessors and causing a momentous shift for people who have struggled to quit smoking for years. But, medical experts are citing new studies that suggest one is not necessarily healthier than the other.
E-cigarettes and vaping — the term for using an e-cig — have been around for less than a decade. But it has only been the past few years that vaping has become so popular across America — and on Delmarva. As their presence increases, fierce debate has begun over their usage – including why, how and where they should be used.
Lounge Popularity Explodes
One need only look around Delmarva to see how vaping and the e-cig supply industry has grown dramatically within just the past year. Vaping lounges — where vapers can buy vaporizers or the hundreds of liquid concoctions that go in them – offer vapers an atmosphere for testing out various flavors. These lounges have popped up in strip malls and shopping centers all over the peninsula. From Dover to Delmar, Del., Salisbury to Ocean City, Md., numbers now reach into the double digits.
A local chain, called Vape It, has contributed greatly to that increase. About a quarter of all of the lounges on Delmarva are Vape Its, with locations in Millsboro, Del., and north and south Salisbury.
“The first one opened in April 2014; then I believe it was June 1 when we opened Millsboro,” said Russell Sutherland, who manages the lounge in south Salisbury, near the Salisbury University campus. “We opened (south Salisbury) Aug. 1.”
Sutherland said the significant and quick expansion wasn’t originally in the plans. But the market seemed to justify opening more than just one store.
“The first location was planned to be the only location; but with the growing popularity of e-cigarettes and vaping, it just started blowing up everywhere,” Sutherland said. “We actually have a couple more that we’re opening.”
Vaping’s explosion in popularity is recent, and its introduction to America didn’t happen all that long ago either. According to the Consumer Advocates for Smoke-Free Alternatives Association, modern vaping traces its roots to an invention from a Chinese pharmacist named Hon Lik in the early 2000s. The first e-cigarettes appeared in the U.S. by the mid-2000s.
Availability of the product, as well as the public’s awareness of them, has grown a lot since then. A Centers for Disease Control and Prevention study published in September showed that between 2010 and 2013, the percentage of U.S. adults who were at least aware of e-cigarettes had doubled from 40 percent to about 80 percent.
In mid-November Oxford English Dictionaries named “vape” its “Word of the Year.” The word was added to the dictionary website in August – defined as “to inhale and exhale the vapor produced by an electronic cigarette or similar device.”
I don't want this place to feel like a head shop. Russell Sutherland, Vape It Manager
Various kinds of e-cigarettes are now available at many gas stations and convenience stores. Many of the product options come from some of the world’s largest cigarette manufacturers. For example, Lorillard, the nation’s third-largest tobacco company, owns the popular and heavily advertised “Blu” brand of e-cigarettes.
Vaping lounges take what is happening behind the counters and registers of all of those gas stations and convenience stores and turn it into an entire store. They sell various kinds of e-cigarettes, from ones that look like actual cigarettes to ones that look like large pens. Some even resemble small flashlights. The lounges also sell the flavored liquids and juices that go in vaporizers.
Sutherland’s store has the feel of a small, quiet nightclub aiming for a cool, modern vibe. The only thing missing from the picture at 11 a.m. on a Wednesday is a bunch of hip 20-somethings wearing trendy clothes and sipping complex cocktails; except this lounge doesn’t sell alcohol. According to Sutherland, the perception many people have of places that sell the devices are of cramped, dank shops with obligatory signs above colorful pieces of blown glass shaped like pipes reading, “These devices are only for tobacco.”
However, Sutherland’s Vape It strikes a noticeably different tone.
“I don’t want this place to feel like a head shop,” he said. “I don’t want people to feel uncomfortable walking in, like they’re doing something wrong.”
A few miles to the north of Sutherland’s lounge, across the state line in Delaware, is Delmar Vapor Lounge. If Vape It is going for cool and modern, Delmar Vapor Lounge is going for bright and cheery. The shop is clean, comfortable and inviting.
“We have over 200 flavors available for trial. They can try any of the 200,” said David Eisenhour, the store’s owner. “There’s no charge to sit here. We give free water out. We have tea available for customers. It’s a lounge. It’s a place to relax.”
Unlike Vape It, Eisenhour’s store only has one location. But he said he has seen tremendous customer growth all the same.
“The most people I’ve had in here is 27 people at once; that was a bit hectic,” he said. “Most days there’s usually one to two customers at a time. We’ve been open about four and a half months. It’s just starting to pay its bills. I expected to lose money for about a year.”
For Sutherland, every day he gets someone new wandering through his door to try vaping.
“[We’re] growing rapidly,” he said. “There’s not one day that goes by that we don’t get at least one person who is trying to quit (tobacco). Most of the days it’s 10 to 20 new people trying to get off cigarettes.”
The “trying to quit” crowd is a huge part of the customer base for every vaping lounge in the country. Talking with those quitters, Sutherland said themes emerge in their rationales and experiences.
Robert Brunke stopped into the south Salisbury Vape It with his wife, Crystal, to buy supplies. His switch from tobacco cigarettes was a recent one, but he’s already starting to notice a difference – in his wallet.
“It ends up costing me so much less,” Brunke said. “We were smoking three packs a day. This costs us $5 a week.”
One of the reasons for the lower costs is that e-cigs aren’t taxed like tobacco. A bill that went nowhere in the Delaware General Assembly in 2013 would have taxed the products.
At Delmar Vapor Lounge, Nathan Allen sits at the counter testing out a new vaporizer. He’s a young man, 21 years of age, who started smoking cigarettes when he was 16. He is weaning himself off them through vaping.
“I used to be a pack and a half a day,” he said. “Now it’s just one or two cigarettes.”
And the most common thing these quitters mention is how much better they feel after making the switch from tobacco cigarettes to e-cigarettes.
Trading Cigarettes for E-Cigs
“It’s a lot healthier,” Allen said. “I don’t wake up in the morning having trouble breathing. I can really feel a difference.”
Asked about the health impact of vaping, the men who run Vape It and Delmar Vapor Lounge plant their feet and declare that they, too, use e-cigarettes.
Eisenhour said he used to swear he’d be buried with a pack of cigarettes. He smoked tobacco for nearly three decades before trading them for a vaporizer.
“About a week later, I felt immensely better. I always lied and said I don’t have a smokers cough. It turned out I did. I can run. I feel better.”
Sutherland smoked cigarettes for 14 years. He said after he made the switch he found he had a lot more energy.
“I tried the gum, the patch, lozenges…none of those worked for me,” Sutherland said.
While ceding some of the argument to the former cigarette smokers, Dr. Karyl Rattay, Director of the Delaware Division of Public Health, said the health benefits they claim may not turn out to be all that beneficial.
“I cannot tell you that vaping is healthier than smoking cigarettes,” she said. “I can tell you there are individuals who believe they feel better once they go from cigarettes to vaping.”
Rattay was impressed with a study released this past spring from researchers at the University of California, San Francisco. That study, published in the American Heart Association journal Circulation, was the most comprehensive review of research of e-cigarettes to date.
The study did not call e-cigarettes a good cessation option. It said limited research showed “no proven cessation benefits.” Instead, the study provided a long list of reasons smokers should not use vaping to quit smoking.
“If a patient has failed initial treatment…and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt,” according to the study.
A big part of the argument for not using e-cigarettes to quit traditional smoking centers on what is being inhaled by users and what chemicals are released from e-cigarettes.
Questions about what is fact vs. fiction create the greatest divide between vapor proponents and public health advocates.
For those in the public health arena, more studies are ending in support of their belief that the chemicals used for vaping are harmful.
“There have been a number of studies that do demonstrate that there are a lot of toxins that are released into the environment from vaping,” Rattay said. “Although the tobacco industry has claimed this is harmless water vapor, that’s not what studies are finding.”
The UCSF study claims e-cigarettes “can be a source of indoor air pollution.”
Across a wide variety of vaping products, those researchers did concede that there appears to be much less nicotine per puff in e-cigarettes. The levels of toxicants were lower, too. But that does not mean they were non-existent.
The study listed several polysyllabic words ending in things like -ehyde, -one, -ene, -ine and much more. And it went on to claim e-cigs definitely release particulate matter, which is unhealthy. It is unclear how the amounts compare to regular cigarettes.
Sutherland said he looks at the math and believes there is no way the contents of e-cigarette vapor is as harmful as that of their traditional counterparts.
“In cigarettes there are over 600 ingredients. That’s a dry cigarette. When you light the end, it turns into 6,000 or 7,000 different chemicals – 49 to 67 of those are carcinogens,” he said. “There’s on average five ingredients in a typical e-juice. Even if every single one was a carcinogen, that’s still 50 to 60 less than a traditional cigarette. The math is there. It is safer.”
In the study, “Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality,” which was done in connection with the National Vapers Club, researchers concluded, “For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed.”
My concern is we're exposing individuals to these toxins, and we don't know the impact. Delaware Rep. Debra Heffernan
Drexel University in Philadelphia conducted a separate study, “Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks”, which called into question other researchers’ claims on a wide variety of questions and found many over-estimations. For example, on toxicants found in the vapor – they claim the studies that found problematic amounts had used unrealistic levels of heating.
The funding for the study came from the Consumer Advocates for Smoke-free Alternatives Association Research Fund. The organization said it did not have any editorial control over the study.
Researchers say while their work applies to a large number of products, there is a lack of quality control that means it can’t be applied to every option in the marketplace.
It’s not just a problem for the Drexel study. The UCSF study claims the existing level of regulation on e-cigarettes means vaporizers vary widely, as do the contents of the liquids put in them.
In fact, such a proposal would extend the FDA’s regulatory authority far beyond e-cigarettes to cigars, pipe tobacco, nicotine gels and hookahs. All of those do not presently fall under the administration’s authority. If that came to pass, new nationwide rules for the those products would include minimum age and ID restrictions, health warning labeling and a prohibition on most vending machine sales.
A final decision from the FDA is still forthcoming.
States & Towns Target E-Cig Usage
Lawmakers nationwide are anxious to see what the FDA decides and to get more definitive answers on vapor contents from researchers.
“I think we’re going to be a long time before we really get professional opinions on whether they’re good for you, bad for you or neither,” said Delaware House Minority Whip Rep. Debbie Hudson, R-Fairthorne.
Hudson said that’s why she has been hesitant to support recent pushes to add e-cigarettes to the First State’s Clean Indoor Air Act, which banned smoking in public places, such as bars and restaurants, back in 2002.
“I don’t know that I’m quite ready to begin the process of adding it to the Clean Indoor Air Act just because of all these uncertainties,” she said.
“We didn’t know for a long time how cigarettes affected people — second-hand smoke,” Heffernan said upon introducing HB 309 in April. “I think it’s prudent to be on the safe side now.”
Rattay said that for many years the tobacco industry has denied that second-hand smoke was harmful to millions of non-smoking people.
“My concern is we’re exposing individuals to these toxins, and we don’t know the impact,” she said.
The movement to add e-cigarettes to the Clean Indoor Air Act also has what would have once been considered an unlikely supporter — the state’s restaurant industry. The Delaware Restaurant Association was strongly opposed to the original act but came out for the addition of vaping to the list.
“Since the original law was passed over a decade ago in 2002, Delaware’s restaurant and bar community, its employees and patrons have grown accustomed to the law, which bans smoking in indoor places,” Carrie Leishman, DRA president, wrote in a statement at the time of HB 309’s introduction.
The statement mentions nothing about concerns for the potential second-hand health effects of vaping.
HB 309 got through the House of Representatives in June by a vote of 25 to 12. But, after being assigned to a Senate committee, it never came up for discussion.
Eisenhour is very much opposed to seeing the bill go through.
“You can’t ban a product that’s a good idea because there are other products that do the same thing that are more harmful,” he said.
Sutherland said he supports banning vaping in places where regular smoking is already prohibited, adding some e-cigarette users are being careless about using them in public places to the point of being rude.
“It makes other people who never smoked a cigarette uncomfortable,” he said. “I don’t think e-cigarettes should be used as a loophole to vape where you’re not allowed to smoke.”
Del. Aruna Miller, D-Montgomery County, introduced House Bill 1291 in Maryland in February. It had much the same goal of Heffernan’s bill in Delaware. But the results for the Maryland legislation were very different. It was shot down forcefully in committee with an “unfavorable” vote of 19 to 3 in March.
Right now, the number of places on Delmarva that specifically ban e-cigarette use is relatively small.
The University of Delaware in August enacted a new smoking policy that bans smoking, the use of smokeless tobacco and e-cigarettes throughout its campuses, including in Dover, Lewes and Georgetown. Bethany Beach added e-cigarettes to its smoking ban in the spring. In December Lewes City Council banned both traditional cigarette and e-cigarette smoking on its beaches.
In a meeting held in November, the Rehoboth Beach Commissioners discussed including e-cigarettes to the city’s already enacted smoking ban.
“Seeing people smoke e-cigarettes within the banned areas; does that send the wrong message?” said Rehoboth Beach Commissioner Stan Mills, who during that same meeting was chosen by the commissioners to draft an ordinance that would add e-cigarettes to the city’s smoking ban.
Though Ocean City approved a new no smoking ordinance over the summer, Maryland’s largest resort town continues to permit vaping. There are a number of e-cigarette and vaping product stores on the Ocean City Boardwalk.
For now it seems the push to ban public vaping is gaining the most traction in small localities. But state lawmakers are finding other places to affect change, like blocking minors from buying e-cigs.
Protecting Kids from Vaping
Hudson has concerns about the way e-cigarettes are being presented to kids.
“I think that the way that these companies were marketing them to children, it would be easy to get their attention,” Hudson said.
That's the generally accepted thing - that this be an adult product. Debbie Hudson, Delaware House Minority Rep.
Rattay agrees with that.
“A lot of the marketing – even though youth may not be able to legally buy these products here — is directed toward youth; the flavors — fruit loops, sour grape,” Rattay said. “Those kinds of flavors are angled toward youth.”
Sutherland said this argument doesn’t hold water when compared to the way alcohol is marketed in America.
“I know the FDA says the sweet flavors appeal to kids, so we shouldn’t have sweet flavors. I disagree with that completely. I’m an adult. I like sweet flavors. I should be able to get sweet flavors,” he said. “However, liquors out there – birthday cake vodka and stuff like that. I don’t understand how it’s OK for a vodka to be birthday cake. That’s made for adults. But I can’t have strawberry in my e-cigarette.”
Still, just banning minors from buying does have the support of Sutherland and others in the vaping lounge community.
“I don’t sell to anyone under 18,” said Eisenhour. “The law says I have to have that posted on the counter. I put it there. I fully support that. That’s good legislation.”
In late January, Hudson introduced HB 241, which banned the purchase of the products by minors. It received near unanimous support in the Delaware House and Senate. Only one lawmaker, Senate Minority Leader Sen. Gary Simpson, R-Milford, voted against the bill.
Maryland has had a similar ban in place since 2013. Virginia’s ban was signed into law in March. In fact, at this point, about 40 states have laws that prevent minors from buying e-cigarettes. Some states — Virginia among them — also have laws banning the use of e-cigs around schools.
“That’s the generally accepted thing — that this be an adult product,” Hudson said.
Advocates for the ban in Delaware will have to wait to see what impact it has on vaping among the state’s kids. Rattay said the pre-ban numbers are disheartening.
“We had seen among Delaware youth a doubling of e-cigarette usage from one year to the next from 2011 to 2012,” she said. “Ten percent of Delaware youth were using e-cigarettes. That went from 0 percent just a few years before.”
Ten percent of Delaware youth were using e-cigarettes. That went from zero percent just a few years before. Karyl Rattay, DE Division of Public Heath Director
That increase came before the marked jump in the amount of vaping-centric stores in Delaware and on Delmarva as a whole. Rattay worries now that 10 percent is no longer accurate.
“I am concerned that is an underestimate. We don’t have 2013 data on e-cigarettes,” she said. “We’re going to have to wait to know what our usage is.”
According to a study published in August from the CDC, more than a quarter-million kids who have never smoked cigarettes used an e-cigarette in 2013 — three times as many as those who used them in 2011.
Staring into a hazy future
The expansion of vaping lounges on Delmarva has not yet reached its peak. In addition to the possibility that more businesspeople could make their first forays into the industry, there are existing establishments planning to grow, including EFactor Vape and Vape It.
“I think Dagsboro, Georgetown, College Park,” said Sutherland, listing off planned sites for new stores.
The strength of the trend, locally and nationally, hinges on the FDA’s upcoming decisions on regulation. What officials choose to do could impact how the products are sold, made and what they contain. All of those items could serve to draw more people into e-cigarettes or push them away.
Studies into contents and health effects of e-cigarettes will continue, as well. The products are still fairly new. That is especially true in comparison to traditional cigarettes, and those went through decades of in-depth study before large-scale consensus was reached on their effects.
And as all of that happens, the push to get Delaware and Maryland to add e-cigarettes to the Indoor Clean Air Act will continue. Supporters are ready to take another crack at the legislation.
“I feel that there was not enough helpful information that was put into the hands of elected officials last year to make a decision, a well-informed decision,” Rattay said.
Delaware House Democrats say there are plans to reintroduce a bill to add e-cigarettes to Delaware’s Clean Indoor Air Act, when lawmakers go back into session in January.
The fight for and against vaping is a long way from going up in smoke.
About the Author
Mike Chesney joined WBOC News as the Dover Bureau Director in October 2012. Before covering the First State’s capital, he was a reporter (and fill-in anchor/producer) at WWMT in Grand Rapids, Michigan, WTVW in Evansville, Indiana, and KOMU in Columbia, Missouri. Mike graduated from the University of Missouri’s prestigious School of Journalism. While he was in college, Mike worked at CNN International in London, ABC News in Washington, DC, WHYY-TV in Philadelphia/Wilmington and KMIZ-TV in Columbia, MO. Mike is a native of suburban Philadelphia. Follow him on Twitter @MikeChesneyWBOC.