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HomeMy WebLinkAbout2013-12-17; City Council; 21466; Prohibition Electronic Cigarettes\^^^^ CITY OF CARLSBAD - AGENDA BILL i 9 AB# 21.466 PROHIBITION OF ELECTRONIC CIGARETTES WHEREVER SMOKING IS PROHIBITED DEPT. DIRECTOR MTG. 12/17/13 PROHIBITION OF ELECTRONIC CIGARETTES WHEREVER SMOKING IS PROHIBITED CITY ATTORNEY DEPT. Clerk PROHIBITION OF ELECTRONIC CIGARETTES WHEREVER SMOKING IS PROHIBITED CITY MANAGER RECOMMENDED ACTION; Adopt Ordinance No. CS-237. amending section 6.14.020 and 11.32.110 ofthe Carlsbad Municipal Code to prohibit the use of electronic cigarettes wherever smoking is prohibited. ITEM EXPLANATION: Ordinance No. CS-237 was introduced and first read at the City Council meeting held on December 3, 2013. The second reading allows the City Council to adopt the ordinance which will become effective thirty days after adoption. The City Clerk will have the ordinance or a summary ofthe ordinance published within fifteen days, if adopted. FISCAL IMPACT: See AB #21,446 on file in the Office ofthe City Clerk. ENVIRONMENTAL IMPACT: Pursuant to Public Resources Code Section 21065, this action does not constitute a "project" within the meaning of CEQA in that it has no potential to cause either a direct physical change in the environment, or a reasonably foreseeable indirect physical change in the environment, and therefore does not require environmental review. EXHIBIT: 1. Ordinance No. CS-237. 2. Correspondence received regarding this item. DEPARTMENT CONTACT: Sherry Freisinger 760-434-2808 Sherry.Freisinger(5)carlsbadca.gov FOR CITY CLERKS USE ONLY COUNCIL ACTION: APPROVED CONTINUED TO DATE SPECIFIC • DENIED • CONTINUED TO DATE UNKNOWN • CONTINUED n RETURNED TO STAFF • WITHDRAWN • OTHER-SEE MINUTES • AMENDED • 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ORDINANCENO. CS-237 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AMENDING SECTIONS 6.14.020 AND 11.32.110 OF THE CARLSBAD MUNICIPAL CODE AND ADDING CHAPTER 6.18 TO THE CARLSBAD MUNICIPAL CODE TO PROHIBIT THE USE OF ELECTRONIC CIGARETTES WHEREVER SMOKING IS PROHIBITED WHEREAS, electronic cigarettes or "e-cigarettes" are designed to resemble traditional cigarettes but do not contain tobacco; and WHEREAS, there is currently minimal federal or state regulation or control of the use e-cigarettes; and WHEREAS, there are significant health concerns regarding the use of e- cigarettes; and WHEREAS, the use of e-cigarettes in locations where other types of cigarettes, pipes and cigars are prohibited may cause confusion and uncertainty and make it more difficult to enforce bans on smoking; and WHEREAS, the City Council of the City of Carlsbad wishes to promote a smoke-free environment for youth in the City of Carlsbad. NOW, THEREFORE, the City Council ofthe City of Carlsbad ordains as follows that: SECTION 1: That section 6.14.020 of the Carlsbad Municipal Code is amended to read as follows: 6.14.020 Definitions. (a) "Enclosed dining area" as defined in this chapter shall mean an area enclosed by a roof and walls with appropriate openings for ingress and egress. /I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (b) "Public place" as defined in this chapter shall mean any place, publicly or privately owned, which is open to the general public regardless of any fee or age requirement. (c) "Reasonable distance" as defined in this chapter shall mean a distance of twenty feet in any direction from an area in which smoking is prohibited. (d) "Smoke" or "smoking" as defined in this chapter shall mean and include (1) the carrying of a lighted pipe, or lighted cigar, or lighted cigarette of any kind, or the lighting of a pipe, cigar or cigarette of any kind; or (2) the use of an electronic cigarette as defined in California Health & Safety Code Section 119405 ("e-cigarette") or a similar device intended to emulate smoking, which permits a person to inhale vapors or mists that may or may not include nicotine. (e) "Unenclosed dining area" as defined in this chapter shall mean any dining area, which is not an enclosed dining area, including streets and sidewalks, which is available to or customarily used by the general public, an employee, or any invitee, and which is designed, established, or regularly used for consuming food or drink. SECTION 2: That Title 6 of the Carlsbad Municipal Code is amended with the addition of Chapter 6.18 to read as follows: CHAPTER 6.18 ELECTRONIC CIGARETTES 6.18.010 Electronic Cigarettes—Prohibited wherever smoking is prohibited. In any location where the smoking of pipes, cigars or cigarettes is prohibited by any federal, state or local law, it shall also be unlawful for any person to use an electronic cigarette as defined in California Health & Safety Code Section 119405 ("e-cigarette") or a similar device intended to emulate smoking, which permits a person to inhale vapors or mists that may or may not include nicotine. The provisions ofthis chapter do not apply in any circumstance where federal or state law regulates smoking or the use of e-cigarettes, ifthe federal or state law is more restrictive. 3 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SECTION 3: That section 11.32.110 of the Carlsbad Municipal Code is amended to read as follows: 11.32.110 Smoking in public parks and beaches—Prohibited. It is unlawful for any person to smoke, including emitting or exhaling the fumes of any pipe, cigar, cigarette or any other lighted smoking equipment used for burning any tobacco product, weed or plant, or carry or hold a lighted pipe, cigar, cigarette or other lighted smoking products used for burning any tobacco product, weed or plant in a public park or public beach except in areas designated by the city manager, and indicated by signage, as smoking areas. In any location where smoking is prohibited, it shall also be unlawful for any person to use an electronic cigarette as defined in California Health &. Safety Code Section 119405 ("e-cigarette") or a similar device intended to emulate smoking, which permits a person to inhale vapors or mists that may or may not include nicotine. The provisions ofthis chapter do not apply in any circumstance where federal or state law regulates smoking or the use of e- cigarettes, ifthe federal or state law is more restrictive. // // // // // // // // // // // // 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 EFFECTIVE DATE: This ordinance shall be effective thirty days after its adoption; and the city clerk shall certify the adoption ofthis ordinance and cause the full text of the ordinance or a summary of the ordinance prepared by the City Attorney to be published at least once in a newspaper of general circulation in the City of Carlsbad within fifteen days after its adoption. INTRODUCED AND FIRST READ at a regular meeting of the Carlsbad City Council on the 3"^*^ day of December, 2013, and thereafter PASSED AND ADOPTED at a regular meeting ofthe City Council ofthe City of Carlsbad on the 17**^ day of December, 2013, by the following vote, to wit: AYES: Council members Hall, Packard, Wood, Blackburn and Douglas. NOES: None. ABSENT: None. APPROVED AS TO FORM AND LEGALITY: CELIA BREWER, City Attorney ATTEST: Cl,BARBARA ENGLESON, City Clerk December 10,2013 Dear Mayor Hall and City Council Members: I am writing to respectfully urge your "NO" vote on CS-237, the proposed ordinance prohibiting the use of electronic cigarettes wherever smoking is prohibited in the city of Carlsbad. My opposition is based upon the fact that there has been NO finding that the use of electronic cigarettes is harmful to users of these devices, let alone others in the vicinity of those users. Although the proposed ordinance states that "there are significant health concerns regarding the use of e-cigarettes", the FDA website states that "FDA conducted a preliminarv analysis on some samples of electronic cigarettes and components from two leadmg brands. Due to the variahiUty amons products, this analvsis should not be used to draw conclusions." (emphasis added). (http://www.fda.gov/newsevents/publichealthfocus/ucm 173146.htm) Additionally, the FDA analysis identified certain harmful substances present in SOME samples of the vapors tested, but there was NO finding that the level of these substances was harmful, or even meaningful. Why should the City outlaw a device that may help some people stop smoking cigarettes? It hasn't been proven to harm users of the device and it certainly hasn't been shown to harm those in the vicinity of those users. This proposed ordinance is another step in the soft tyranny that is enveloping the United States. With the govemment takeover of our health care system, it is very convenient for self-appointed do-gooders to control our behavior simply by alleging something is "not healthy," and thus adds to our overall health care costs. Then government then steps in with its heavy hand to outlaw certain behaviors that activists wish eliminated. This is not the America I grew up in or the one I want my grandchildren to inherit. The writer-philosopher CS. Lewis wrote: "of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience." Although I will be unable to attend the next city council meeting, as a citizen of Carlsbad and as a member of the Tri-City Tea Party, I ask for your "NO" vote on this un-American proposal. Sincerely, George W. Tye 7316 Binnacle Drive Carlsbad, CA 92011 760.931.7706 gtye@roadrunner.com Kira Linberg From: Tim Cady <tcady@NorthCoastMed.com> Sent: Monday, December 09, 2013 12:32 PM To: Council Internet Email Cc: tbcady@earthlink.net; TCampbell Subject: E-Cigarette Restrictions As a tax paying business owner in Carlsbad (over 100 employees) I wanted to express my extreme disappointment regarding Carlsbad's decision to ban e-cigs where smoking is illegal. Smoke Free Technology is clearly proving to be a viable alternative to the most devastating and preventable public health risks of our time. Anybody who closely follows the industry understands that SFT is an amazing altemative to traditional cigarettes. This technology is working for millions and the industry is growing exponentially. There are no carcinogens, no second hand smoke, and no lingering smell. Mind you, this was the reason tobacco cigarettes were banned in public places to begin with. Therefore, it's astounding to me that Carlsbad acted so hastily. If s perplexing and worrisome that public policy is being formed based on hysteria and a clear lack of understanding of the industry. Our government bodies (i.e., Carlsbad) should be embracing this technology as an altemative to the leading cause of death in world. In effect, you are demonizing and restricting e-cigs based on hypothetical fears. If s shameful and dangerous when public policy is made based on miss-guided hypothesis. I have included a recent article that appeared in the New York Times as an example of responsible joumalism. Please lead the way and take a leadership position on e-cigs, rather than perpetuating exaggerated concems and ignoring the facts. http://wvm.nytirnes.com/2Q 13/12/07/opinion/two-chcers-for-e-cigarettes.html?refHoenocera&r=2& Respectfully, Tim Cady 760-803-8635 Smoke Free Technologies This message and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this message in error please notify the system manager. This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this message. 1 Kira linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Sunday, December 08, 2013 4:40 PM To: Council Internet Email Subject: Ecig ban Several surveys [84-M] paint a picture of the typical e-cig consumer as a long-term smoker who tried repeatedly to quit. The median age of respondents ranges from late 30s to mid 40s. The percentage of respondents using e-cigs as a complete replacement for smoking ranged from 31% to 79%. Etter and Bullen found that 11% of daily users were former smokers, and \9% who were still daily smokers reduced their cigarettes per day from 25 to 15. The most-used flavour was tobacco, but 61%) preferred various fruit flavours, coffee, vanilla, and chocolate [86]. Over 90%o of respondents reported that their health has improved. When asked the main reason why they chose to use an e-cig, 64.6% selected "to continue to have a 'smoking' experience, but with reduced health risks." [85]. Sent from my iPad Kira Linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Saturday, December 07, 2013 11:36 PM To: Council Internet Email Subject: Ecig ban IMO the government can say if we can/can't vape in or near government and government funded buildings. However outdoors unless on government property should not be banned, in and around private businesses should not have bans based on legal bans. Basically the government should only ban things that are perfectly legal on their own property not everybody else's property. Business owners should have the right to allow or deny vaping or anything else on their own. Sent from my iPad Kira Linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Saturday, December 07, 2013 11:29 PM To: Council Internet Email Subject: Ecig ban Unfortunately it takes a iong time to fight ignorance and fear ofthe unknown. Hopefully cooler heads will prevail in the future. Sent from my iPad lo Kira Linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Saturday, December 07, 2013 11:19 PM To: Council Internet Email Subject: Ecig ban The professionals that came to my city and got vaping banned all get paid to ban smoking everywhere. So adding vaping to there pursuits just means job security. If they really cared about smokers (and others around them) they would be trying to get smokers to switch to vaping not out law it. Sent from my iPad n Kira linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Saturday, December 07, 2013 11:10 PM To: Council Internet Email Subject: Ecig ban He says the motivation behind city leaders is misguided. "People are moving away from tobacco products in strides. And we want to punish them for it. Why? It all comes back to money," he said. "If they can demonize e-cigarettes, it will be an easier push to get them taxed." In Shawnee, the city passed the ban specifically to apply for the grant — not for the health of its citizens, said Commissioner Linda Agee, who voted against the measure. "My main objection was we're no longer protecting people from secondhand smoke. We're going way beyond that," she said. She pointed to the lack of scientific evidence showing e-cigarettes are harmful. Sent from my iPad Kira linberg From: chris barkley <quadshot45@gmail.com> Sent: Friday, December 06, 2013 1:14 PM To: Council Internet Email Subject: Ecig ban By lumping vaping in with smoking, an e-cigarette ban will discourage other smokers from trying a product that could literally save their lives. All in the name of health. 3 Kira linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Thursday, December 05, 2013 8:28 PM To: Council Internet Email Subject: Ecig ban But Stephens and Shelly Kiser, advocacy director for the American Lung Association in Ohio, say youth-access laws are among the least-effective ways to prevent minors from getting hold of tobacco products — so tobacco companies lose little by advocating the provision. But higher taxation, they argue, is a key deterrent. Sent from my iPad Kira linberg ^ From: Chris Barkley <quadshot45@gmail.com> Sent: Thursday, December 05, 2013 8:15 PM To: Council Internet Email Subject: Ecig ban http://cherokeecountvgop.wordpress.com/2013/ll/29/e-cigs-vapinR-do-our-policv-makers-ask-real-questions-before- deciding/ Sent from my iPad Cherokee County Republican Party- Blog E-Cigs & Vaping, Do Our Policy Makers Ask Real Questions Before Deciding? 29 Friday Nov 2013 POSTED BY DOCLIBERTY IN EDUCATION, FREEDOM, GOVERNMENT, HEALTHCARE, LIBERTY, LIMITED GOVERNMENT, LOCAL, OPINION, UNCATEGORIZED « 6 COMMENTS Ta^s ban, City Council, e-ci^arette, Follow the money, Oklahoma, ordinance, smokinf^, Tahlequah, TSET, vaping Recently I posted a series of questions on Facebook for our Community, the Tahlequah City Council, and the Cherokee County Health Coalition to consider in regards to the proposed Vaping/E-cigarette ban ordinances that are being promoted around the State. Below is my original commentary and questions in black with research and answers provided by Kaye Beach, an independent researcher and activist that has over the years shown herself to be a wonderful asset to the people of Oklahoma in helping keep everyone informed on many issues our State faces. If you are interested you can find more on Kayes work Here. Dr. Shannon Grimes, Chairman Cherokee County Republican Party The discussion about prohibiting Vaping products continues in our community. I think we would all agree that there are a great many serious questions that need to be asked and addressed when we are looking to limit and control the behavior of others. Carol Choate recently had these comments in a news interview with Channel 2 out of Tulsa: "We're kind of with e-cigarettes like we were 50 years ago with cigarettes. We had no idea what cigarettes could do to us, but we know now that they cause cancer." "What this ordinance is all about is Public Health. Its about changing environments. Its about keeping our social norms." Regarding Vaping what do these statements mean? What environmental change is sought? What social norm is going to be maintained? Those are just a few question based just on that interview. I have a lot more questions and not just for Carol Chaote, the Cherokee County Community Health Coalition, our commimity officials, and other interested parties. I would love for all interested parties to stop and consider these questions and more as we move forward. Where did the proposed ordinance prohibiting Vaping originate? From the Cherokee Coimty Commimity Health Coalition and they were prompted to push the ordinance by the promise of funding from the Oklahoma Tobacco Settlement Endowment Trust (TSET) TSET uses funds from the tobacco Master Settlement Agreement to incentivize policies that the TSET and their partners determine is desirable for the community. Did the Cherokee County Community Health Coalition propose the Vaping ban ordinance at the request of entities outside our community? The ordinance is financially incentivized by entities outside the community. The direct impetuous for the ordinance is provided by the Oklahoma Tobacco Settlement Endowment Trust that is providing millions of dollars from the Master Settlement Agreement to commimities for a variety of (sometimes) remotely related health initiatives under the Healthy Communities Incentive Grants program. In 2013, TSET is incentivizing cash strapped commimities 'tobacco control' measures wdth $4.1 million dollars in grant money. Banning e-cigarettes cams the highest level of grant rewards. Communities of Excellence in Tobacco Control - A One-Year RFP (PDF), Nov. 20, 2013." http://www.ok.gov/tset/Grants/Communities of Excellence Tobacco Control 1 year RFP.html (In 2012, TSET's 'tobacco control' incentive budget was $6.06 million) Does the Cherokee County Community Health Coalition have a financial incentive to see this prohibitive ordinance in place? Yes. TSET Grant funding is conditional upon the grant applicant working to ban e-cigarettes on city property and elsewhere. Millions have been set aside by TSET specifically for funding tobacco coalition grantees' activities to reduce tobacco use in communities for 2013 (TSET has redefined 'tobacco' to include vapor devices and products) http://www.ok.gov/tset/documents/TSET%20ProgramFact%20SheetFY12FinaI2%201.pdf Grant applicants, like the Cherokee County Tobacco Coalition, led by Carol Choate, get 10% of the grant award. Carol Choate is the Cherokee County "Communities of Excellence in Tobacco Control" grant Coordinator This grant money is contingent upon the community achieving certain 'communitv indicators' established by TSET including the establishment of a city ordinance to prohibit the use of e-cigarettes and vapor devices/products on all city property both inside and out. There are a total of nine Community Indicators (or goals) These nine 'community' goals were chosen by TSET (and the Oklahoma Tobacco Research Center (OTRC) which is funded by TSET) Grant Applicants must, at a minimum, develop work plans to achieve all five of TSET designated "Core Indicators" and one "Optional Indicator" Three of the five "Core Indicators" require e-cigarettes or vapor devices/products prohibitions so any organization that applies for TSET's grant must work to achieve vaping bans. This year, "The TSET Board of Directors doubled grant funds available to communities as part of the Healthy Communities Incentive Grant." According to TSET. In reference to Carol's statement quoted above about the state of our cigarette knowledge 50 years ago, has our clinical sciences and testing improved in the last 50 years? Indeed it has. And I would like to state, up front, that any person, entity or group claiming that there is no evidence that using e-cigarettes is much safer than smoking is either ignorant, misinformed or (as much as I hate to use this term) lying. Do you think we can have a better idea about the risks quicker than in the case of cigarettes? Science already provides enough evidence to conclude that vapor is much safer, by orders of magnitude, than smoking. For example: 'Using the multi-criteria decision analysis method previously used by the Independent Scientific Committee on Drugs (ISCD) to rank the harms of drugs used in the UK, a working group of international nicotine experts convened by the ISCD considered the potential harms of a wide range of nicotine containing products based on sixteen parameters of harm to individuals and harm to others. Not only conventional cigarettes were judged to be by far the most harmful form of nicotine containing product, but e-cigarettes were ranked as similar in harm to nicotine patches [33]. By and large, nicotine per se does not cause much risk when separated from inhaling smoke.' Multi-criteria Decision Analysis: A new approach to evaluating the harm caused hy nicotine delivery products. http://www.drugsdence.org.uk/external-resources/nicotine-mcda-briefing/ "E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA." Is there any evidence of big business hiding and lying about the effects of Vaping such as was done by the Tobacco Industry historically? None that I am aware of although it is apparent that the anti-smoking industry advocates are unfairly conflating the e-cigarette business with Big Tobacco. The truth is that this product was not developed or marketed by the tobacco industry until very recently, after it became clear that vaping is the wave of the future. Is there any evidence that Vaping is anywhere near as toxic as tobacco use? 1^ If you mean the use of smoking tobacco, no. Not all tobacco use is equal. Smokeless tobacco products are well-established by science and historical statistical data to be 98% safer than smoking tobacco. Smoking cigarettes accoimts for every one of the app. 440,000 deaths that the CDC attributes to tobacco each year. The number of deaths from all other tobacco products combined is so small and difficult to track that the CDC doesn't even bother. (Centers for Disease Control and Prevention, "Smoking & Tobacco Use: Tobacco-Related Mortality," August 1, 2013. http://www.cdc.gov/tobacco/data statistics/fact sheets/health effects/tobacco related mortality/index.htm) 'E-cigarette vapor, as inhaled by the users, is mainly water, propylene glycol and glycerin, with small amounts of nicotine and flavoring. There is no carbon monoxide, no tar and no products of combustion. There is no side-stream smoke or vapor. None. Propylene glycol and glycerin are generally recognized as safe. Propylene glycol has been used as the propellant in asthma inhalers and is the main ingredient in theatrical fog'(Statement by Joel L. Nitzkin, MD, MPH, DPA Past Co-Chair, Tobacco Control Task Force American Association of Public Health Physicians Senior Fellow for Tobacco Policy, R Street Institute September 4, 2013 http://www.rstreet.org/wp-content/uploads/2013/09/Nitzkin-duluth-statement.pdf Evidence to date indicates that e-cigarettes do not raise serious health concerns and is considered to be much safer than smoking tobacco by orders of magnitude. Is there any compelling evidence or research showing harm to Vaping users beyond possible nicotine addiction realizing that not all even use the nicotine versions? No. While e-cigarettes are relatively new and any long term effects cannot be established, we do know a great deal about the ingredients of e-liquid and their effects on the human body. Community 'health leaders' that refuse to provide truthful information about alternative nicotine sources and misguided prohibitions are a far greater threat to public health. How many current smokers will be dissuaded from switching to a safer alternative for nicotine and continue to smoke? This is nothing short of tragic because smoking is the single most harmful method of delivering nicotine and it is smoking cigarettes, in fact, that responsible for all of the some 440,000 deaths attributed to tobacco. Is there any evidence, compelling or otherwise, about risks to those around persons using Vaping product? Evidence isn't evidence unless it is compelling and there is no such evidence. There is much evidence, however, to show that, not only is vaping much safer that smoke, e- cigarettes have less toxins that FDA approved nicotine inhalers and no one is suggesting that this product be banned from public use. Passive vaping, compared to cigarette environmental tobacco smoke: Total organic carbon in the test chamber after 5 hours of smoking or vaping, showed no detectable levels of acrolein, toluene, xylene and PAHs for the e-cigarettes, compared to high levels in the cigarette chamber. (Giorgio Romagna, Konstantinos Farsalinos, et al, Mth Annual Meeting of the Society for Research on Nicotine and Tobacco, 2012) 0{ FDA approved nicotine inhalers have higher amounts of six carcinogens, including five to ten times the amount of three heavy metals compared to e-cigarettes. (Michael Siegel, "Anti-Smoking Researcher Misleads Public with Invalid Comparison of E-Cigs and Nicotine Inhaler: Correct Analysis Shows that Nicotine Inhalers Have Higher Amounts of Six Carcinogens," Tobacco Analysis, July 25, 2013. http://www.tobaccoanalysis.blogspot.com/2013/07/anti-smoking-researcher-misleads-public.htm) As Dr. Joel L. Nitzkin, speaking against a similar prohibition ordinance in Duluth, MN. Recently pointed out "If the nicotine and trace carcinogens in e-cigarette vapor presented any significant hazard to bystanders, those advocating for this legislation could have and should have included pharmaceutical nicotine inhalers in this ban. The fact that they have not done so strongly suggests a perception on their part that no such hazard exists" "For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk tohuman health from e-cigarette emissions based on the compounds analyzed." T.R. McAuley, et al, "Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality,"Inhalation Toxicology October 2012. http://www.ncbi.nlm.nih.gov/pubmed/23033998 There is simply no threat to bystanders from exhaled e-cigarette vapor that justifies a ban. Are the fears about tobacco risks and dangers being applied to Vaping? Is that fair or honest given that the two products pretty much only share one factor, nicotine? Yes to the first question and No to the second. And it is the fears and risks of smoking, not tobacco, that is being fantastically misapplied to vapor. If people actually stop using tobacco and thus stop paying the tobacco sin taxes do many of the non-profits and organizations that nominally seek cessation risk having lower funding? 46 states get a bundle of money from the tobacco Master Settlement Agreement. The Master Settlement Agreement was an agreement reached in 1998 between the tobacco industry and a number of states that had filed lawsuits against tobacco manufacturers for reimbursement for smoking-related health costs. The amount that the states get from the Master Settlement Agreement (MSA) each year varies depending on inflation and the quantity of traditional tobacco products that are being shipped within the U.S. E-cigarettes and other smokeless tobacco products don't count towards MSA funds. E-cigarette sales means less tobacco settlement money for the TSET Master Settlement Agreement (MSA) Payment Distribution Through FY2013 "NOTE:As tobacco use declines nationally, MSA payments to all states will be reduced." http://www.ok.gov/tset/documents/MSAFinancial4 30.pdf Is the desire to have cessation of Tobacco use with all its problems or nicotine in general? Good question because the goalpost keeps moving. First the goal was 'smokefree' then 'tobacco free" (although smokeless tobacco carries only about 2% of the risk that smoking tobacco does) and now it appears the war that began with smoking, is being extended to nicotine regardless of the deliver y system, unless of course, the delivery system happens to be a profitable pharmaceutical product. It is important to remember that these govemment approved smoking cessation products fail 93% of smokers who use them as directed Link Here are some key terms and definitions issued by TSET to guide tobacco coalitions: DEFINITIONS: The definitions of tobacco,tobacco-free, smoke-free and vape-free is consistent throughout this document: o Tobacco: Any product that contains or is derived from tobacco and is intended for human consumption excluding dmgs or devices approved for cessation by the United States Food and Dmg Administration. This includes e-cigarettes and vapor devices. o Tobacco-free: Prohibits the use of any tobacco product by anyone, anywhere, at any time. o Smoke-free: Prohibits the use of combustible tobacco products. o Vape-free: Prohibits the use of e-cigarettes and vapor devices/products Does the Cherokee County Community Health Coalition really want to decrease Tobacco use and if so why try to prohibit a product that is very promising in actually helping attain that goal? The Cherokee County Community Health Coalition will have to answer that question themselves because I am at a loss to explain the incongmence of their efforts. You might try asking them some pointed questions about their stance, for instance, "fiToif nmch safer than smoking does an altemative source of nicotine have to be before it is considered an acceptable altemative?" Does the altemative need to be 20% safer than smoking? 50%? If they say 100%, you are not dealing with a rational mind. If I had a loved one who smoked and couldn't or wouldn't quit, an altemative that they found to be an acceptable substitute for smoking that was 20% safer would be enough for me to encourage them to switch. E-cigarettes, which contain no tobacco, no tar, no carbon monoxide are 99% safer that smoking cigarettes The truth is that the efforts of overzealous anti-tobacco organizations like the Cherokee County Community Health Coalition means that more smokers will continue this deadly habit. Is there any evidence that prohibiting Vaping would have any significant positive impact on public health? Yes! .As the American Association of Public Health Physicians (AAPHP) points out, "Almost all tobacco- attributable mortality in the USA is due to cigarette smoking." Link and there are no serious denies that that vapor is much safer than smoking. (AAPHP) states that it "favors a permissive approach to e-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years." Link If there is no compelling evidence regarding public dangers of Vaping and there is no compelling evidence regarding significant positive public health benefits from a ban then is there any REASONABLE grounds for such a ban in our community? There is not. I trust the people of Tahlequah will guide their elected officials towards a rational stance on vapor product use Kaye Beach, Independent Researcher 11/29/2013 thoughts on "E-Cigs & Vaping, Do Our Policy Makers Ask Real Questions Before Deciding?" 1. c^fVf.MrAlexC November 29, 2013 at 7:31 pm Reblogged this on The Flving Vapor and commented: Q:" .. .has our clinical sciences and testing improved in the last 50 years?" A: "Indeed it has. And I would like to state, up front, that any person, entity or group claiming that there is no evidence that using e-cigarettes is much safer than smoking is either ignorant, misinformed or (as much as I hate to use this term) lying." REPLY 2. q^/J-Ieff Hundley November 29. 2013 at 10:38 pm This is an awesome question and answer article. It really gets to the heart of the matter Here's my story.. .E-cigarettes have saved my life. I smoked at least two packs of non filter cigarettes everyday for 36 years, from the age of 16 to the age of 52. My health was in decline, and breathing freely was getting harder each day. I tried to quit using various methods including cold turkey, nicotine patches, nicotine gum, nicotine inhalers and even hypnotism. Nothing worked until I tried e-cigarettes last October 2012. I have stayed away from regular cigarettes for 13 months now, with no withdrawal symptoms. I no longer have the phlegm and lung congestion that had developed over the years. My smokers cough is gone completely. I can mn and exercise without getting out of breath. I can smell a smoker from twenty feet away now, and it stinks. I'm ashamed to have subjected family, friends and strangers to that smell for so many years. I have gone from the highest nicotine level that is available from e-cig manufacturers, to the lowest. My next step is the 0 nicotine content vapor, and then to quit completely. This is my real life study of the health effects of E Cigarettes, and the only one that counts for me. My wife, who has never smoked and hated the smell, now allows me to vape my E-cig in her presence. Even in the car. She told me just today that I no longer have bad morning breath since quitting smoking. 13 months, and I cannot even entertain the idea of going back to tobacco products. See, that's the thing. These are not tobacco products. Nicotine is said to be the main addictive ingredient in tobacco, but also occurs naturally in many plants and foods. Niacin, also known as vitamin B3, is also known as Nicotinic Acid and nicotinamide. I think that nicotine is not the most addictive ingredient, otherwise I wouldn't have been able to reduce my nicotine intake the way I have. There has to be another more addictive substance in tobacco. Over the years I've always increased my tobacco consumption, but now I'm reducing my nicotine intake. Something is very different now. REPLY 3. f^aid-leii Hundley November 29. 2013 at 10:39 pm Thank you Republican party!! REPLY 4. sai^^;aceejuice November 30, 2013 at 11:55 am I will add the same thing yet to another ecig / vaping post. The whole thing boils down to the tax money . The fact that the Insurance and Pharmas can't make money if we vape . Thus less money in Kick backs for the federal government and the EU government. No one has an ounce of KNOWLEDGE about vaping it has not been out or studied long enough. As a vaper and owner of a small ejuice business I forsee terrible trouble for us all after the 1st of the year. REPLY 5. fimd'AxXiom November 30, 2013 at 1:26 pm There is a dead link in the article. 'Michael Siegel, "Anti-Smoking Researcher Misleads Public with Invalid Comparison of E-Cigs and Nicotine Inhaler: Correct Analysis Shows that Nicotine Inhalers Have Higher Amounts of Six Carcinogens," Tobacco Analysis, July 25, 2013' Here is a live link: http://tobaccoanalysis.blogspot.com/2013/07/anti-smoking-researcher-misleads- public.html REPLY 6. <^md-]im Rothenberger December 4, 2013 at 6:11 pm Having smoked for 43 years, 2-3 PAD at the end and attempting to quit a couple dozen times, I have a very partisan view of this situation. I had given up trying to quit for nearly 10 years, convinced I'd remain a smoker until I died. Then, reluctantly, I was talked into trying an e cig. That was over 4 years ago. I cut my cigarette intake immediately down to 6 a day for over 6 months and today I'm nearly 3 years and 10 months since I lifted a cigarette to my mouth for even one drag. I still use my e cig today, but not nearly at the pace that I smoked. Actually, I use it more as an advertisement to smokers that there are much better altematives. The efforts in Oklahoma are not health driven, in fact they are anti-health. If I were to guess what's happening behind the scenes is a conscious effort to protect both the moneys coming in from the MSA tobacco agreement and the ineffective dmgs supplied by the Pharma industry. After all, MSA money dries up if nobodies smoking and the ?non-profit?"health" associations who are nothing more than the marketing arm of Big Pharma really want something that works for smokers off the street. Trying to ban e cigarettes is tmly not in the name of public health, but more public pocketbook oriented. REPLY Blog at WordPress.com. The Chateau Theme. Follow Follow "Cherokee County Republican Party" 6 Powered by WordPress.com 2^ Kira linberg From: Chris Barkley <quadshot45@gmail.com> Sent: Thursday, December 05, 2013 8:13 PM To: Council Internet Email Subject: Ecig ban "E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA.' Sent from my iPad Kira I inberg From: Chris Barkley <quadshot45@gmail.com> Sent: Thursday, December 05, 2013 8:12 PM To: Council Internet Email Subject: Ecig ban Community ^health leaders' that refuse to provide truthful information about alternative nicotine sources and misguided prohibitions are a far greater threat to public health. How many current smokers will be dissuaded from switching to a safer alternative for nicotine and continue to smoke? This is nothing short of tragic because smoking is the single most harmful method of delivering nicotine and it is smoking cigarettes, in fact, that responsible for all of the some 440,000 deaths attributed to tobacco. Sent from my iPad Kira linberg From: Matthew Wimberley <junkyard_hooliganscc(g)verizon.net> Sent: Wednesday, December 04, 2013 10:27 AM To: Council Internet Email Subject: Ban on e-cigarettes... Due to your recent ban on e-cigarettes, I believe that no one on the city council actually did any research, or else you would have read this, proving that e-cigarettes are not a gateway or harmful to anyone in all actuality This is the Drexel Study, the most definitive and thorough study to date done on liquids and deviSces in the e-cigarette industry. http://publichealth.drexel.edU/~/media/Files/publichealth/ms08.pdf Maybe you should read and reconsider, because e-cigarettes are far less harmful than cigarettes to both the user and those around the user. The reports you got your information from are false, mostly propgated and paid for by medicinal manufacturers and tobacco companies. Also, claiming that e- cigarettes will lead children to smoking, well, smoking leads children to smoking, people use e- cigarettes to get away from smoking. I am all for regulating the sales as far as banning sales to minors, and I also believe smoke shops and stores that are not Vapor Lounges or Vapor Stores should not carry e-cigarettes, due to the fact that gas stations and cigarette/cigar stores do not research what they are selling. I will also share my personal story, which echoes the story of many people I know that started using e-cigarettes to quit smoking. I started smoking when I was 15, back in 1995,11 years before electronic cigarettes were invented. I had a habit of 2 packs a day, which not only was a problem in itself, but was compounded by the fact I was diagnosed asthmatic when I was 13.1 had tried patches, nicorette gum, lozenges, and every other alternative treatment, and they never worked. I was hospitalized a few times for having sever asthma attacks. Skip forward several years to about 3 months ago, when I was introduced to electronic cigarettes as an alternative to smoking by a friend of mine. The reason he showed me all about electronic cigarettes is because my doctor said if I didn't quite smoking, due to how bad my lungs had become, that I would not get to grow old to raise my step son with my wife, and any other child we could possibly have in the future. So, I decided to pick up my first electronic cigarette kit. That was 3 months ago, and I haven't had a traditional tobacco cigarette since. In fact, my lungs have improved and started healing and becoming healthy again. According to my doctor, I am also no longer asthmatic, my blood pressure and flow to my extremities has improved. My sense of smell and taste have improved, and I actually went on my first 3.5 mile hike with my family for the first time since I was 16, and did not have an asthma attack. Electronic cigarettes has literally saved my life and given me the chance to raise my family and get to grow old with them. I have shown zero side effects from using electronic cigarettes. Whether you choose to believe me or not is up to you, but I have no reason to lie to you and make up some sob story, as your ban doesn't even effect me because I live nowhere near your county or city, but I believe you must thoroughly educate yourself before you pass any bans or laws. The ingredients used in the liquid that we use in our APV/E-Cigarettes, well, three out of the 4 ingredients are FDA approved for inhalation, ingestion and injection. Medical Grade Propylene Glycol, which ios one of the 4 ingredients in the liquids we use, is FDA approved for inhalers and nebulizers, and also found in some medications such as insulin, which is and injectable medication. People tend to confuse this a7 ingredient with Ethylene Glycol, which is a toxic automotive coolant. Vegetable Glycerine is FDA approved for inhalation and ingestion, and is a main ingredient found it the liquids used in fog machines, which means it gets inhaled. It is also a naturally produced sweetener. Then you have food flavoring, which is just an extract. You inhale this every time you cook, bake, fry, saute, boil or prepare food in a way that makes it cause a steam vapor. Then there's nicotine, which by itself is a stimulant, just like caffeine. In order for it to be lethal, one person must ingest 50 milligrams of 100% pure nicotine in one single serving, so the equivalent of taking a 50ml shot of 100% pure Nicotine out of a glass. A normal cigarette contains 1 Bmg per cigarette, our liquids range from Omg to 32mg, and one bottle, which is usually 10 to 15 milliliters, contains the total amount of nicotine, and a bottle will last anywhere from 2 days to sometimes a week. This means, if you are using a liquid that is 6mg of nicotine, and it';s a 15 ml bottle that lasts you a week, by the time you finished that bottle at the end of the week, you have inhaled the equivalent of a third of the nicotine found in a cigarette in an entire week. So, minus the other 4000 chemicals found in an actual cigarette, you are inhaling a third of a cigarette's nicotine content over the span of a week. Do the math on that, and you will see, it is pretty much impossible to get nicotine poisoning from this. Please, reconsider your ban, because you are stripping former smokers of a healthier alternative by placing and enforcing this ban on our community, which could result in people using e-cigarettes to switch back to tobacco cigarettes. Respectfully, Matthew Wimberley Kira linberg ^ From: Tiffany DeMichele <tiffanydemichele@gmail.com> Sent: Friday, November 15, 2013 4:00 PM To: Council Internet Email Subject: Electronic cigarettes Hello, I am a Carlsbad resident interested in learning how to create a ban on Electronic Cigarettes where tobacco is already prohibited. Please let me know what I need to do to bring this issue to light. When I ask severs at a bar about it they simply state that it is harmless vapor, this may not be the case as scientist are proving carcinogens are being released. Thanks, Tiffany DeMichele 2010 K'iancer Hero: Mr. Hon Lik | PRLog 12/9/13 1:24 PM PRLOG Press Release Distribution Search J <- ^ [| Submit Press Release | -'^iH>-.f^ls Feeds Alerts Submit Free Press JoiH-nalist Account FRMewswIm Distribution CountrY^ United States Australia India Hong. Kong United Kingdom More Countries Industry News All News : Exclusive News December 2013 Mo Su Sa Fr Th We Tu 9 8 7 6 5 4 3 2010 Kcancer Hero: Mr. Hon Lik Mr. Hon Lik was elected 2010 Kcancer Hero for his inventing ofthe revolutionary Electronic Cigarette FOR IMMEDIATE RELEASE PRLog (Press Release) - Oct. 31, 2010 - New York and San Diego - Kcancer Inc announces today that Mr. Hon Lik was elected 2010 Kcancer Hero for his inventing of the revolutionary Electronic Cigarette. Electronic Cigarette is a small battery powered device that delivers nicotine liquid solution in a vaporized form, fog, when inhaled air activates an atomizer. It has a red light at the tip that lightes up with each drag. Electronic Cigarette performs similarly to traditional smoking. It looks, feels and tastes like a cigarette, and delivers all the pleasures of smoking, but it does not contain tobacco, tar or known carcinogens. Fight Nicotine Addiction www.nicorette.com Visit Here To Learn How To Control Nicotine Cravings. KCANCER Official Kcancer Logo Despite obvious health risks and negative social stigma from tobacco smoking, still for every five people in the world, one is a tobacco smoker. Out ofthe 6.7 billion people living in this world, 1.2 billion people smoke tobacco. That's 18% ofthe world's population! Throughout history smoking bans and prohibitions introduced by authorities resulted in minimal quit-smoking outcome. In spite of some harsh punishments including death penalty, smoking and smokers had continued to thrive and spread all over the world. Repressive measures seem to have aroused a spirit of popular rebellion and helped to increase the use of tobacco. The psychological pleasures and physiological satisfaction derived from tobacco smoking proved much more powerful than religious, moral, and legal persuasions. It seems that the senses of excitement derived from a cigarette can't be obtained from anything else. Food, drink, games, and even sex all seem to lose their appeal without an accompanying cigarette. Some smokers survived so many challenges in life, whose last, largest pleasure and perhaps his most effective way of relieving stress, is the treasured freedom to smoke. Some smokers have had multiple heart attacks, circulatory conditions resulting in amputations, cancers, emphysema and a host of other disabling and deadly diseases. They are fully aware that smoking is crippling and killing them, but continue to smoke anyway. To them, life seems not worth living without smoking. The pleasure miracle provided by the little white paper roll has so much to offer that I can safely predict the cigarette is here to stay. It should point out that this predication is not intended as a eulogy ofthe habit of smoking, but rather as an objective estimation on why people smoke cigarettes. Electronic Cigarette will be a great health story. About one-third of total cancer deaths are caused by tobacco smoking in the world. In US alone, more than 200,000 lung cancer deaths are due to tobacco smoking. The Electric Cigarette offers an alternative to smoking tobacco, yet still allows them to have the nicotine they want and to engage in the most realistic mock smoking act available. It will be an effective way to quit or reduce tobacco smoking and to minimize the catastrophic health effects linked to cigarette smoking. We finally have the alternative method of delivering nicotine that is truly enjoyable. With the novel Electronic Cigarette, the tobacco industry will be certainly transformed into a "healthy industry" in near future. Mr. Hon Lik is vice president of Ruyan, a leading Electronic Cigarette manufacturer in Beijing, China. He is the second Kcancer Hero. The first Kcancer Hero, 2009 Kcancer Hero, is Dr. Ralph W Moss, who made significant contributions on integrative treatment of cancer. Similar ? Florida Hospital Memorial Medical Center Awarded Grant RN Cancer Guides. LLC introduces First Employee Cancer Assistance Proaram in the Ngtipn Weymouth dentist announces December as oral cancer screening month Byron Hewett Appointed as Chief Executive Officer of Soma Logic. Inc ASC New Executive Board Annouced Daily News! 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The mission of Kcancer is to create a rendezvous where cancer patients and their loved ones can interact, communicate, create and harness the power of cancer knowledge to start the healing journey. Photo: http ://www.prlOQ.ora/11037370/1 — End — Foiiow Email Embed PDF / Print Lil<e : i Tweet; s g+l Share \ Contact Email Source Phone Zip City/Town Industry Tags Shortcut ; Contact Author i ***@kcancer.com k Kcancer 845-239-1818 10926 Harriman - New York - United States Health, Fitness, Lifestyle kcancer, cancer prlog.org/11037370 Disclaimer: Issuers of the press releases are solely responsible for the content of their press releases. PRLog can't be held liable for the content posted by others. Report Abuse Latest Press Releases By "Kcancer" • Kcancer Hosts Forum On Skin Cancer • Kcancer Hosts Forum On Cancer Controi More... Upcoming Press Releases... • Goodbye Corev Brooks Band: Hello Spoken For • Hyginex Commits to Eliminating Hand Hygiene Related HAIs bv 2020 at IHi Annua! 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Igor Burstyn, PhD Department of Environmental and Occupational Health School of Public Health Drexel University 1505 Race St., Mail Stop #1034 Philadelphia, PA 19102 USA Tel: 215.762.2909 | Fax: 215.762.8846 igor.burstyn@drexel.edu Abstract The aim of this paper is to review available data on chemistry of aerosols and liquids of electronic cigarettes and to make predictions about compliance with occupational exposure limits of personal exposures of vapers (e-cigarette users) to compounds found in the aerosol. Both peer-reviewed and "grey" literatures were accessed and more than 9000 observations of highly variable quality were extracted. Comparisons to the most universally recognized workplace exposure standards. Threshold Limit Values (TLVs), were conducted under "worst case" assumptions about both chemical content of aerosol and liquids as well as behavior of vapers. The calculations reveal that there was no evidence of potential for exposures of e-cigarette users to contaminants that are associated with risk to health at a level that would warrant attention if it were an involuntary workplace exposures by approaching half of TLV. The vast majority of predicted exposures are «1% of TLV. Predicted exposures to acrolein and formaldehyde are typically <5% TLV. Considering exposure to the aerosol as a mixture of contaminants did not indicate that exceeding half of TLV for mixtures was plausible. Only exposures to the declared major ingredients propylene glycol and glycerin - warrant attention because of precautionary nature of TLVs for exposures to hydrocarbons with no established toxicity. Comparing the exposure to nicotine to existing occupational exposure standards is not valid so long as nicotine- containing liquid is not mislabeled as nicotine-free. It must be noted that the quality of much of the data that was available for these assessment was poor, and so much can be done to improve certainty in this risk assessment. However, the existing research is ofthe quality that is comparable with most workplace assessments for novel technologies. In summary, an analysis of current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants ofthe aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients), if it were an emission from industrial process, creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern. Keywords: vaping, e-cigarettes, tobacco harm reduction, risk assessment, aerosol, occupational exposure limit Technical Report July - August 2013 Introduction Electronic cigarettes (also known as e-cigarettes) are generally recognized as a safer alternative to combusted tobacco products (reviewed in [1]), but there are conflicting claims about the degree to which these products warrant concern for the health of the vapers (e-cigarette users). A vaper inhales aerosol generated during heating of liquid contained in the e-cigarette. The technology and patterns of use are summarized by Etter [1], though there is doubt about how current, complete and accurate this information is. Rather conclusive evidence has been amassed to date on comparison ofthe chemistry of aerosol generated by electronic cigarettes to cigarette smoke [2-8]. However, it is meaningful to consider the question ofwhether aerosol generated by electronic cigarettes would warrant health concerns on its own, in part because vapers will include persons who would not have been smokers and for whom the question of harm reduction from smoking is therefore not relevant, and perhaps more importantly, simply because there is value in minimizing the harm of those practicing harm reduction. One way of approaching risk evaluation in this setting is to rely on the practice, common in occupational hygiene, of relating the chemistry of industrial processes and the emissions they generate to the potential worst case of personal exposure and then drawing conclusions about whether there would be interventions in an occupational setting based on comparison to occupational exposure limits, which are designed to ensure safety of unintentionally exposed individuals. In that context, exposed individuals are assumed to be adults, and this assumption appears to be suitable for the intended consumers of electronic cigarettes. "Worst case" refers to the maximum personal exposure that can be achieved given what is known about the process that generates contaminated atmosphere (in the context of airborne exposure considered here) and the pattern of interaction with the contaminated atmosphere. It must be noted that harm reduction notions are embedded in this approach since it recognizes that while elimination ofthe exposure may be both impossible and undesirable, there nonetheless exists a level of exposure that is associated with negligible risks. To date, a comprehensive review of the chemistry of electronic cigarettes and the aerosols they generate has not been conducted, depriving the public ofthe important element of a risk-assessment process that is mandatory for environmental and occupational health policy making. The present work considers both the contaminants present in liquids and aerosols as well as the declared ingredients in the liquids. The distinction between exposure to declared ingredients and contaminants of a consumer product is important in the context of comparison to occupational or environmental exposure standards. Occupational exposure limits are developed for unintentional exposures that a person does not elect to experience. For example, being a bread baker is a choice that does not involve election to be exposed to substances that cause asthma that are part ofthe flour dust (most commonly, wheat antigens and fungal enzymes). Therefore, suitable occupational exposure limits are created to attempt to protect individuals from such risk on the job, with no presumption of "assumed risk" inherent in the occupation. Likewise, special regulations are in effect to protect persons from unintentional exposure to nicotine in workplaces (http://www.cdc.gov/niosh/docs/81-123/pdfs/0446.pdf: accessed July 12, 2013), because in environments where such exposures are possible, it is reasonable to protect individuals who do not wish to experience its effects. In other words, occupational exposure limits are based on protecting people from involuntary and unwanted exposures, and thus can be seen as appropriately more stringent than the standards that might be used for hazards that people intentionally choose to accept. By contrast, a person who elects to lawfully consume a substance is subject to different risk tolerance, as is demonstrated in the case of nicotine by the fact that legally sold cigarettes deliver doses of nicotine that exceed occupational exposure limits[9]: daily intake of 20 mg of nicotine, assuming nearly 100% absorption in the lungs and "53 Technical Report July - August 2013 inhalation of 4 m^ of air, corresponds to roughly 10 times the occupational exposure limit of 0.5 mg/m^ atmosphere over 8 hours[10]. Thus, whereas there is a clear case for applicability of occupational exposure limits to contaminants in a consumer product (e.g. aerosol of electronic cigarettes), there is no corresponding case for applying occupational exposure limits to declared ingredients desired by the consumer in a lawful product (e.g. nicotine in the aerosol of an electronic cigarette). Clearly, some limits must be set for voluntary exposure to compounds that are known to be a danger at plausible doses (e.g. limits on blood alcohol level while driving), but the regulatory framework should reflect whether the dosage is intentionally determined and whether the risk is assumed by the consumer. In the case of nicotine in electronic cigarettes, ifthe main reason the products are consumed is as an alternative source of nicotine compared to smoking, then the only relevant question is whether undesirable exposures that accompany nicotine present health risks, and the analogy with occupational exposures holds. In such cases it appears permissible to allow at least as much exposure to nicotine as from smoking before admitting to existence of new risk. It is expected that nicotine dosage will not increase in switching from smoking to electronic cigarettes because there is good evidence that consumers adjust consumption to obtain their desired or usual dose of nicotine[11 ]. The situation is different for the vapers who want to use electronic cigarettes without nicotine and who would otherwise not have consumed nicotine. For these individuals, it is defensible to consider total exposure, including that from any nicotine contamination, in comparison to occupational exposure limits. In consideration of vapers who would never have smoked or would have quit entirely, it must be remembered that the exposure is still voluntary and intentional, and comparison to occupational exposure limits is legitimate only for those compounds that the consumer does not elect to inhale. The specific aims of this review were to: 1. Synthesize evidence on the chemistry of liquids and aerosols of electronic cigarettes, with particular emphasis on the contaminants. 2. Evaluate the quality of research on the chemistry of liquids and aerosols produced by electronic cigarettes. 3. Estimate potential exposures from aerosols produced by electronic cigarettes and compare those potential exposures to occupational exposure standards. Methods Literature search Articles published in peer-reviewed journals were retrieved from PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) using combinations ofthe following keywords: "electronic cigarettes", "e-cigarettes", "smoking alternatives", "chemicals", "risks", "electronic cigarette vapor", "aerosol", "ingredients", "e-cigarette liquid", "e-cig composition", "e- cig chemicals", "e-cig chemical composition", "e-juice electronic cigarette", "electronic cigarette gas", "electronic cigars". In addition, references ofthe retrieved articles were examined to identify further relevant articles, with particular attention paid to non-peer reviewed reports and conference presentations. Unpublished results obtained through personal communications were also reviewed. The Consumer Advocates for Smoke-free Alternatives Association (CASAA) was asked to review the retrieved bibliography to identify any reports or articles that were missed. The papers and reports were retained for analysis if they reported on the chemistry of e-cigarette liquids or aerosols. No explicit quality control criteria were applied in selection of literature for examination, except that secondary reporting of analytical results was not used. Where substantial methodological problems that precluded interpretation of analytical results were noted, these are described below. For each article that contained relevant analytical results, the compounds quantified, limits of detection, and analytical results were summarized in a spreadsheet. Wherever possible, individual analytical results (rather than averages) were recorded (see electronic Appendix A: 3 54 Technical Report July-August2013 https:/,'dl.dropboxusercontent.com/ii/4285761/CASAA/e/^ Data contained in Appendix A is not fully summarized in the current report but can be used to investigate a variety of specific questions that may interest the reader. Each entry in Appendix A is identified by a Reference Manage ID that is linked to source materials in a list in Appendix B (linked via ReflD: https:/ydl.dropboxusercontent.com/u/428576LCASAA/AppencitxB.rtf) and attached electronic copies of all original materials (Biobliography.zip: littps:.//dJ.dropboxusercontent.com/ii/4285761/CAS.AA/bibliogra^ Comparison of observed concentrations in aerosol to occupational exposure limits For articles that reported mass or concentration of specific compounds in the aerosol (generated by smoking machines or from volunteer vapers), measurements of compounds were converted to concentrations in the "personal breathing zone",^ which can be compared to occupational exposure limits (OELs). The 2013 Threshold Limit Values (TLVs)[10] were used as OELs because they are the most up to date and are most widely recognized internationally when local jurisdictions do not establish their own regulations (see http:/'/Ww.ilo.org/oshenc/part-iv/occupational-hvRien accessed July 3, 2013). Whenever there was an uncertainty in how to perform the calculation, a "worst case" scenario was used, as is the standard practice in occupational hygiene, where the initial aim is to recognize potential for hazardous exposures and to err on the side of caution. The following assumptions were made to enable the calculations that approximate the worst-case personal exposure of a vaper (Equation 1): 1. Air the vaper breathes consists of a small volume of aerosol generated by e-cigarettes that contains a specific chemical plus pristine air; 2. The volume of aerosols inhaled from e-cigarettes is negligible compared to total volume of air inhaled; 3. The period of exposure to the aerosol considered was normalized to 8 hours, for comparability to the standard working shift for which TLVs were developed (this does not mean only 8 hours worth of vaping was considered (see point 4) but rather that amount of breathing used to dilute the day's worth of vaping exposure was 8 hours); 4. Consumption of 150 puffs in 8 hours (an upper estimate based on a rough estimate of 150 puffs by a typical vaper in a day[l]) was assumed to be conservative; 5. Breathing rate is 8 liters per minute [12,13]; 6. Each puff contains the same quantity of compounds studied. [mg/m^] = mg/puff x puffs/(8 hr day) x l/(m^ air inhaled in 8 hr) Eq. 1 The only exception to this methodology was when assessing a study of aerosol emitted by 5 vapers in a 60 m^ room over 5 hours that seemed to be a sufficient approximation of worst-case "bystander" exposure[6]. All calculated concentrations were expressed as the most stringent (lowest) TLV for a specific compound (i.e. assuming the most toxic form if analytical report is ambiguous) and expressed as "percent of TLV". Considering that all the above calculations are approximate and reflecting that exposures in occupational and general environment can easily vary by a factor of 10 around the mean, we added a 10-fold safety factor to the "percent of TLV" calculation. Details of all calculations are provided in an Excel spreadsheet (see electronic Appendix C: https:/./dl.dropboxusercontent.com/ii/4285761./CASAA/eAppendixC.x]sx). No systematic attempt was made to convert the content of the studied liquids into potential exposures because sufficient information was available on the chemistry of aerosols to use those studies rather than making the necessary Atmosphere that contains air inhaled by a person 35 Technical Report July - August 2013 simplifying assumptions to do the conversion. However, where such calculations were performed in the original research, the following approach as used: under the (probably false - see the literature on formation of carbonyl compounds below) assumption of no chemical reaction to generate novel ingredients, composition of liquids can be used to estimate potential for exposure if it can be established how much volume of liquid is consumed in given 8 hours, following an algorithm analogous to the one described above for the aerosols (Equation 2): [mg/m^] = mg/(mL liquid) x (mL liquid)/puff x puffs/(8 hr day) x i/(m^ air inhaled in 8 hr) Eq. 2 Comparison to cigarette smoke was not performed here because the fact that e-cigarette aerosol is at least orders of magnitude less contaminated by toxic compounds is uncontroversial [2-8]. Results and discussion General comments on methods In excess of 9,000 determinations of single chemicals (and rarely, mixtures) were reported in reviewed articles and reports, typically with multiple compounds per electronic cigarette tested [2-8,14-42]. Although the quality of reports is highly variable, if one assumes that each report contains some information, this asserts that quite a bit is known about composition of e-cigarette liquids and aerosols. The only report that was excluded from consideration was work of IVIcAuley et al.[23] because of clear evidence of cross-contamination - admitted to by the authors - with cigarette smoke and, possibly, reagents. The results pertaining to non-detection of tobacco-specific nitrosamines (TSNAs) are potentially trustworthy, but those related to PAH are not since it is incredible that cigarette smoke would contain fewer polycyclic aromatic hydrocarbons (PAH; arising in incomplete combustion of organic matter) than aerosol of e-cigarettes that do not burn organic matter [23]. In fairness to the authors of that study, similar problems may have occurred in other studies but were simply not reported, but it is impossible to include a paper in a review once it is known for certain that its quantitative results are not trustworthy. When in doubt, we erred on the side of trusting that proper quality controls were in place, a practice that is likely to increase appearance of atypical or erroneous results in this review. From this perspective, assessment of concordance among independent reports gains higher importance than usual since it is unlikely that two experiments would be flawed in the same exact manner (though of course this cannot be assured). It was judged that the simplest form of publication bias - disappearance of an entire formal study from the available literature - was unlikely given the exhaustive search strategy and the contested nature of the research question. It is clearly the case that only a portion of all industry technical reports were available for public access, so it is possible that those with more problematic results were systematically suppressed, though there is no evidence to support this speculation. No formal attempt was made to ascertain publication bias in situ though it is apparent that anomalous results do gain prominence in typical reviews ofthe literature: diethylene glycol [43,44] detected at non-dangerous levels (see details below) in one test of 18 of early-technology products by FDA[22] and one outlier in measurement of formaldehyde content of exhaled air [4] and aldehydes in aerosol generated from one e-cigarette in Japan [37]. It must be emphasized that the alarmist report of aldehydes in experiments presented in [37] is based on the concentration in generated aerosol rather than air inhaled by the vaper over prolonged period of time (since vapers do not inhale only aerosol). Thus, results reported in [37] cannot be the basis of any claims about health risk, a fallacy committed both by the authors themselves and commentators on this work [44]. Technical Report July - August 2013 It was also unclear from [37] what the volume of aerosol sampled was - a critical item for extrapolating to personal exposure and a common point of ambiguity in the published reports. However, in a personal exchange with the authors of [37][July 11, 2013], it was clarified that the sampling pump drew air at 500 mL/min through e-cigarette for 10 min, allowing more appropriate calculations for estimation of health risk that are presented below. Such misleading reporting is common in the field that confuses concentration in the aerosol (typically measured directly) with concentration in the air inhaled by the vaper (never determined directly and currently requiring additional assumptions and modeling). This is important because the volume of aerosol inhaled (maximum ~8 L/day) is negligible compared to the volume of air inhaled daily (8L/min); this point is illustrated in the Figure. A similar but more extreme consideration applies to the exposure of bystanders which is almost certainly several orders of magnitude lower than the exposure of vapers. In part this is due to the absorption, rather than exhalation, of a portion of the aerosol by the vapers: there is no equivalent to the "side-stream" component of exposure to conventional cigarettes, so all ofthe exposure to bystanders results from exhalation. Furthermore, any environmental contamination that results from exhalation of aerosol by vaper will be diluted into the air prior to entering a bystander's personal breathing zone. Lastly, the number of puffs that affects exposure to bystander is likely to be much smaller than that of a vaper unless we are to assume that vaper and bystander are inseparable. It is unhelpful to report results in cigarette-equivalents, as in [42], because this does not enable one to estimate exposures of vapers. Moreover, there is no value in comparison ofthe content of e-cigarette aerosol to cigarette smoke when the two products produce emissions that are orders of magnitude apart. To be useful for risk assessment, the results on the chemistry ofthe aerosols and liquids must be reported in a form that enables the calculations in Equations 1 and 2. It must be also be noted that typical investigations consisted of qualitative and quantitative phases such that quantitative data is available mostly on compounds that passed the qualitative screen. This biased all reports on concentration of compounds towards both higher levels and chemicals which a particular lab was most adept at analyzing. Declared Ingredients: comparison to occupational exposure limits Propylene glycol and glycerin have default or precautionary TLV of 10 mg/m^ over 8 hours set for all organic mists with no specific exposure limits or identified toxicity (http://www.osha.gov/dts/chemicalsampling/data/CH 243600.html; accessed July 5, 2013). These interim TLVs tend to err on the side of being too high and are typically lowered if evidence of harm to health accumulates. For example, in a study that related exposure of theatrical fogs (containing propylene glycol) to respiratory symptoms [45], "mean personal inhalable aerosol concentrations were 0.70 mg/m^ (range 0.02 to 4.1)" [46]. The only available estimate of propylene concentration of propylene glycol in the aerosol indicates personal exposure on the order of 3-4 mg/m^ in the personal breathing zone over 8 hours (under the assumptions we made for all other comparisons to TLVs) [2]. The latest (2006) review of risks of occupational exposure to propylene glycol performed by the Health Council ofthe Netherlands (known for OELs that are the most protective that evidence supports and based exclusively on scientific considerations rather than also accounting for feasibility as is the case for the TLVs) recommended exposure limit of 50 mg/m^ over 8 hours; concern over short-term respiratory effects was noted fhttp://www.gezondheidsraad.nl/sites/default/files/200702O$H.pdf: accessed July 29, 2013]. Assuming extreme consumption of the liquid per day via vaping (5 to 25 ml/day and 50-95% propylene glycol in the liquid)^ levels of propylene glycol in inhaled air can reach 1-6 mg/m^. It has been suggested that propylene glycol is This estimate of consumption was derived from informal reports from vaping community; 5 ml/day was identified as a high but not rare quantity of consumption and 25 ml/day was the high end of claimed use, though some skepticism was expressed about 6 Technical Report July-August 2013 very rapidly absorbed during inhalation [4,6] making the calculation under worst case scenario of all propylene glycol becoming available for inhalation credible. It must also be noted that when consuming low-nicotine or nicotine-free liquids, the chance to consume larger volumes of liquid increases (large volumes are needed to reach the target dose or there is no nicotine feedback), leading to the upper end of propylene glycol and glycerin exposure. Thus, estimated levels of exposure to propylene glycol and glycerin are close enough to TLV to warrant concern. Nicotine is present in most liquids and has TLV of 0.5 mg/m^ for average exposure intensity over 8 hours. If approximately 4 m^ of air is inhaled in 8 hours, the consumption of 2 mg nicotine from e-cigarettes in 8 hours would place the vaper at the occupational exposure limit. For a liquid that contains 18 mg nicotine/ml, TLV would be reached upon vaping ~0.1-0.2 ml of liquid in a day, and so is achieved for most anyone vaping nicotine-containing e-cigarettes[l]. Results presented in [24] on 16 e-cigarettes also argue in favor of exceedance of TLV from most any nicotine-containing e-cigarette, as they predict >2mg of nicotine released to aerosol in 150 puffs (daily consumption figure adopted in this report). But as noted above, since delivery of nicotine is the purpose of nicotine-containing e-cigarettes, the comparison to limits on unintended, unwanted exposures does not suggest a problem and serves merely to offer complete context. If nicotine is present but the liquid is labeled as zero-nicotine [24,43], it could be treated as a contaminant, with the vaper not intending to consume nicotine and the TLV, which would be most likely exceeded, is relevant. However, when nicotine content is disclosed, even if inaccurately, then comparison to TLV is not valid. Accuracy in nicotine content is a concern with respect to truth in advertising rather than unintentional exposure, due to self-regulation of consumption by persons who use e-cigarettes as a source of nicotine. Overall, the declared ingredients in the liquid would warrant a concern by standards used in occupational hygiene, provided that comparison to occupational exposure limits is valid, as discussed in the introduction. However, this is not to say that the exposure is affirmatively believed to be harmful; as noted, the TLVs for propylene glycol and glycerin mists is based on uncertainty rather than knowledge. These TLVs are not derived from knowledge of toxicity of propylene glycol and glycerin mists, but merely apply to any compound of no known toxicity present in workplace atmosphere. This aspect of the exposure from e-cigarettes simply has little precedent (but see study of theatrical fogs below). Therefore, the exposure will provide the first substantial collection evidence about the effects, which calls for monitoring of both exposure levels and outcomes, even though there are currently no grounds to be concerned about the immediate or chronic health effects of the exposure. The argument about nicotine is presented here for the sake of completeness and consistency of comparison to TLVs, but in itself does not affect the conclusions of this analysis because it should not be modeled as if it were a contaminant when declared as an ingredient in the liquid. Polycyclic Aromatic Hydrocarbons Polycyclic aromatic hydrocarbons (PAH) were quantified in several reports in aerosols [5,6,42] and liquids [7,18,41]. These compounds include well-known carcinogens, the levels of which are not subject to TLV but are instead to be kept "as low as reasonably achievable" (the so called ALARA principle)[10]. For PAH, only non-carcinogenic pyrene that is abundant in the general environment was detected at 36 ng/cartridge in 5 samples of liquid [7]; PAHs were not detected in most of the analyses of aerosols, except for chrysene in the analysis of the aerosol of one e-cigarette[42]. Tobacco-Specific Nitrosamines whether the latter quantity was truly possible. High-quality formal studies to verify these figures do not yet exist but they are consistent with report of Etter (2012). 7 Technical Report July - August 2013 The same risk assessment considerations that exist for PAH also hold for carcinogenic tobacco-specific nitrosamines (TSNAs)[47] for which no occupational exposure limits exist because (a) these exposures do not appear to occur in occupational settings often enough to warrant development of TLVs, and (b) it is currently accepted in establishing TLVs that carcinogens do not have minimal thresholds of toxicity. As expected because the TSNAs are contaminants of nicotine from tobacco leaf, there is also evidence of association between nicotine content ofthe liquid and TSNA concentrations, with reported concentrations <5 ng/cartridge tested [7]. Smaller studies of TSNA content in liquids are variable, with some not reporting any detectable levels [17,32,34] and others clearly identifying these compounds in the liquids when controlling for background contamination (n=9)[22]. Analyses of aerosols indicate that TSNAs are present in amounts that can results in doses of <ng/day[5,32] to |ig/day [8] (assuming 150 puffs/day) (see also [42]). The most comprehensive survey of TSNA content of 105 samples of liquids from 11 manufactures indicates that almost all tested liquids (>90%) contained TSNAs in ng/L quantities [35]. This is roughly equivalent to 1/1000 ofthe concentration of TSNAs in modern smokeless tobacco products (like snus), which are in the ppm range [47]. The TSNA concentration of the liquids is orders of magnitude less than smokeless tobacco products, though the actual dosage from e-cigarettes vs. smokeless tobacco remains to be clearly understood. For example, 10 \xg/l (0.01 ppm) of total TSNA in liquid[35] can translate to a daily dose of 0.000025-0.00005 \ig from vaping (worst case assumption of 5 ml/day); if 15 g of snus is consumed a day [48] with 1 ppm of TSNAs [47] and half of it were absorbed, then the daily dose is estimated to be 0.008 pig, which is 160-320 times that due to the worst case of exposure from vaping. Various assumptions about absorption of TSNAs alter the result of this calculation by a factor that is dwarfed in magnitude compared to that arising from differences considered above. This is reassuring because smokeless tobacco products, such as snus, pose negligible cancer risk[49], certainly orders of magnitude smaller than smoking (if one considers the chemistry of the products alone). In general, it appears that the cautious approach in face of variability and paucity of data is to seek better understanding of predictors of presence of TSNA in liquids and aerosols so that measures for minimizing exposure to TSNAs from aerosols can be devised. This can include considering better control by manufactures of the nicotine. Volatile Organic Compounds Total volatile organic compounds (VOC) were determined in aerosol to be non-detectable[3] except in one sample that appeared to barely exceed the background concentration of 1 mg/m^ by 0.73 mg/m^[6]. These results are corroborated by analyses of liquids[18] and most likely testify to insensitivity of employed analytic methods for total VOC for characterizing aerosol generated by e-cigarettes, because there is ample evidence that specific VOC are present in the liquids and aerosols.*^ Information on specific commonly detected VOC in the aerosol is given in Table la. It must be observed that these reported concentrations are for analyses that first observed qualitative evidence ofthe presence of a given VOC and thus represent worst case scenarios of exposure when VOC is present (i.e. zero exposures are missing from the overall summary of worst case exposures presented here). For most VOC and aldehydes, one can predict the concentration in air inhaled by a vaper to be «1% of TLV. The only exceptions to this generalization are: (a) acrolein: ~1% of TLV (average of 12 measurements) and measurements at a mean of 2% of TLV ( average of 150 measurements)[39,40] and (b) formaldehyde: between 0 and 3% of TLV based on 18 tests (average of 12 measurements at 2% of TLV, the most reliable test) and an average of 150 results at 4% of TLV [39,40]. The term "VOC" loosely groups together all organic compounds present in aerosol and because the declared ingredients of aerosol are organic compounds, it follows that "VOC are present" 8 Technical Report July - August 2013 Levels of acrolein in exhaled aerosol reported in [6] were below 0.0016 mg/m^ and correspond to predicted exposure of <1% of TLV (Table 2). It must re-emphasized that all calculations based on one electronic cigarette analyzed in [37] are best treated as qualitative in nature (i.e. indicating presence of a compound without any particular meaning attached to the reported level with respect to typical levels) due to great uncertainty about whether the manner in which the e- cigarette was operated could have resulted in overheating that led to generation of acrolein in the aerosol. In fact, a presentation made by the author of [37] clearly stated that the "atomizer, generating high concentration carbonyls, had been burned black" [39,40]. In unpublished work,[39] there are individual values of formaldehyde, acrolein and glyoxal that approach TLV, but it is uncertain how typical these are because there is reason to believe the liquid was overheated; considerable variability among brands of electronic cigarettes was also noted. Formaldehyde and other aldehydes, but not acrolein, were detected in the analysis one e-cigarette [42]. The overwhelming majority ofthe exposure to specific VOC that are predicted to result from inhalation of the aerosols lie far below action level of 50% of TLV at which exposure has to be mitigated according to current code of best practice in occupational hygiene[50]. Finding of an unusually high level of formaldehyde by Schripp et al. [4] - 0.5 ppm predicted vs. 15-minute TLV of 0.3 ppm (not given in Table 2) - is clearly attributable to endogenous production of formaldehyde by the volunteer smoker who was consuming e-cigarettes in the experimental chamber, since there was evidence of build-up of formaldehyde priorto vaping and liquids used in the experiments did not generate aerosol with detectable formaldehyde. This places generalizability of other findings from [4] in doubt, especially given that the only other study of exhaled air by vapers who were not current smokers reports much lower concentrations for the same compounds [6] (Table 2). It should be noted that the report by Romagna et al. [6] employed more robust methodology, using 5 volunteer vapers (no smokers) over an extended period of time. Except for benzene, acetic acid and isoprene, all calculated concentrations for detected VOC were much below 1% of TLV in exhaled air [6]. In summary, these results do not indicate that VOC generated by vaping are of concern by standards used in occupational hygiene. Diethylene glycol and ethylene glycol became a concern following the report of their detection by FDA[43], but these compounds are not detected in the majority of tests performed to date [3,14,16,18,22]. Ten batches ofthe liquid tested by their manufacture did not report any diethylene glycol above 0.05% of the liquid [41]. Methods used to detect diethylene glycol appear to be adequate to be informative and capable of detecting the compound in quantities «1% of TLV[14,16,22]. Comparison to TLV is based on a worst case calculation analogous to the one performed for propylene glycol. For diethylene glycol, TLV of 10 mg/m^ is applicable (as in the case of all aerosols with no know toxicity by inhalation), and there is a recent review of regulations ofthis compound conducted for the Dutch government by the Health Council ofthe Netherlands (jurisdiction with some ofthe most strict occupational exposure limits) that recommended OEL of 70 mg/m^ and noted lack of evidence for toxicity following inhalation [http://www.gezondheidsraad.nl/sites/default/files/200703OSH.pdf: accessed July 29; 2013]. In conclusion, even the quantities detected in the single FDA result were of little concern, amounting to less than 1% of TLV. Inorganic compounds Special attention has to be paid to the chemical form of compounds when there is detection of metals and other elements by inductively coupled plasma mass spectrometry (ICP-MS)[8,25]. Because the parent molecule that occurs in the aerosol is destroyed in such analysis, the results can be alarmist and not interpretable for risk assessment. For example, the presence of sodium (4.18 |ig/10 puffs)[25] does not mean that highly reactive and toxic sodium metal is in the aerosol, which would be impossible given its reactivity, but most likely means the presence ofthe ubiquitous compound that contains sodium, dissolved table salt (NaCI). If so, the corresponding daily dose of NaCI that arises from 40 Technical Report July - August 2013 these concentrations from 150 puffs is about 10,000 times lower than allowable daily intake according to CDC (http://www.cdc.gov/features/dssodium/: accessed July 4, 2013). Likewise, a result for presence of silica is meaningless for health assessment unless the crystalline form of Si02 is known to be present. When such ambiguity exists, a TLV equivalence calculation was not performed. We compared concentrations to TLVs when it was even remotely plausible that parent molecules were present in the aqueous solution. However, even these are to be given credence only in an extremely pessimistic analyst, and further investigation by more appropriate analytical methods could clarify exactly what compounds are present, but is not a priority for risk assessment. It should also be noted that one study that attempted to quantify metals in the liquid found none above 0.1-0.2 ppm levels [7] or above unspecified threshold [18]. Table lb indicates that most metals that were detected were present at <1% of TLV even if we assume that the analytical results imply the presence ofthe most hazardous molecules containing these elements that can occur in aqueous solution. For example, when elemental chromium was measured, it is compared to TLV for insoluble chromium IV that has the lowest TLV of all chromium compounds. Analyses of metals given in [42] are not summarized here because of difficulty with translating reported units into meaningful terms for comparison with the TLV, but only mercury (again with no information on parent organic compound) was detected in trace quantities, but arsenic, beryllium, chromium, cadmium, lead and nickel were not. Taken as the whole, it can be inferred that there is no evidence of contamination ofthe aerosol with metals that warrants a health concern. Consideration of exposure to a mixture of contaminants All calculations conducted so far assumed only one contaminant present in clean air at a time. What are the implications of small quantities of various compounds with different toxicities entering the personal breathing zone at the same time? For evaluation of compliance with exposure limits for mixtures. Equation 3 is used: OEL^ixture =E!Li(Q/rLKi), Eq. 3 where C, is the concentration ofthe i^^ compound (/=l,...,n, where n>l is the number of ingredients present in a mixture) in the contaminated air and TLV, is the TLV for the i^^ compound in the contaminated air; if OELmixture > 1, then there is evidence ofthe mixture exceeding TLV. The examined reports detected no more than 5-10 compounds in the aerosol, and the above calculation does not place any of them out of compliance with TLV for mixture. Let us imagine that 50 compounds with TLVs were detected. Given that the aerosol tends to contain various compounds at levels, on average, of no more than 0.5% of TLV (Table 1), such a mixture with 50 ingredients would be at 25% of TLV, a level that is below that which warrants a concern, since the "action level" for implementation of controls is traditionally set at 50% of TLV to ensure that the majority of persons exposed have personal exposure below mandated limit [50]. Pellerino et al.[2] reached conclusions similar to this review based on their single experiment: contaminants in the liquids that warrant health concerns were present in concentrations that were less than 0.1% of that allowed by law in the European Union. Of course, if the levels of the declared ingredients (propylene glycol, glycerin, and nicotine) are considered, the action level would be met, since those ingredients are present in the concentrations that are near the action level. There are no known synergistic actions of the examined mixtures, so Equation 3 is therefore applicable. Moreover, there is currently no reason to suspect that the trace amounts of the contaminants will react to create compounds that would be of concern. 10 4 Technical Report July - August 2013 Conclusions By the standards of occupational hygiene, current data do not indicate that exposures to vapers from contaminants in electronic cigarettes warrant a concern. There are no known toxicological synergies among compounds in the aerosol, and mixture ofthe contaminants does not pose a risk to health. However, exposure of vapers to propylene glycol and glycerin reaches the levels at which, ifone were considering the exposure in connection with a workplace setting, it would be prudent to scrutinize the health of exposed individuals and examine how exposures could be reduced. This is the basis for the recommendation to monitor levels and effects of prolonged exposure to propylene glycol and glycerin that comprise the bulk of emissions from electronic cigarettes other than nicotine and water vapor. From this perspective, and taking the analogy of work on theatrical fogs [45,46], it can be speculated that respiratory functions and symptoms (but not cancer of respiratory tract or non-malignant respiratory disease) of the vaper is of primary interest. Monitoring upper airway irritation of vapers and experiences of unpleasant smell would also provide early warning of exposure to compounds like acrolein because of known immediate effects of elevated exposures (http://www.atsdr.cdc.gov/toxprofiles/tpl24-c3.pdf: accessed July 11, 2013). However, it is questionable how much concern should be associated with observed concentrations of acrolein and formaldehyde in the aerosol. Given highly variable assessments, closer scrutiny is probably warranted to understand sources ofthis variability, although there is no need at present to be alarmed about exceeding even the occupational exposure limits, since occurrence of occasional high values is accounted for in established TLVs. An important clue towards a productive direction for such work is the results reported in [39,40] that convincingly demonstrate how heating the liquid to high temperatures generates compounds like acrolein and formaldehyde in the aerosol. A better understanding about the sources of TSNA in the aerosol may be of some interest as well, but all results to date consistently indicate quantities that are of no more concern than TSNA in smokeless tobacco products. Exposures to nicotine from electronic cigarettes is not expected to exceed that from smoking due to self-titration[ll]; it is only a concern when a vaper does not intend to consume nicotine, a situation that can arise from incorrect labeling of liquids[24,43]. The cautions about propylene glycol and glycerin apply only to the exposure experienced by the vapers themselves. Exposure of bystanders to the listed ingredients, let alone the contaminants, does not warrant a concern as the exposure is likely to be orders of magnitude lower than exposure experienced by vapers. Further research employing realistic conditions could help quantify the quantity of exhaled aerosol and its behavior in the environment under realistic worst-case scenarios (i.e., not small sealed chambers), but this is not a priority since the exposure experienced by bystanders is clearly very low compared to the exposure of vapers, and thus there is no reason to expect it would have any health effects. The key to making the best possible effort to ensure that hazardous exposures from contaminants do not occur is ongoing monitoring of actual exposures and estimation of potential ones. Direct measurement of personal exposures is not possible in vaping due to the fact the aerosol is inhaled directly, unless, of course, suitable biomarkers of exposure can be developed. The current review did not identify any suitable biomarkers, though cotinine is a useful proxy for exposure to nicotine-containing liquids. Monitoring of potential composition of exposures is perhaps best achieved though analysis of aerosol generated in a manner that approximates vaping, for which better insights are needed on how to modify "smoking machines" to mimic vaping given that there are documented differences in inhalation patterns[51]. These smoking machines would have to be operated under a realistic mode of operation of the atomizer to ensure that the process for generation of contaminants is studied under realistic temperatures. To estimate dosage (or exposure in personal breathing zone), information on the chemistry of aerosol has to be combined with models of the inhalation pattern of vapers, mode of operation of e-cigarettes and quantities of liquid consumed. Assessment of 11 Technical Report July - August 2013 exhaled aerosol appears to be of little use in evaluating risk to vapers due to evidence of qualitative differences in the chemistry of exhaled and inhaled aerosol. Monitoring of liquid chemistry is easier and cheaper than assessment of aerosols. This can be done systematically as a routine quality control measure by the manufacturers to ensure uniform quality of all production batches. However, we do not know how this relates to aerosol chemistry because previous researchers have failed to appropriately pair analyses of chemistry of liquids and aerosols. It is standard practice in occupational hygiene to analyze the chemistry of materials generating an exposure, and it is advisable that future studies of the aerosols explicitly pair these analyses with examination of composition ofthe liquids used to generate the aerosols. Such an approach can lead to the development of predictive models that relate the composition ofthe aerosol to the chemistry of liquids, the e-cigarette hardware, and the behavior ofthe vaper, as these, if accurate, can anticipate hazardous exposures before they occur. The current attempt to use available data to develop such relationships was not successful due to studies failing to collect appropriate data. Systematic monitoring of quality of the liquids would also help reassure consumers and is best done by independent laboratories rather than manufactures to remove concerns about impartiality (real or perceived). Future work in this area would greatly benefit from standardizing laboratory protocols (e.g. methods of extraction of compounds from aerosols and liquids, establishment of "core" compounds that have to be quantified in each analysis (as is done for PAH and metals), development of minimally informative detection limits that are needed for risk assessment, standardization of operation of "vaping machine", etc.), quality control experiments (e.g. suitable positive and negative controls without comparison to conventional cigarettes, internal standards, estimation of %recovery, etc.), and reporting practices (e.g. in units that can be used to estimate personal exposure, use of uniform definitions of limits of detection and quantification, etc.), all of which would improve on the currently disjointed literature. Detailed recommendations on standardization of such protocols lie outside of scope ofthis report. All calculations conducted in this analysis are based on information about patterns of vaping and the content of aerosols and liquids that are highly uncertain in their applicability to "typical" vaping as it is currently practiced and says even less about future exposures due to vaping. However, this is similar to assessments that are routinely performed in occupational hygiene for novel technology as it relied on "worst case" calculations and safety margins that attempt to account for exposure variability. The approach adopted here and informed by some data is certainly superior to some currently accepted practices in the regulatory framework in occupational health that rely purely on description of emission processes to make claims about potential for exposure (e.g.[52]). Clearly, routine monitoring of potential and actual exposure is required if we were to apply the principles of occupational hygiene to vaping. Detailed suggestions on how to design such exposure surveillance are available in [53]. In summary, analysis ofthe current state of knowledge about the chemistry of contaminants in liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to these contaminants at a level that would prompt measures to reduce exposure by the standards that are used to ensure safety of workplaces. Indeed, there is sufficient evidence to be reassured that there are no such risks from the broad range ofthe studied products, though the lack of quality control standards means that this cannot be assured for all products on the market. However, aerosol generated during vaping on the whole, when considering the declared ingredients themselves, if it were treated in the same manner as an emission from industrial process, creates personal exposures that would justify surveillance of exposures and health among exposed persons. Due to the uncertainty about the effects of these quantities of propylene glycol and glycerin, this conclusion holds after setting aside concerns about health effects of nicotine. This conclusion holds notwithstanding the benefits of tobacco harm reduction, since 12 Technical Report July - August 2013 there is value in understanding and possibly mitigating risks even when they are known to be far lower than smoking. It must be noted that the proposal for such scrutiny of "total aerosol" is not based on specific health concerns suggested by compounds that resulted in exceedance of occupational exposure limits, but is instead a conservative posture in the face of unknown consequences of inhalation of appreciable quantities of organic compounds that may or may not be harmful at doses that occur during vaping. Key Conclusions: • Even when compared to workplace standards for involuntary exposures, and using several conservative (erring on the side of caution) assumptions, the exposures from using e-cigarettes fall well below the threshold for concern for compounds with known toxicity. That is, even ignoring the benefits of e-cigarette use and the fact that the exposure is actively chosen, and even comparing to the levels that are considered unacceptable to people who are not benefiting from the exposure and do not want it, the exposures would not generate concern or call for remedial action. • Expressed concerns about nicotine only apply to vapers who do not wish to consume it; a voluntary (indeed, intentional) exposure is very different from a contaminant. • There is no serious concern about the contaminants such as volatile organic compounds (formaldehyde, acrolein, etc.) in the liquid or produced by heating. While these contaminants are present, they have been detected at problematic levels only in a few studies that apparently were based on unrealistic levels of heating. • The frequently stated concern about contamination of the liquid by a nontrivial quantity of ethylene glycol or diethylene glycol remains based on a single sample of an early technology product (and even this did not rise to the level of health concern) and has not been replicated. • Tobacco-specific nitrosamines (TSNA) are present in trace quantities and pose no more (likely much less) threat to health than TSNAs from modern smokeless tobacco products, which cause no measurable risk for cancer. • Contamination by metals is shown to be at similarly trivial levels that pose no health risk, and the alarmist claims about such contamination are based on unrealistic assumptions about the molecular form of these elements. • The existing literature tends to overestimate the exposures and exaggerate their implications. This is partially due to rhetoric, but also results from technical features. The most important is confusion of the concentration in aerosol, which on its own tells us little about risk to heath, with the relevant and much smaller total exposure to compounds in the aerosol averaged across all air inhaled in the course of a day. There is also clear bias in previous reports in favor of isolated instances of highest level of chemical detected across multiple studies, such that average exposure that can be calculated are higher than true value because they are "missing" all true zeros. • Routine monitoring of liquid chemistry is easier and cheaper than assessment of aerosols. Combined with an understanding of how the chemistry of the liquid affects the chemistry of the aerosol and insights into behavior of vapers, this can serve as a useful tool to ensure the safety of e-cigarettes. • The only unintentional exposures (i.e., not the nicotine) that seem to rise to the level that they are worth further research are the carrier chemicals themselves, propylene glycol and glycerin. This exposure is not known to cause health problems, but the magnitude of the exposure is novel and thus is at the levels for concern based on the lack of reassuring data. 13 44 Technical Report July - August 2013 Acknowledgements Funding for this work was provided by The Consumer Advocates for Smoke-free Alternatives Association (CASAA) Research Fund. CASAA is an all-volunteer, donation-funded, non-profit organization devoted to defending consumer access to and promoting tobacco harm reduction; for more information, see http://casaa.org/. CASAA exercised no editorial control over the author's writing or analysis: the author, not the funder, had full control of the content. The author is thankful to Dr Carl V Phillips, the CASAA Scientific Director, for frank discussion of relevant scientific matters, as well as Drs. Uchiyama and Laugesen for access to presently unpublished data. Lastly, the contribution of Charity Curtis, Masters of Public Health student at Drexel University to the initial literature search was greatly appreciated. 14 Technical Report July - August 2013 Figure: illustrating the difference between concentrations in the aerosol generated by vaping and inhaled air in a day. Panel A shows black square that represents aerosol contaminated by some compound as it would be measured by a "smoking machine" and extrapolated to dosage from vaping in one day. This black square is located inside the white square that represents total uncontaminated air that is inhaled in a day by a vaper. The relative sizes ofthe two squares are exaggerated as the volume of aerosol generated in vaping relative to inhaled air is much smaller in the figure. Panel B shows how exposure from contaminated air (black dots) is diluted over a day for appropriate comparison to occupational exposure limits that are expressed in terms of "time-weighted average" or average contamination over time rather than as instantaneous exposures (with the exception of "ceiling limits" that do not affect the vast majority of comparisons in this report). Exposure during vaping occurs in a dynamic process where the atmosphere inhaled by the vaper alternates between the smaller black and larger white squares in Panel A. Thus, the concentration of contaminants that a vaper is exposed to over a day is much smaller than that which is measured in the aerosol (and routinely improperly cited as reason for concern about "high" exposures). 15 40 Technical Report July-August 2013 Table la: Exposure predictions based on analysis of aerosols generated by smoking machines: Volatile Organic Compounds Compound Estimated concentration in personal breathing zone Ratio of most stringent TLV (%) Reference PPM mg/m^ Calculated directly Safety factor 10 Acetaldehyde 1 0.005 0.02 02 [5] 3 0.003 0.01 0.1 [4] 12 0.001 0.004 0.04 [8] 1 0.00004 0.0001 0.001 [3] 1 0.0002 0.001 0.008 [3] 150 0.001 0.004 0.04 [39,40] 1 0.008 0.03 3 [37] Acetone 1 0.002 0.0003 0.003 [37] 150 0.0004 0.0001 0.001 [39,40] Acrolein 12 0.001 1 13 [8] 150 0.002 2 20 [39,40] 1 0.006 6 60 [37] Butanal 150 0.0002 0.001 0.01 [39,40] Crotonaldehyde 150 0.0004 0.01 0.1 [39,40] Formaldehyde 1 0.002 0.6 6 [5] 3 0.008 3 30 [4] 12 0.006 2 20 [8] 1 <0.0003 <0.1 <1 [3] 1 0.0003 0.1 1 [3] 150 0.01 4 40 [39,40] 1 0.009 3 30 [37] Glyoxal 1 0.002 2 20 [37] 150 0.006 6 60 [39,40] o-Methylbenzaldehyde 12 0.001 0.05 0.5 [8] p,m-Xylene 12 0.00003 0.001 0.01 [8] Propanal 3 0.002 0.01 0.1 [4] 150 0.0006 0.002 0.02 [39,40] 1 0.005 0.02 02 [37] Toluene 12 0.0001 0.003 0.03 [8] Valeraldehyde 150 0.0001 0.0001 0.001 [39,40] # average is presented when N>1 16 Technical Report July - August 2013 Table lb: Exposure predictions based on analysis of aerosols generated by smoking machines: Inorganic Compounds'* Element quantified Assumed compound containing the element for comparison with TLV Estimated concentration in personal breathing zone (mg/m^) Ratio of most stringent TLV (%) Reference Element quantified Assumed compound containing the element for comparison with TLV Estimated concentration in personal breathing zone (mg/m^) Calculated directly Safety factor 10 Reference Aluminum Respirable Al metal & insoluble compounds 0.002 02 1.5 [25] Barium Ba & insoluble compounds 0.00005 0.01 0.1 [25] Boron Boron oxide 1 0.02 0.1 1.5 [25] Cadmium Respirable Cd & compounds 12 0.00002 1 10 [8] Chromium Insoluble Cr (IV) compounds 3E-05 03 3 [25] Copper Cu fiime 1 0.0008 0.4 4.0 [25] Iron Soluble iron salts, as Fe 1 0.002 0.02 02 [25] Lead Inorganic compounds as Pb 7E-05 0.1 1 [25] Lead Inorganic compounds as Pb 12 0.000025 0.05 0.5 [8] Magnesium Inhalable magnesium oxide 1 0.00026 0.003 0.03 [25] Manganese Inorganic compounds, as Mn 8E-06 0.04 0.4 [25] Nickel Inhalable soluble inorganic compounds, as Ni 2E-05 0.02 0.2 [25] Nickel Inhalable soluble inorganic compounds, as Ni 12 0.00005 0.05 0.5 [8] Potassium KOH 0.001 0.1 1 [25] Tin Organic compounds, as Sn 1 0.0001 0.1 1 [25] Zinc Zinc chloride fume 1 0.0004 0.04 0.4 [25] Zirconium Zr and compounds 1 3E-05 0.001 0.01 [25] Sulfur SO2 1 0.002 03 3 [25] # The actual molecular form in the aerosol unknown and so worst case assumption was made if it was physically possible (e.g. it is not possible for elemental lithium & sodium to be present in the aerosol); there is no evidence from the research that suggests the metals were in the particular highest risk form, and in most cases a general knowledge of chemistry strongly suggests that this is unlikely. Thus, the TLV ratios reported here probably do not represent the (much lower) levels that would result if we knew the molecular forms. ## average is presented when N>1 17 Technical Report July-August 2013 Table 2: Exposure predictions for volatile organic compounds based on analysis of aerosols generated by volunteer vapers Compound Estimated concentration in personal breathing zone (ppm) Ratio of most stringent TLV (%) Reference Calculated directly Safety factor 10 2-butanone (MEK) 3 0.04 0.02 0.2 [4] 1 0.002 0.0007 0.007 [6] 2-furaldehyde 3 0.01 0.7 7 [4] Acetaldehyde 3 0.07 03 3 [4] Acetic acid 3 0.3 3 30 [4] Acetone 3 0.4 02 2 [4] Acrolein 1 <0.001 <0.7 <7 [6] Benzene 3 0.02 3 33 [4] Butyl hydroxyl toluene 1 4E-05 0.0002 0.002 [6] Isoprene 3 0.1 7 70 [4] Limonene 3 0.009 0.03 0.3 [4] 1 2E-05 0.000001 0.00001 [6] m,p-Xyelen 3 0.01 0.01 0.1 [4] Phenol 3 0.01 03 3 [4] Propanal 3 0.004 0.01 0.1 [4] Toluene 3 0.01 0.07 0.7 [4] # average is presented when N>1 18 Technical Report July - August 2013 Reference List 1. 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Society for Research on Nicotine and Tobacco, Dublin, April 30, 2009.2009. Ref Type: Abstract 27. Tytgat J. "Super Smoker" expert report. Edited by CATHOLIC UNIVERSITY L 2007. Ref Type: Report 28. Valance C, Ellicott M. Analysis of chemical components from high, med & low nicotine cartridges; Report Number: D318. EditedbyLPDLaboratoryServices, Blackburn MicroTech Solutions Ltd. 2008. Ref Type: Reportwww.lpdlabservices.co.uk 20 51 Technical Report July - August 2013 29. Kubica P, Kot-Wasik A, Wasik A, Namiesnik J: "Dilute & shoot" approach for rapid determination of trace amounts of nicotine in zero-level e-liquids by reversed phase liquid chromatography and hydrophilic interactions liquid chromatography coupled with tandem mass spectrometry-electrospray ionization. J ChromatogrA 2013,1289:13-18. 30. Trehy ML, Ye W, Hadwiger ME, Moore TW, Allgire JF, Woodruff JT et al.: Analysis of Electronic Cigarette Cartridges, Refill Solutions, and Smoke for Nicotine and Nicotine Related Impurities. Journal of Liquid Chromatography & Related Technologies 2011,34:1442-1458. 31. Graves I. Report no. 468304. 60 ml sample of mist from 11 mg nicotine e-cigarette cartridge. Thermal desorption tubes. 468304.9-5-2008. Hamilton, New Zealand, Hill Laboratories. Ref Type: Report 32. Pattison J, Valenty SJ. Material characterization report. 0910.14.10-21-2009. Analyze Inc. Ref Type: Reportanalvzeinc.comhttp://vapersdub.com/NJOYvaporstudv.pdf 33. Sodoma A, Caggiano CM. Material characterization report. 0706.04. 6-28-2007. Analyze Inc. Ref Type: Reporthttp://truthaboutecigs.com/science/16.pdf 34. Anspach T. Determination of tobacco-specific nitrosamines (TSNA) in aroma fluid for e-cigarettes. 11-57021. 9-1- 2011. Eurofins Dr.Specht Laboratorien. Ref Type: Reporthttp://clearstream.flavourart.it/site/wp- content/uploads/DATI/vari/nitrosaminanalvse%20Virginia%2018.pdf 35. Kim HJ, Shin HS: Determination of tobacco-specific nitrosamines in replacement liquids of electronic cigarettes by liquid chromatography-tandem mass spectrometry. J ChromatogrA 2013,1291:48-55. 36. Hadwiger ME, Trehy ML, Ye W, Moore T, Allgire J, Westenberger B: Identification of amino-tadalafil and rimonabant in electronic cigarette products using high pressure liquid chromatography with diode array and tandem mass spectrometric detection. J ChromatogrA 2010,1217: 7547-7555. 37. Uchiyama S, Inaba Y, Kunugita N: Determination of acrolein and other carbonyls in cigarette smoke using coupled silica cartridges impregnated with hydroquinone and 2,4-dinitrophenylhydrazine. J C/iromatogrA 2010,1217:4383-4388. 38. Uchiyama S. Determination of acrolein and other carbonyls in cigarette smoke using coupled silica cartridges impregnated with hydroquinone and 2,4-dinitrophenylhydrazine. 2013. Ref Type: Personal Communication 39. Uchiyama S. <unpublished concentrations from experiments presented in https://www.istage.ist.go.ip/article/bunsekikagaku/60/10/60 10 791/ pdf: through personal communications>. 2013. Ref Type: Unpublished WorkUchiyama_E-cigarette_rml851.PDF 40. Ohta K, Uchiyama S, Inaba Y, Nakagome H, Kunugita N: Determination of Carbonyl Compounds Generated from the Electronic Cigarette Using Coupled Silica Cartridgeslmpregnated with Hydroquinone and 2,4- Dinitrophenylhydrazine. BUNSEKl KAGAKU 2011,60: 791-797. 41. eSmoke. Analytical reports on batches of e-liquids. http://www.esmoke.net/pages.php?pageid=20 . 2009. 7-11- 2013. 21 Technical Report July - August 2013 Ref Type: Electronic Citationhttp://www.esmoke.net/pages.php?pageid=20 42. Murphy J, Wong E, Lawton M. Chemical and operational assessment of the Ruyan classic e-cigarette. Report P.474. 2-8-2010. British American Tobacco. Ref Type: Report 43. Trtchounian A, Talbot P: Electronic nicotine delivery systems: is there a need for regulation? Tob Control 2011, 20: 47-52. 44. Etter JF, Bullen C, Flouris AD, Laugesen M, Eissenberg T: Electronic nicotine delivery systems: a research agenda. Tob Control 2011,20: 243-248. 45. Varughese S, Teschke K, Brauer M, Chow Y, van NC, Kennedy SM: Effects of theatrical smokes and fogs on respiratory health in the entertainment industry. Am J Ind Med 2005,47:411-418. 46. Teschke K, Chow Y, van NC, Varughese S, Kennedy SM, Brauer M: Exposures to atmospheric effects in the entertainment industry. J Occup Environ Hyg 2005, 2: 277-284. 47. Hecht SS, Hoffmann D: Tobacco-specific nitrosamines, an important group of carcinogens in tobacco and tobacco smoke. Carcinogenesis 1988,9: 875-884. 48. Digard H, Errington G, Richter A, McAdam K: Patterns and behaviors of snus consumption in Sweden. Nicotine Tob Res 2009,11:1175-1181. 49. Phillips CV, Sargent C, Rabiu D, Rodu B. Calculating the comparative mortality risk from smokeless tobacco vs. smoking. American Journal of Epidemiology, 163 (11):S189, 2006. American Journal of Epidemiology 163[11], S189. 2006. Ref Type: Abstract 50. Liedel NA, Busch KA, Crouse WE. Exposure measurement action level and occupational environmental variability. HEW Publication No. (NIOSH) 76-131.1975. Cincinnati, OH, US Departement of Health, Education, and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, Division of Laboatories and Criteria Development. Ref Type: Reporthttp://www.cdc.gov/niosh/docs/76-131/pdfs/76-131.pdf 51. Trtchounian A, Williams M, Talbot P: Conventional and electronic cigarettes (e-cigarettes) have different smoking characteristics. Nicotine Tob Res 2010,12:905-912. 52. Tischer M, Bredendiek-Kamper S, Poppek U, Packroff R: How safe is control banding? Integrated evaluation by comparing OELs with measurement data and using monte carlo simulation. Ann Occup Hyg 2009, 53:449-462. 53. British Occupational Hygiene Society, Nederlandse Vereniging voor Arbeidshygiene. Testing compliance with occupational exposure limits for airborne substances. 2011. Ref Type: Report 22 Andrea Dykes From: quadshot45 <quadshot45@gmail.com> Sent: Wednesday, December 11, 2013 2:28 PM To: Council Internet Email Subject: Ecig ban On ECig Safety Professor Carl Phillips 1. "Three months of additional smoking poses a greater risk to someone's health, on average, than a lifetime of using a low-risk altemative." Source: ECigarette Politics David Sweanor: Former Advisor to the WHO on Tobacco Control David Sweanor 2. "Safe doesn't exist. But electronic cigarettes are low risk compared to regular cigarettes. It's the equivalent of having a four-wheel-drive Volvo compared to a high-powered motorcycle with bald tires in an ice storm.: 3. "Rather than the unattainable standard of 'safe' we should be thinking in terms of 'safer'. Despite the risks associated with soccer, I would, for instance, prefer my children play soccer rather than play with live hand grenades." Source: An Interview with David Sweanor Cohn and Siegel 4. ".. .they [electronic cigarettes] are undoubtedly safer than tobacco cigarettes." Click to tweet this quote Source: Palgrave Journals Professor Siegel Headshot of Michael Siegel 5. "Electronic cigarettes are a potential lifeboat. No, they have not been tested and approved by the FDA. "But if you were in a sinking ship, would you remain in the ship because the lifeboats had not been FDA-tested and approved?" Source: Tobacco Analysis Blog Dr J Nitzkin, AAPHP 6. "If we get all tobacco smokers to switch from regular cigarettes to electronic cigarettes, we would eventually reduce the US death toll from more than 400,000 a year to less than 4,000, maybe as low as 400." Source: An Interview with Dr Joel Nitzkin David Halpem, UK Govemment Nudge Unit David Halpem, UK Govemment Nudge Unit 7. "There's no doubt it [The Electronic Cigarette] can save many lives and hundreds of millions of pounds." Click to tweet this quote Source: Daily Mail Dr Murray Laugesen: Health New Zealand 8. ".. .inhaling mist from the e-cigarette is rated several orders of magnitude (100 to 1000 times) less dangerous than smoking tobacco cigarettes." Source: Health New Zealand Deborah Amott, Action of Smoking and Health Head shot of Deborah Arnott 9. ".. .in comparison to tobacco products they are safer by several orders of magnitude." Click to tweet this link Deborah still supports regulation which would outlaw all ecigarettes today. Professor John Britton, chair of the Tobacco Advisory Group of the Royal College of Physicians 10. "If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths in people who are alive today. It's a massive potential public health prize." Source: BBC On Passive Vaping ASH US 11. ".. .new research shows that nicotine emitted by e-cigs combines with chemicals in the air to form extremely potent cancer-causing chemicals which adhere to surfaces like seats and carpeting where they linger and further expose unsuspecting passengers." Professor Siegel later responded: "This is an outright lie. There is no such evidence. No study has ever been done which documents that vaping results in the formation of carcinogens that adhere to surfaces, and no study has ever been done which documents that vaping on airplanes results in the deposition of such carcinogens or to carcinogen exposure among passengers." Source: Tobacco Analysis Blog Freedom to Choose 12. "They [the electronic cigarette] are a product of coercion, who would use them anywhere you could smoke?" Official position of pro-smoking website Freedom to Choose in 2011 On the Tobacco Control Lobby Scott Ballin Headshot of Scott Ballin 13. "Stakeholders who wish to hold on to the past will be the forgotten ones when we look back ten to fifteen years from now. They can exit gracefully as the environment continues to change, but I know that some will go kicking and screaming unfortunately." Source: An Interview with Scott Ballin On The Modem ECigarette Herbert A Gilbert Herbert A Gilbert 14. "There is no electric cigarette today, that I have seen, that does not follow the basic road map set forth in my original patent." Source: An interview with The Inventor of the Electronic Cigrette David Sweanor in the LA Times 15. "E-Cigarettes are, 'exactly what the tobacco companies have been afraid of all these years' - a tobacco-free cigarette altemative." Source: LA Times On Regulation Professor JF Etter at the ECigaretteSummit Head shot of Jean Francois Etter. 16. "You can not stop a tsunami with a law." Tweet this link (Note: Dr Etter is currently conducting a survey on ecigarettes - click here to take part!) Deborah Amott: Action on Smoking and Health at the ECigarette Summit 17. ".. .ecig manufacturers don't understand how their own products work." Jeremy Mean, MHRA at the ECigarette Summit Headshot of Jeremy Mean. 18. "Vaper's don't want the next new flavour, they just want a droplet of nicotine delivered to their lungs." Click to tweet this post Professor Polosa Headshot of Professor Polosa 19. "The dream of a tobacco-free, nicotine-free world is just that - a dream!" Click to tweet this quote Source: Five Scientists Examine the Case for Electronic Cigarettes Chris Snowden, author and blogger at Velvet Glove Iron Fist Chris Snowden 20. ".. .once e-cigarette use hits critical mass, the revolution will become unstoppable." Click to tweet this post Source: What's next for EU Vapers? Kate from Vaper's Network 21. "They're prepared to sacrifice millions of lives to keep themselves on top." Click to tweet this quote Source: An Interview with the Smoking Nun Chris Price on consequences of an e-cigarette ban Chris Price 22. "it will... be the first time in history that the public have had to revert to the black market for safer products in order to stay alive and healthy." Source: ECigarette Politics 23. Elaine Keller: Vaping Advocate from CASAA ' WTiy is YOUR concem about my "addiction" to nicotine more important than MY concem about getting lung cancer?" Click to tweet this quote Why the ECigarette Should Be Banned Dr Jonathan Whiteson: 24. ".. .there's no proof that these cigarettes are safe. No proof whatsoever. They are made in China." Source: Made in China Serena Chen 25. "I understand why people use the nicotine replacement aids, but I don't understand why people want to pretend that they're smoking. "If you had a serial killer who liked to stab people, would you give him a mbber knife?" Click to tweet this quote Source: Smoker's Are Mass Murderers Pme Talbot 26. "Someone in my lab just showed me a bright pink one. And they're selling them with flavors like chocolate and bubble gum.. .These things have nicotine, and you can tell who they're trying to hook." Source: 25 Quotes on Smoking, Anti-Smoking and the Electronic Cigarette Dr Florante Trindad of The WHO 27. "While regular cigarettes have a filter, [with] this delivery device the electronic cigarette, the nicotine goes directly to the lungs." Source: Filipino News Broadcast An Italian MEP to the European Council 28. "Can the Council state what action it intends to take to address the differences in tax revenue materialising in State coffers following the proliferation of electronic cigarettes, which currently appear to be free from any form of duty?" Source: ECigarette Tobacco Tax Since this quote Italy has announced a tax on electronic cigarettes. On Cormption Headshot of Adrian Payne. 29. "Certainly large pharmaceutical companies with interests in stop-smoking medicines provide very substantial financial support to some of the 'public health' groups that are calling for e-cigarettes to be banned." Source: An Interview with Adrian Payne On Falling in Love With ECigarettes Steve Paugh vaping an e-cigarette lookalike. 30. "I watched while the LED light that simulates the red ember of a buming cigarette glowed in response to my pull on the E-Cig, and as I pulled away and breathed in, I fell in love. "There was the kick I had been craving; there was the feeling of something in my hand; there was the 'smoke' that danced from my mouth like a frozen whisper." Source: Sur La Terre Magazine More Great Quotes 25 Great Quotes on Smoking, Anti-Smoking and Electronic Cigarettes Churchill and Hitler on Smoking, Eating and Drinking See more quotes at the World Vaping Day website 99 86 0 430 Leave a comment: Related posts: 25 great quotes on smoking, anti-smoking and electronic cigarettes The Great Vaping Quiz: Day 5 Your Electronic Cigarette Kindle Ebook: Now available on Amazon for 79p/$l .21 with all profits donated to Vaping Groups Petition Competition: Spread the news, save US vaping and win one of eleven great prizes! 14 Great New Vaping Blogs <— Weird Things to Do With E Cigarette Suction Cups Plus Giveaway Share this Post: Twitter Facebook Technorati Reddit Delicious Pinterest AUTHOR: About James Dimworth Main blogger at the Ashtray Blog, co-author of a University of Alberta study of "Electronic cigarettes as potential harm reduction products", co-author of the book: "Electronic Cigarettes: What the Experts Say." Works at ecigarettedirect.co.uk. View Website View other posts No comments yet. Leave a Reply Name (Required) Email (Required) Website Comment Notify me of follovsoip comments via e-mail. You can also subscribe without commenting. SEARCH THE BLOG Submit SUBSCRIBE Follow our social media accounts to be kept up to date with the latest vaping & ecigarette news and offers. FREE GUIDE TO ELECTRONIC CIGARETTES WHEN YOU SIGN UP TO THE NEWSLETTER Sign up to our newsletter and get access to this FREE Electronic cigarette user guide worth £9.99. Electronic Cigarette User Guide Name: Email: Submit Form We respect your email privacy Subscriber Counter 12 WEEKS OF CHRISTMAS PROMOTIONS 12 Weeks of Christmas Promotions RECENT POSTS 29 Great Vaping Quotes Weird Things to Do With E Cigarette Suction Cups Plus Giveaway How Much Eliquid Does It Take to kill You? 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