I sent the following comments to the Boston Public Health Commission today.
The following comments are submitted by Smokefree Pennsylvania and Bill Godshall to the Boston Public Health Commission (PHC) regarding two recently proposed regulations: "A Regulation Limiting
tobacco and Nicotine Access By Youth" and "Clean Air Works Workplace Smoking and E-Cigarette Use Restrictions".
Since 1990, Smokefree Pennsylvania has advocated organizational, local, state and federal policies to protect people from
tobacco smoke pollution, reduce tobacco marketing to youth, increase cigarette tax rates, preserve civil justice remedies for injured smokers, increase funding for smoking prevention and cessation programs, and inform smokers that smokefree tobacco/nicotine products are far less hazardous alternatives to cigarettes. For disclosure, neither Smokefree Pennsylvania nor I have ever received any funding from tobacco, drug or e-cigarette companies or their trade associations.
A Regulation Limiting Tobacco and Nicotine Access By Youth
Two federal laws [1992 Synar Amendment and 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA)], and a Massachusetts statute already prohibit tobacco sales to minors, and already require compliance checks/inspections of tobacco retailers to ensure compliance.
Persuant to the 1992 Synar law, 40% of retailers nationwide were found willing to sell tobacco to minors in 1997, a percentage that declined to an all time low of 9.3% in 2010
New national report shows that state/federal partnership has reduced illegal tobacco sales to minors to an all-time low.
In 2010, 13.7% of retailers in MA were willing to sell tobacco to minors in 2010, and an average of fewer than 15% of retailers in MA have been found willing to sell to tobacco to minors since 2000.
http://www.samhsa.gov/prevention/2010_Annual_Synar_Report.pdf
http://www.samhsa.gov/prevention/TobaccoRatesFFY97_08.pdf
In the past year, the FDA has awarded contracts to many states, including MA, to enforce the youth access provisions in the FSPTCA
States Awarded FDA Tobacco Retail Inspection Contracts.
According to the FDA, 97 youth access compliance inspections of tobacco retailers have been conducted in Boston
Compliance Check Inspections of Tobacco Product Retailer, and just three (out of 97) retailers were caught selling tobacco to a minor, with the following warnings letters sent to the three retailers.
Alizach, Inc d/b/a Downtown Convenience
Brothers Mini Market, Inc 7/21/11
One Stop Convenience 7/21/11
Subsequent violations (of the FSPTCA) by tobacco retailers are very likely to result in graduated fines, as the FDA had previously imposed $250 fines for retailers caught with a subsequent violation of this same youth access regulation prior to the Supreme Court striking down the 1996 FDA tobacco regulation.
Since virtually every tobacco retailer in Boston has refused to sell tobacco to minors during compliance inspections, and since federal and state laws already prohibit tobacco sales to minors and require/fund compliance inspections of retailers, there is no public health justification for establishing a tobacco retailer permit regulation. Even if the proposed regulation is enacted and aggressively enforce, there will be little if any reduction in tobacco sales to minors since very few retailers sell to minors.
Similarly, since there is no evidence that any youth use electronic cigarettes (e-cigarettes) in Boston or anywhere else, nor evidence that e-cigarettes are marketed to youth, there is no public health justification for establishing a retailer permit regulation for e-cigarette retailers.
While banning the sale of e-cigarettes to minors is sound public health policy, the Boston PHC probably doesn't have the legal authority to ban e-cigarette sales to minors unless/until the Commownwealth of MA does so first. Furthermore, the Boston PHC probably doesn't have the legal authority to ban internet and mail order sales of e-cigarettes to adults.
Daily cigarette smoking in the US and MA has declined sharply since 1998 (with 8th grade prevalence declining 75%, 10th grade prevalence declining 66%, and 12th grade prevalence declining 50%). Past-month smoking also has declined dramatically in the past decade.
But since nearly all 12th graders are 18 years of age, and since many/most underage smokers now primarily obtain cigarettes from friends or relatives (who are 18 or older), the proposed PHC regulation would do very little to further reduce youth smoking or youth access to cigarettes. The most effective way to reduce youth smoking and youth access to cigarettes would be to increase MA's mininum age for cigarette sales to 19 years. Claiming a desire to reduce youth smoking while allowing tobacco sales to most 12th graders makes no sense.
The proposal to require cigars costing less than $2 to be sold in packages of 5 will do little if anything to reduce cigar consumption, and could be challenged in court by cigar companies. It is important to note that cigars aren't as hazardous as cigarettes as the vast majority of cigar smokers don't inhale the smoke, and the vast majority of cigar smokers don't smoke daily. While some people (primarily urban blacks) use cigars/wrappers to smoke ........., cigar regulations (similar to ......... parapernalia bans and regulations) aren't likely to reduce ......... smoking.
For these reasons, the Boston PHC should reject its proposed tobacco youth access regulation, and instead encourage the MA legislature to enact a statewide law banning sales of tobacco products (including e-cigarettes) to any minor under the age of 19 years of age. Four states (AL, AK, UT, NJ) currently prohibit tobacco sales to minors under nineteen, while e-cigarettes sales to minors have been banned in CA, UT, MN, NH, CO and TN.
Clean Air Works Workplace Smoking and E-Cigarette Use Restrictions
In 2006, I coauthored a comprehensive scientific report "Tobacco harm reduction: an alternative cessation strategy for inveterate smokers" at
HRJ | Full text | Tobacco harm reduction: an alternative cessation strategy for inveterate smokers and in 2007 the Royal College of Physicians
issued a similar report "Harm reduction in nicotine addiction; Helping people who can't quit" at
http://www.tobaccoprogram.org/pdf/4fc74817-64c5-4105-951e-38239b09c5db.pdf. Epidemiology studies have consistently found that cigarette smoking poses 100 times greater morbidity and mortality risks than use of smokeless tobacco products in the US and Sweden, and the available evidence indicates that all noncombustible tobacco/nicotine products (including e-cigarettes, nicotine gums, lozenges, patches) are also about 99% less hazardous alternatives to cigarettes.
Smokers who switch to smokefree tobacco/nicotine products reduce their health risks nearly as much as smokers who quit all tobacco/nicotine usage, and several million smokers have already switched to smokeless tobacco products, e-cigarettes and/or NRT products. Besides, usage of e-cigarettes or other noncombustible tobacco/nicotine products poses no known risks for nonusers because they emit ZERO smoke.
Approximately one million smokers have quit smoking or sharply reduced their cigarette consumption by switching to or substituting smokefree e-cigarettes. To date, there is no evidence that e-cigarette usage has harmed anyone, which is logical since the products emit a tiny amount of vaporized nicotine (similar to nicotine inhalers that are marketed as smoking cessation aids) and water vapor. All of the dozen plus laboratory tests conducted on e-cigarettes found that e-cigarettes emit no hazardous levels of any constitutents, and that levels of nitrosamines in e-cigarettes are nearly identical (i.e. very little if any) to those in nicotine gums and patches.
http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf
http://www.starscientific.com/404/stepanov tsna in.pdf
http://www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf
http://www.casaa.org/files/Study_TSNAs_in_NJOY_Vapor.pdf
Lab Reports / E Liquid Facts / E Cigarette and E Liquid from Totally Wicked
http://cdn.johnsoncreeksmokejuice.com/downloads/JCE_GCMS_Report.pdf
http://www.libertystix.com/LibertyStixLabAnalysis072309.pdf
http://truthaboutecigs.com/science/8.pdf
http://www.casaa.org/files/Exponent Response-to-the-FDA-Summary.pdf
http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf
Taylor & Francis Online :: ANALYSIS OF ELECTRONIC CIGARETTE CARTRIDGES, REFILL SOLUTIONS, AND SMOKE FOR NICOTINE AND NICOTINE RELATED IMPURITIES - Journal of Liquid Chromatography & Related Technologies - Volume 34, Issue 14
A Literature Review for Glycerol and Glycols for Entertainment Services & Technology Association also found no health risks to humans
http://tsp.plasa.org/tsp/working_groups/FS/docs/HSE.pdf, while new pharmacology, pharmacokinetic and toxicology studies at
ScienceDirect - Toxicology : Non-clinical safety and pharmacokinetic evaluations of propylene glycol aerosol in Sprague-Dawley rats and Beagle dogs found that laboratory animals were not harmed by very high levels of propylene glycol aerosol.
E-cigarettes also have been found to contain/emit similar or lower levels of nicotine than nicotine gums and lozenges
http://www.healthnz.co.nz/2010 Bullen ECig.pdf and
http://www.casaa.org/files/Virgiania Commonwealth University Study.pdf. This indicates that e-cigarettes emit enough to satisfy the cravings of smokers, but may not emit enough nicotine to addict nonsmokers. There is no evidence that any youth or non-tobacco users have become addicted to e-cigarettes.
In a recent Boston Globe article, Nikysha Harding, director of tobacco control for the Boston PHC was quoted as saying: “We don’t know what people are inhaling with these e-cigarettes,” and “We see these as a gateway for youth to become addicted to nicotine.” Based upon the evidence cited above, the Boston PHC should issue a correction of those inaccurate and inflamatory claims by Harding.
Many published surveys have confirmed that e-cigarettes satisfy the cravings of smokers, help many smokers quit and/or sharply reduce cigarette consumption, and provide perceived health benefits to users who switched from cigarettes.
Sign In
http://www.biomedcentral.com/content/pdf/1471-2458-10-231.pdf
THR2010. (tobaccoharmreduction.org) (see chapter 9)
http://ectoh.org/documents/3B.5 Ett...ation satisfaction and perceived efficacy.pdf
http://www.ajpmonline.org/webfiles/images/journals/AMEPRE/AMEPRE3013.pdf
Electronic cigarettes (e-cigs): views of af... [Int J Clin Pract. 2011] - PubMed - NCBI
Interviews With
Electronic Cigarettes
A Japanese study similarly found e-cigarettes to be effective for decreasing cigarette consumption.
SEIKATSUEISEI : Vol. 55 (2011) , No. 1 p.59-64, while a recent case study found e-cigarettes effective for smoking cessation among depressed patients
http://www.scirp.org/journal/PaperInformation.aspx?paperID=6134&publishStatus=2.
A new e-cigarette clinical trial on smokers at
CASAA.org found that 22.5% of participants remained smokefree after 24 weeks and another 32.5% of participants reduced daily cigarette consumption by 50%, including 12.5% who reduced daily cigarette consumption by 80%.
Former FDA Commissioner David Kessler has also acknowledged the benefits of smokeless tobacco, dissolvables and e-cigarettes as less hazardous alternatives for cigarette smokers at
Q&A: Former FDA Commissioner talks about tobacco - Westport News by stating "there's no doubt that in terms of risk of death there are some advantages to that substitution."
Other public health organizations that have extensively studied e-cigarettes have also endorsed their use by smokers, including The American Association of Public Health Physicians
Regulations.gov and the American Council on Science and Health
NEJM editorial: e-cigarette users should resume smoking for their own good > Facts & Fears > ACSH.
In sharp contrast to indoor smokefree policies/laws (which are largely self enforced because of broad public support), enforcing an e-cigarette usage ban is impossible (since the products can be used discreetly without anyone else knowing) and it is very difficult and expensive to enforce outdoor smoking bans at locations where other people aren't directly exposed to smoke. Enacting unwarranted and unenforceable regulations also would reduce the public credibility of the PHC.
Therefore, the Boston PHC should reject its proposed regulation to ban the usage of e-cigarettes where smoking is banned, as the regulation would pose far more harm than benefit to public health.
Sincerely,
William T. Godshall, MPH
Executive Director
Smokefree Pennsylvania
1926 Monongahela Avenue
Pittsburgh PA 15218
412-351-5880
smokefree@compuserve.com
