What is Driving Oklahomas E-cigarette Bans?

Back in Nov. 2013, Dr. Shannon Grimes, a Tahlequah resident (who uses no tobacco products or electronic cigarettes) asked some pointed questions about the proposed ordinance to ban e-cigarettes in his town. Since I had been studying this very issue myself, I took the liberty of answering his questions resulting in the following document . (Kaye Beach updated 1/8/2014) ** SG Shannon Grimes, KB - Kaye Beach Shannon Grimes writes: 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 community officials, and other interested parties. I would love for all interested parties to stop and consider these questions and more as we move forward. SG: Where did the proposed ordinance prohibiting Vaping originate? KB: From the Cherokee County Community 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.

SG: Did the Cherokee County Community Health Coalition propose the Vaping ban ordinance at the request of entities outside our community? KB: 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 communities for a variety of (sometimes) remotely related health initiatives under the Healthy Communities Incentive Grants program. In 2013, TSET is incentivizing cash strapped communities tobacco control measures with $4.1 million dollars in grant money. Banning e-cigarettes earns the highest level of grant rewards. 1

Communities of Excellence in Tobacco Control One Year RFP, Nov. 25, 2013.

. RFP and additional related document can be found here http://www.ok.gov/tset/Grants/Communities_of_Excellence_Tobacco_Control_1_year_RFP.html (In 2012, TSETs tobacco control incentive budget was $6.06 million) SG: Does the Cherokee County Community Health Coalition have a financial incentive to see this prohibitive ordinance in place? KB: Yes. TSET grant funding at Excellence level is conditional upon the grant applicant working to ban e-cigarettes on city property and elsewhere. Grant coordinators, 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

Val Dobbins, chairman of the county program, said TSET sent down these ordinances and they ask us to propose (them) in the cities, according to a report in the Tahlequah Daily Press. First thing off the bat, in order for us to be certified healthy at the excellent level for a city, the first thing they ask us for is to add e-cigarettes, or electronic smoking devices, to our ordinances that have to do with tobacco, Dobbins said. At stake is at least $42,000 in prospective grant funding from TSET. However, that sum may understate the cash incentives for a ban. John Yeutter, a certified public accountant and an associate professor of accounting at Northeastern State University, told officials the county programs own online reports identified TSET grants totaling $146,9987 in the fiscal year that ended in June 2012.
(Reported by The Oklahoma Watchdog, Nov. 13, 2013 )

Additional grant money of $42,000 would be granted to Choates group as part of TSETs Communities of Excellence in Tobacco Control. An amount of $200,000 is received annually by her group from the tobacco settlement. She emphasized that it is not money that motivates them to push ecig ban.
(Reported by North West Watch http://www.northwestwatch.org/news/speculations-that-money-push-council-to-banecigarettes/)

KB: Millions have been set aside by TSET specifically for funding tobacco coalition grantees activities to reduce tobacco use in communities for 2013 (For the top grant amounts, TSET has redefined tobacco to include vapor devices and products) http://www.ok.gov/tset/documents/TSET%20ProgramFact%20SheetFY12Final2%201.pdf This grant money is contingent upon the community achieving certain community 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. 2

There are a total of nine Community Indicators (or goals) established by TSET (and the Oklahoma Tobacco Research Center (OTRC) which is funded by TSET) and five community indicators that guide the coalition grant facilitators. Grant Applicants must, at a minimum, develop work plans to achieve all five of TSET de signated 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 TSETs 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.

SG: 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? KB: 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. SG: Do you think we can have a better idea about the risks quicker than in the case of cigarettes? KB: 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 by nicotine delivery products . http://www.drugscience.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. http://www.tobaccosolutions.net/electronic-cigarettes-health/

SG: Is there any evidence of big business hiding and lying about the effects of Vaping such as was done by the Tobacco Industry historically? KB: 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 created or developed by tobacco companies. (History of electronic cigarettes http://www.v2cigs.com/blog/2013/10/the-real-history-of-electroniccigarettes/) It wasnt until recently when it became clear to the tobacco industry that vaping is the wave of the future, did they begin to show interest. Now tobacco companies are beginning marketing their own brands of e-cigarettes. 3

SG: Is there any evidence that Vaping is anywhere near as toxic as tobacco use?
KB: If you mean the use of smoking tobacco, no. Not all tobacco use is equal. Smokeless tobacco products are wellestablished by science and historical statistical data to be 98% safer than smoking tobacco. Some forms of smokeless tobacco such as Swedish Snus is even safer. Smoking cigarettes accounts 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 doesnt 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/wpcontent/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. SG: 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? KB: 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 in my opinion. As they work for to earn TSET funds by instigating tobacco and e-cigarette bans, the coalitions are also required to promote pharmaceutical nicotine replacement products (such as patches, gum and nicotine inhalers) as well as drugs like Chantix. The FDA itself warns that this drug can cause serious psychiatric problems, including suicidal thinking. In addition a wide range of side effects attributed to Chantix have been reported including cardiovascular events, diabetes and renal failure. Source In 2009, the FDA approved smoking cessation drug, Chantix, was deemed to require a black box warning on the label to alert users to dangerous possible side-effects. Why is it that no one seems interested in the fact that the single best, proven method of quitting smoking is going cold turkey?

92% of successful ex-smokers did not use the nicotine patch, gum, Zyban, or Chantix http://www.gallup.com/poll/163763/smokers -quit-tried-multiple-times.aspx
And how many current smokers will be dissuaded from switching to a safer alternative for nicotine by the overblown claims about e-cigarette safety and decide to just continue to smoke? SG: Is there any evidence, compelling or otherwise, about risks to those around persons using Vaping product? 4

KB: Evidence isnt 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, 14th Annual Meeting of the
Society for Research on Nicotine and Tobacco, 2012)

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. 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 to human 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

Bottom line: There is simply no threat to bystanders from exhaled e-cigarette vapor that justifies a ban. SG: 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? KB: Yes to the first question and No to the second. And it is the fears and risks of smoking, not tobacco, that are being fantastically misapplied to vapor. SG: 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? KB: YES! E-cigarettes and other smokeless tobacco sales dont count towards the tobacco Master Settlement

Agreement which provides the funding for the TSET. 46 states (including OK), 5 territories and the District of Columbia, get a bundle of money from the tobacco Master Settlement Agreement. The Master Settlement Agreement was an agreement reached in 1998 between the 5 of the largest tobacco companies and athe states and territories that had filed lawsuits against tobacco manufacturers for reimbursement for smoking-related health costs due to smoking-related illness. 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-cigarette sales are cutting into the cigarette market and that means less tobacco settlement money for the TSET and all of their beneficiaries such as the non-profit organizations currently pushing for the vaping bans. 5

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

SG: Is the desire to have cessation of Tobacco use with all its problems or nicotine in general? KB: Good question because the goalpost keeps moving. First the goal was smokefree then tobacco free (although smokeless tobacco carries only about 1or 2% of the risk that smoking tobacco does) and now it appears the war that began with smoking, is now being extended to nicotine regardless of the delivery system, unless of course, the delivery system happens to be a profitable pharmaceutical product. It is important to remember that the government approved smoking cessation products fail 93% of smokers who use them as directed Link Recently TSET added e-cigarettes to their definition of Tobacco (page 25 TSETs OneYear RFP) SG: 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? KB: The Cherokee County Community Health Coalition will have to answer that question themselves because I am at a loss to explain the incongruence of their efforts. You might try asking them some pointed questions about their stance, for instance, "How much safer than smoking does an alternative source of nicotine have to be before it is considered an acceptable alternative?" Does the alternative 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 couldnt or wouldnt quit, an alternative 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 estimated by 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. SG: Is there any evidence that prohibiting Vaping would have any significant positive impact on public health? KB: Yes! As the American Association of Public Health Physicians (AAPHP ) points out, Almost all tobaccoattributable mortality in the USA is due to cigarette smoking. Link and no one seriously denies that that vaporizing 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
SG: 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? KB: There is not. I trust the people of Tahlequah will guide their elected officials towards a rational stance on vapor product use Kaye Beach 11/29/2013 - Updated 1/8/2014