ROCHESTER — For those who work in nicotine reduction, the new law in Minnesota against vaping in workplaces is as much about making nicotine systems socially unwelcome as it is about public health.
Unfortunately, the products' most enthusiastic users are too young to be deterred by prohibitions on vaping in places patronized by adults.
As of Aug. 1st, Minnesota became the 20th state in the nation to ban vaping in workplaces, public places, restaurants and bars. The change that goes into effect this week expands on vaping ordinances already in place in over 20 counties and 43 municipalities across the state, according to the American Non-Smokers Rights Foundation. The hope is to provide a hedge against the many unknowns about the health effects of vaping, say clinicians, including the risks unknown to us now posed to bystanders.
"I think it's the right thing to do," says Dr. J. Taylor Hays, Director of the Nicotine Dependence Center at Mayo Clinic. "Minnesota was a leader in smoke-free indoor air. With their widespread use and the impression among some users that they are completely safe, we need to protect people from second hand aerosolized nicotine vapors released by electronic cigarettes indoors. We all have to breathe the same air. We don't have good scientific evidence about the effects of breathing second-hand vapor and what's in it. People have a right to breathe air free of unknown substances."
The point has grown more urgent as the popularity of vaping climbs among what could become an emerging generation of smokers. According to the 2017 Minnesota Youth Tobacco Survey, nearly one in five high school students reported having tried an e-cigarette over the previous 30 days. That was more than double the 9.6 percent who had tried cigarettes. Vaping was not supposed to create a generation of youth accustomed to concealable, higher-dose delivery systems for nicotine. Early vaping systems delivered 1 to 2.4 percent nicotine solutions, albeit accompanied by flavors that appealed to new users.
JUUL changed all that.
With the introduction in 2017 of the now-dominant brand — it resembles a USB stick and had 72 percent share of the market as of 2018 — vaping often delivers 5% nicotine, or twice the previous amount. Nicotine intake is normally self-regulated according to individual tolerance. JUUL, however, packages nicotine as salts, a preparation some believe diminishes the harshness of the addictive drug, thereby easing greater intake.
The only E-cig that pairs an addictive drug with the generation's beloved electronics aesthetic, JUUL also supplies nicotine in large supply. A cartridge of JUUL delivers as many puffs as 20 cigarettes. Experts say this means the brand has the potential, should the appeal of sucking on a data fob ever become diminished and the ordinary cigarette return to favor, to produce waves of pack-a-day smokers.
"It was envisioned that they could be attractive to smokers to use in places where they could not smoke," says Hays. E-cigarettes are often seen as an adjunct for those hoping to quit, moreover, though there is no data showing the products do any such thing. To the contrary, popular E-cigarette brands are funded by major tobacco companies, suggesting cigarette makers anticipate a back end to the on-boarding of millions of new nicotine addicts now underway. "Phillip Morris owner Altria owns a 35 percent stake in JUUL," says Hays. "They are not champions of public health."
What the products mean for health is unknown. Though manufacturers make no such claims, e-cigarettes are perceived as free of health-damaging and socially unwelcome byproducts of combustion. "Nicotine in itself appears to be safe," says Hays, although addictive. Some research suggests adolescents are more susceptible to becoming addicted to nicotine than are adults, and in some cases on as little as two cigarettes a day. According to the CDC, vaping exposes bystanders to this nicotine.
Vaping also releases small quantities of the metals nickel and lead, volatile organic compounds, and formaldehyde. As for the social consequences of the vapor, as anyone who has ever spent time in a confined space with others who were vaping knows, the aerosolized nicotine can leave a detectable scent on clothes and even objects. The long term health effects of this exposure are unknown.
"It's a natural experiment that we do not know the outcome," says Hays. "We did that in the 1920's and 1930s with cigarettes, and 20 years later saw lung cancer rates skyrocket. We'd like to not replay that scenario with e-cigarettes.
"We don't want to reverse changes in social norms if vaping becomes something that's just acceptable."