A Cloud of Confusion

For Mandie Garrett, lighting up an e-cigarette “feels like being out on a really, really foggy day and breathing the air in.”

Garrett is an e-cigarette convert, one of thousands in Northeast Florida, who believes the smokeless devices are safer and less costly than cigarettes and can serve as a bridge to kicking a smoking habit. She switched to e-cigarettes about three years ago for health and financial concerns and has no plans to switch back.

“I enjoy it. I enjoy it more than smoking cigarettes. It’s definitely relaxing without the guilt of smoking cigarettes,” Garrett said.

E-cigarettes are electronic devices which use a battery and atomizer to produce a vapor that can be inhaled like regular cigarette smoke. They can be infused with nicotine, flavorings or other chemicals.

Those who use the cigarette-looking devices swear by them, claiming they have improved their health by cutting back on the use of deadlier cigarettes.

“It’s a healthier habit. There are no carcinogens or tar,” said Garrett, 32. “I also don’t get the nicotine crazies. If I need some nicotine, I just take one or two puffs on my e-cigarette.”

Cigarette smoking remains a public health disaster, causing an estimated 28,600 deaths in Florida each year and 438,000 deaths annually in the United States. The annual health cost in Florida directly caused by smoking is $6.32 billion a year, according to the Campaign for Tobacco-Free Kids.

Health officials are not convinced that e-cigarettes are as safe as users and manufacturing companies claim.

Dr. Gary M. Reisfield, an assistant professor in the Department of Psychiatry’s Division of Addiction Medicine at University of Florida College of Medicine, said in an email interview: “As a means for reducing tobacco-related harms, e-cigarettes hold some promise.

“They are more attractive to many smokers than existing nicotine replacement products. They are cheap, they mimic the cigarette experience and they deliver nicotine more quickly and sufficiently to the brain. Early evidence indicates that e-cigarettes decrease smoking desire and behavior, but we’re still lacking good quality outcomes data.”

Reisfield said he has concerns about e-cigarettes, including use of the products by nonsmokers as a starter product, potential overdose with the liquid nicotine products, and the short-term and long-term effects on the lungs and other organs by inhaling aerosolized toxins.

The U.S. Food & Drug Administration said e-cigarettes contain cancer-causing chemicals and toxins, and are largely untested.

“Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and novel tobacco products,” said FDA spokesperson Jennifer Haliski.

Due to few clinical studies, the FDA said consumers have no way of knowing what types of potentially harmful chemicals are found in e-cigarettes and how much nicotine users are inhaling with the products. Though many e-cigarettes are made in the United States, others come from China.

The American Lung Association also has misgivings about e-cigarettes. “If e-cigarettes sound too good to be true, that’s because they probably are. With a dearth of rigorous studies on their safety and effectiveness, experts are increasingly concerned that e-cigarettes may do little to help you stop smoking – and may actually do more harm than good,” it said in a release.

Tobacco Free Florida has also expressed concerns. “There is currently no scientific evidence to support that electronic cigarettes will help people quit smoking for good, and preliminary research from the Food & Drug Administration reveals that e-cigarettes contain toxic substances and carcinogens.

“Tobacco Free Florida also has concerns about electronic cigarettes utilizing candy flavors and the unique appeal these may have to young people,” it stated in a news release.

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Youth has always been a target of the tobacco industry, and our department will not sit by and watch,” stated Dr. John D. Armstrong, state of Florida surgeon general and secretary of health, in a news release about the use of candy-flavored tobacco products. “Companies perceive youth as an easy target and develop products like flavored tobacco and marketing campaigns aimed at them.”

Shane Johnson, who runs a company in Mandarin that produces flavored juices for e-cigarettes, disagrees and said, “I will not sell to anyone under 18.”

There is nothing harmful in his juices that are inhaled by users of e-cigarettes, he said.

“It’s basically glycerin, liquid nicotine and flavoring,” said Johnson, who runs fuZionvapor, an online business in Julington Creek, producing such flavors as “Endless Summer,” “Purple Pieman” and “Bob Marley Blood.”

With an e-cigarette, users can determine how much nicotine they want to inhale ranging from the maximum, which is 24 mg, down to zero, he said.

“Most people, when they start vaping, want to mimic the cigarette and a tobacco flavor,” he said, adding that they often switch to one of his candy-flavored concoctions.

“Vaping is significantly better than any kind of smoking,” he said.

Johnson expects to see the government try to regulate and tax e-cigarettes, which will make prices go up.

“The FDA is in cahoots with the medical community and Big Tobacco,” he said. “They don’t want vaping to become mainstream.”

That might already be happening, though. In April, the nation’s third-largest producer of cigarettes, Lorillard of Greensboro, N.C., which makes Newport, Kent, True, Maverick and Old Gold, acquired the assets of blu ecigs, an electronic cigarette company based in Charlotte, for $135 million in cash.

“blu ecigs is the best-selling e-cigarette brand, with the look and feel of traditional cigarettes — without the tobacco smoke, ash or smell,” the company said in a statement.

An estimated 2.5 million users spend about $300 million a year on e-cigarettes, stated the Tobacco Vapor Electronic Cigarette Association.

One claim by those who support e-cigarettes is that they can be smoked anywhere, because there’s no flame or smoke. Despite that, they are still banned in many places, creating a patchwork of confusing and inconsistent regulations on when and where e-cigarette users can “vape.”

In 2010, Susan Kurland, U.S. Department of Transportation’s assistant secretary of Aviation & International Affairs, testified in a Senate hearing: “Smoking of electronic cigarettes is already banned on U.S. air carrier and foreign air carrier flights in scheduled intrastate, interstate and foreign air transportation.”

Unlike tobacco products, e-cigarettes are permitted at Jacksonville International Airport and users can vape in the terminal, said JIA spokesperson Debbie Jones. They can be carried through security, but can’t be used aboard aircraft.

Carnival Cruise Lines tightened its policy on using both cigarettes and e-cigarettes on its ships last year, said Aly Bello-Cabreizia, a Carnival spokesperson. On some ships, e-cigarettes and tobacco are allowed only in jazz clubs and designated smoking areas.

As of Dec. 1, 2011, smoking and use of e-cigarettes is prohibited in all guest staterooms. Smoking is permitted outside on balconies. All spa suites and staterooms are entirely smoke-free on the ships Carnival Splendor, Carnival Dream, Carnival Magic and Carnival Breeze. Guests who smoke in staterooms are subject to a $250 cleaning charge.

The University of Florida bans both tobacco and e-cigarettes on its Gainesville campus and at health care facilities in Jacksonville and Gainesville.

However, neither Jacksonville University nor University of North Florida has a campus-wide smoking ban and e-cigarettes are allowed. There is no State University System policy.

Because of Florida’s indoor smoking laws, Johnson said those using e-cigarettes at restaurants and bars sometimes get a second or third look from the manager or a police officer.

“Security will ask. Police will ask. Soccer moms give me a hard time,” Johnson said. “I will not vape if someone is offended about it.”

“They produce a heavy, lingering cloud around your head. I don’t want to deliberately offend someone. I do try to respect peoples’ personal space,” he said.

Johnson took up vaping to try to kick his 18-year smoking habit. He wasn’t satisfied with many of the flavorings available, so he developed his own company to produce a wide variety of inhalable juice.

Many people using e-cigarettes are trying to overcome their smoking habit. Many have tried nicotine patches and nicotine gum, without success. When they’re able to give up cigarettes, “it gives me a warm, tingly feeling,” he said.

“I vape all day long. I enjoy it. It’s relaxing and enjoyable,” Johnson said, adding he has cut down by half the amount of nicotine he uses since he started vaping.

Damon Jones, 20, an employee of Smoke City in Orange Park, is also using an e-cigarette to kick his three-year-old smoking addiction.

“I was coughing up a lot of nasty stuff,” said Jones, who uses vapors without any nicotine. “I was really addicted to cigarettes.”

“It’s so much better than smoking. I don’t think I would have been able to quit without the e-cigarettes,” he said. “My lungs feel a lot better.”

“I don’t even have a craving for a cigarette any more,” said Jones, who admitted to liking some of the flavored varieties, such as strawberries-and-crème and mango.

Jones said he hasn’t had any trouble using e-cigarettes in restaurants or in public.

“You get looks. People are curious,” he said.

Garrett remains convinced that e-cigarettes have been good for her.

“I think they are fantastic. I hope many people tap into it,” Garrett said. “I smoked cigarettes because I enjoyed it. Anybody who smokes is physically addicted.” One of her favorite flavors is atomic fireball.

She has seen some health benefits from e-cigarettes.

“I wake up and I’m not hacking, not coughing. I don’t have phlegm in my throat,” she said. “I work out several times a week, and it doesn’t bother me.” She uses the 24 mg of nicotine.

She said she also looked into e-cigarettes because of the cost. “I was rolling my own cigarettes. I had to find a cheaper alternative,” she said. “It weaned me off of cigarettes.”

The devices are sold almost everywhere — convenience stores, mall kiosks, smoke shops and online. They range in price from just a few dollars to $150.

Once you get past the initial investment, it’s much less expensive to vape than smoke, Garrett said.

Jones said when he was smoking, two packs of cigarettes would cost him about $10 a day. Using the e-cigarettes, he spends about $20 every six weeks for his vaping chemicals.

Johnson remains convinced the e-cigarettes cause no harm. “The best thing is never having started to smoke, but these are the 100 percent alternative to smoking and quitting,” he said.

“My research shows my products are 100 percent safe. There are no chemicals, no dyes and no artificial ingredients. All the ingredients are FDA safe,” he said.

Jesse Dallery, a University of Florida Foundation research professor, said there is not enough information to determine whether the e-cigarette is safe.

“There is a lot we don’t know about e-cigarettes, so saying they are safe is definitely premature. They are probably safer than regular cigarettes, with an emphasis on probably,” Dallery said.

Lynnette Kennison, associate professor of Nursing at Jacksonville University and former chair of the Tobacco Free Jacksonville Coalition Inc., said there are too many questions for her to endorse the product.

“I have some concerns about it,” she said, including the lack of FDA regulation and the candy-flavored vapors.

“Are we bringing kids into it? Kids will try anything,” she said. “It is less harmful that smoking cigarettes — probably.”