TANEYTOWN -- The chatter of two customers, strangers a mere hour ago, filled Quality Vapor Source, as the pair discussed their affinity for electronic cigarettes. They gabbed as they puffed, vapor billowing from their lips.
The door opened, and two more customers walked into the small Taneytown store just off the city's main drag. Stationed behind his glass countertop, store owner Bob Large asked the females a standard question: Can I see your ID?
It's almost redundant, really, as a sign posted on his door states that minors can't enter without a parent or guardian. But protocol is protocol, and Large's rules for his electronic cigarette store are stricter than most.
Maryland law prohibits the sale of e-cigarettes to anyone under 18 years old. It says nothing about who can come in the store.
Yet, Large quickly spotted a trend, even though his business has only been open about seven months. Minors were coming in with their of-age friends, indicating items they wanted. Large nixed that.
He made a blanket policy: No one under the age of 18 is allowed inside unless accompanied by a parent or legal guardian. If it comes to the owner's attention that a person is purchasing e-liquids for minors, they will be permanently banned from the store, a sign on the door states.
The booming e-cigarette business, estimated by analysts to be worth $1.5 billion, has store owners, school officials, public health administrators and more grappling with how to regulate this newfangled industry.
Industry advocates say the device can serve as a smoking cessation tool. Opponents argue there are likely long-term health implications to using nicotine-laced e-liquid. And with research at a minimum, it's unclear how impending regulations can balance the two.
A store owner's worry
Bob Large grabbed his personal electronic cigarette on an April afternoon, motioning to the bottom of the device.
Turn it to the right, he said, and he'll intake more vapor from just one drag. Turn it to the left, and the amount decreases.
Large set his device to four volts -- a relatively low amount. He took a long drag and released. A plume of vapor poured out, colloquially called "vaping."
The battery-powered e-cigarette creates that vapor. The device converts liquid nicotine that comes in a variety of flavors -- from cinnamon bun to blue pomegranate to energy drink -- into a vapor, which the user inhales in the same fashion as a traditional cigarette. Yet, there's no actual smoke.
Large began using the devices in place of cigarettes two years ago. He wanted to quit, he said, but it wasn't easy. He vaped and smoked, vaped and smoked, back and forth.
And then something clicked. He stopped wanting cigarettes, and he hasn't had a drag of one in about six months.
"I can taste food again," he said. "I can walk a flight of stairs without being out of breath. I mean, I am so thankful that this industry exists because it was the only thing that worked for me. The patches, the inhalers, the pills -- none of that stuff worked."
The Quality Vapor Source owner filled his first e-cigarette with e-liquid containing 36 milligrams of nicotine, a concentration he's steadily decreased down to 18 mg. But he didn't need to start that high. That much nicotine, 36 mg, is just not necessary, he said, adding that's why he won't sell e-liquid containing more than 24 mg in his store.
"My biggest concern is anything that promotes us to put more nicotine in our system. I don't know that it's a good thing," he said, sitting inside his store, his personal e-cigarettes nearby. "I'm behind the industry 100 percent in the aspect that it helps people give up cigarettes, but whenever it's being used for recreation and fun, that's where we're going to have problems. I'm already seeing it here in my store."
His biggest concern lies with e-liquids that contain those high levels of nicotine -- and the younger generation that attempts to get its hands on those products. They might not be smoking cigarettes, Large said, but they could be heading for a "very, very big nicotine problem."
And he's not the only one with concerns.
Tightening the rules
S.S. Vape inside TownMall of Westminster now won't sell anything -- not even batteries or accessories -- to minors, according to store manager Tanya Kinser.
Last year, the Carroll County Board of Education approved a measure prohibiting these battery-powered devices in schools.
"We started seeing the e-cigarettes crop up. At first, they were genuinely students who were trying to quit smoking," said Dana Falls, director of student services. "We really tried to take a helpful approach to it, while at the same time saying these things don't belong in school."
An initial violation was less stringent than that of an actual cigarette. The product would be confiscated, a parent would be notified and the school system would recommend the student attend a tobacco education program on a voluntary basis.
Last school year ended with 28 e-cigarette violations. But when students returned in August, they were bolder, Falls said, and there have been 80 violations already this academic year.
"As time went on, we began to see more and more blatant offenses with e-cigarettes," Falls said. "Kids literally using them in the middle of class. Kids using them in the cafeteria, the hallway."
Administrators' feedback suggested these consequences weren't serving as a deterrent, and students weren't using them to quit smoking. But rather, e-cigarettes had become a quick nicotine fix during the school day, Falls said.
So, he revamped the policy, lumping e-cigarette regulations in with tobacco products. Next year, an initial violation will mean the student is required to attend a six-hour tobacco education program at the Carroll County Health Department. The class must be taken again for a second offense, and a third one could result in suspension for insubordination.
The health department Saturday session offers an in-depth look at tobacco and how it affects a person physically and financially. It's geared toward helping students realize that smoking is harmful and addictive, according to Barbara White, the health department's cigarette restitution fund program director.
E-cigarettes do crop up during the six-hour program. Students are handed a brochure listing facts about the devices with an introduction indicating there's controversy circling the industry.
"E-cigarettes are advertised as a safer cigarette. But is this really true?" the brochure asks. It then goes on to state several points: The nicotine in an e-cigarette is addictive. The chemicals in e-cigarettes may harm your health, though long-term effects are unknown. E-liquid comes in many flavors, some of which look like they're targeted at children.
The devices haven't been proven to be a safer alternative to smoking, the health department official will tell the students, and tobacco-free environments are banning e-cigarettes as well.
"We try and help them understand that it's a lot like smoking," White said, "and it can be limited just as much as smoking."
Latest Carroll County Times
The regulation dilemma
Though some shops and schools are enacting e-cigarette rules, the products aren't regulated federally. The U.S. Food and Drug Administration announced it will likely implement rules on the devices and is moving to release a proposal for public comment.
It plans to extend the agency's authority over "tobacco products" -- which are currently cigarettes, cigarette tobacco, smokeless tobacco and roll-your-own-tobacco -- to other items that could be considered a "tobacco product," according to FDA spokeswoman Jenny Haliski. A December 2010 decision by the U.S. Court of Appeals for the D.C. Circuit states that e-cigarettes can be regulated as "tobacco products" and are not drugs or devices unless marketed for therapeutic purposes.
The FDA cannot comment on when this will happen, but the proposed rule has been sent to a division within the Office of Management and Budget. Haliski added that further research is needed to assess potential public health benefits and risks.
That's because scientific conclusions are minimal on both accounts. But a new report by the University of California, San Francisco, suggests teens who use e-cigarettes are more likely to be current smokers, as they are to say they plan to quit smoking. Yet, they are less likely to have done so, according to Lauren Dutra, a postdoctoral fellow at UCSF's Center for Tobacco Control Research and Education.
"As much as people would like to argue that 'Oh, these are recreational products for adults,' it really seems like these companies are targeting kids," she said, "and we find that very disconcerting because nicotine is so addictive."
High school students who have tried an e-cigarette doubled from 4.7 percent in 2011 to 10 percent in 2012, according to a CDC report released in September. Nationwide, about 1.78 million middle and high school students have tried the devices.
There's a perception among some students that the product is cool, Dutra said. There's appealing flavors like gummy bears and bubblegum and Skittles. There's e-cigarettes with USB drives and ones that light up.
"I think there's a lot of [manufacturers] using the current generation's fascination with technology to sell them this product," Dutra said. "It's an attractive product, absolutely."
But there are those on the opposite end of the spectrum who say e-cigarettes are helping them avoid carcinogenic cigarettes. Some, like Brandon Smith, of Taneytown, have stopped smoking and are steadily decreasing their e-cigarette's nicotine level with the overall goal of inhaling nothing but flavoring.
"It's certainly tricky because we are seeing a new product that we really don't know much about," Dutra said. "As far as we know, yes, it's probably better for you than cigarettes, but it's probably worse for you than nothing."