Baltimore's City Council took a significant step in the right direction for public health when it voted to ban the use of e-cigarettes in most public places. Unfortunately, the final legislation, which Mayor Stephanie Rawlings-Blake signed last week, contains a giant loophole that could render the effort almost meaningless. A spokesman said she had reservations about the amendments but still considers the bill progress. It may be, but not enough. She needs to work with the council to enact a stronger version.
Much remains unknown about e-cigarettes, but it's already clear enough that manufacturers' claims that they are a healthier alternative to traditional cigarettes must be taken with a hefty dose of salt. When smokers burn tobacco in traditional cigarettes, they release a noxious mixture of toxic chemicals into the air and their lungs, producing what are by now extremely well documented risks to themselves and those unlucky enough to be in the vicinity. E-cigarettes, by contrast, heat up liquid containing nicotine and often other flavorings. Research is still in its infancy, but it generally indicates that the resulting vapor is less toxic than cigarette smoke.
But that doesn't mean e-cigarettes are safe. The Food and Drug Administration is currently deciding whether to regulate e-cigarettes, but at present, there are no controls on what chemicals e-cigarette cartridges contain. The vapor may be less toxic than smoke, but contrary to proponents' claims, it is also not as benign as water vapor. Most crucially it still contains nicotine, the highly addictive ingredient of tobacco smoke, which carries health risks of its own, particularly for children and adolescents.
Perhaps the most troubling thing about the rise of e-cigarettes is the extent to which they have become popular with young people. The Centers for Disease Control reported in 2013 that 6 percent of adults had tried e-cigarettes, but 6.8 percent of children in grades 6-12 had. Because the federal government doesn't regulate e-cigarettes like traditional ones, they are not subject to the same restrictions on marketing as tobacco products. They are also often flavored in ways that appeal to children — varieties include bubble gum and chocolate. E-cigarette proponents say the devices are a good way to get addicted smokers to quit, much in the same way as nicotine patches or gum, and the research on that question is mixed. But it's clear that the opposite is happening: Particularly for young people, e-cigarettes are a pathway to addiction and, disturbingly often, a gateway drug to smoking tobacco. A study published this year in the Journal of the American Medical Association found that middle and high school students who used e-cigarettes were more likely to smoke tobacco cigarettes and less likely to quit.
There are two good reasons for Baltimore (and, for that matter, other local governments) to extend public smoking restrictions to e-cigarettes. The first is to eliminate second-hand vapor. A crucial argument in the movement to ban smoking in bars, restaurants and elsewhere was that it put other patrons and workers at risk. The best that can be said of e-cigarettes is that we don't yet know how dangerous second-hand vapor may be. That's not very reassuring from a public health standpoint.
The second reason is that allowing e-cigarette use in the very places where we have just banned traditional cigarettes sends a mixed message about nicotine and smoking. One of the great public health triumphs of recent decades has been the reduction in smoking rates and, particularly, the reduction in young people who start smoking. Allowing e-cigarette use, or "vaping," as it is known, re-normalizes nicotine use, particularly in the eyes of young people who otherwise have not known a world in which smoking in bars and restaurants was allowed.
The trouble with the council's legislation is that it purports to ban public vaping but really does no such thing. Bars and restaurants can opt out provided they post prominent signs on the premises and their menus warning patrons, and Baltimore's Horseshoe Casino is similarly exempt. That sends a mixed message and leaves open the possibility that as e-cigarette use becomes more common, we will be right back where we started before indoor smoking bans. We can do better.