While the Food and Drug Administration proposes to regulate the sales, marketing and product quality of e-cigarettes, states and cities are moving forward with their own regulations to restrict e-cigarette exposure.

While the FDA already regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco, relatively new e-cigarettes are still under consideration. E-cigarettes deliver nicotine like cigarettes, but instead turn nicotine and other chemicals into an aerosol which is then inhaled.

The FDA proposal could include e-cigarette product warning labels and marketing restrictions and would be a step toward ending the completely unregulated e-cigarette marketplace.

“E-cigarettes contain uncontrolled and variable amounts of nicotine. At present, there’s no required testing of these products. There has been a rapid evolution of e-cigarette products being marketed, and stringent government regulation is necessary. It’s really buyer beware,” said Matt Myers, President of Tobacco-Free Kids, a Washington, D.C.-based anti-tobacco advocacy group.

Currently, there are also no federal restrictions on the way e-cigarettes are sold or national minimum age requirements.  The companies have an online presence and are on social media, increasing their access to young people. And e-cigarettes are sold in a way that is likely appealing to the youth market, including candy flavors, such as “cherry crush,” “java jolt” and “peach schnapps.”

While the FDA considers regulation, the agency is also trying to learn more about the products and their health impact. 

The FDA plans to hold a public workshop in December to discuss the devices’ design; potential risks and benefits of product characteristics; strategies to mitigate risk to users; methods for evaluating the products; and potential risks to the environment. 

The FDA intends to hold two additional workshops in the future focused on the impact of e-cigarettes on individual health and the population as a whole.

In 2009, the FDA banned candy and fruit flavors from traditional cigarettes, like clove, chocolate and vanilla, in an effort to deter young people from picking up the habit. Congress required FDA to determine what should be done about Menthol cigarettes.

Now, cigarette use is down among teens, but e-cigarette use is growing.

Fewer than 16 percent of high school students report that they smoked cigarettes, however, e-cigarette use appears to be on the rise, doubling among middle- and high school students from 3.3 percent in 2011 to 6.8 percent in 2012. E-cigarettes contain nicotine dissolved in a liquid that becomes an aerosol when heated, which the user inhales.

Meanwhile, states and cities are taking matters into their own hands. North Dakota, New Jersey and Utah prohibit e-cigarette use in workplaces, restaurants, and bars. And North Dakota doesn’t allow e-cigarette use at gambling sites. Arkansas prohibits the use of e-cigarettes on school district property. Colorado, Hawaii, Kansas and Maryland are among the states that have put varying restrictions on e-cigarettes.

Meanwhile, hundreds of cities, such as New York, Chicago and Los Angeles, include e-cigarettes in their prohibition on smoking in public places, private workplaces, restaurants and bars. Iowa City, Iowa, is one of the latest to consider banning e-cigarettes from being smoked on public property and private workplaces.

The American Heart Association considers e-cigarettes that contain nicotine to be tobacco products and supports regulation by states and cities under existing laws relating to the use and marketing of tobacco products.

Myers says that it’s likely more states and individual municipalities will seek to limit e-cigarette use and exposure by enacting regulations at the local level, such as limiting sales of e-cigarettes to only individuals age 18 and older and prohibiting e-cigarette use indoors or on public property.  Limiting sales to people 18 and older is also something the federal government could also address.

The AHA, the World Health Organization and the Campaign for Tobacco-Free Kids, continue to call for significant government regulation to restrict the sales and marketing of e-cigarettes, particularly to youth.

“The challenge is that the product that may be regulated one day could be different than the product that will be marketed tomorrow because there’s so much variability in how e-cigarettes are made,” says Myers. “By the time research has been published related to e-cigarettes, the product has already changed.

What is in e-cigarettes is unclear and may depend on the manufacturer, but what is known is that increased e-cigarette use has coincided with a rise in calls to poison centers. The Centers for Disease Control and Prevention recently reported that the number of calls to poison centers related to e-cigarettes increased from one per month in September 2011 to 215 per month in February 2014. More than half of the calls involved children under age 5, and about 42 percent of the calls involved adults age 20 and older.  How such studies and reports may affect federal or state regulation remains unclear.

The AHA has called for restrictions to e-cigarettes and scientific study of the impact of these products. AHA issued new policy recommendations in August urging strong regulations that would limit access as well as the sales and marketing of e-cigarettes to youth. The AHA also called for more research on the health impact of e-cigarettes.

“E-cigarettes have caused a major shift in the tobacco-control landscape,” said Aruni Bhatnagar, Ph.D. FAHA, lead author and professor of medicine at the University of Louisville. “It’s critical that we rigorously examine the long-term impact of this new technology on public health, cardiovascular disease and stroke, and pay careful attention to the effect of e-cigarettes on adolescents.”

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