E-cigarettes stoke angst on second-hand smoke

The burgeoning electronic cigarette industry is reigniting concerns over second-hand smoke, prompting a major public health organization to call for restrictions on where the products can be used as part of a looming regulatory crackdown.

E-cigarette policy recommendations issued Monday by the American Heart Association largely echo proposals from other groups and lawmakers: a prohibition on sales to minors, a ban on certain kid-friendly flavoring and a halt to various marketing practices.

In addition to urging federal regulators to take those steps, the association is calling for a state-by-state reassessment of existing laws to limit the danger of second-hand smoke.

Smoking, for instance, in restaurants, bars and at sporting events is prohibited in many states, but e-cigarettes, which produce a nicotine vapor instead of smoke and tar, are generally allowed.

The heart association acknowledges in its recommendations that the toxic substances in e-cigarettes are lower than those in cigarette smoke, but argues that non-smokers could still be exposed to unwanted nicotine in confined spaces.

“Unregulated e-cigarettes could potentially turn back the clock to the days when smoking in public was normal behavior, undoing years of work on smoke-free laws and hampering current enforcement,” the group charges.

At the same time, the association argues that clinicians should not discourage certain smokers looking to use electronic cigarettes to help them quit.

There is currently no federally recognized research indicating that e-cigarettes can be used as a cessation tool, and manufacturers are prohibited as marketing them as such.

However, the heart association points to some emerging studies that suggest that e-cigarettes might work as well or even slightly better than nicotine patches in helping smokers to quit.

“The association will continue to encourage clinicians to use proven smoking-cessation strategies as the first line of treatment for any patient,” the group said. “But … when repeated efforts with conventional treatment fails, is intolerant, or rejected by a patient who wants to utilize e-cigarettes to help them quit, clinicians should not discourage their use by the patient.”

The Food and Drug Administration proposed in April to bring the unregulated, $1 billion-plus e-cigarette industry under its supervision. A comment period that closed this month attracted more than 70,000 submissions.

The association’s recommendations come as the agency pores over those comments and faces additional pressure from public health groups and congressional Democrats to issue an aggressive final rule.