Resources: Articles

Covering the e-cigarette controversy Date: 06/11/15

Atlanta independent journalist Sonya Collins has carved a niche for herself covering the controversial world of e-cigarettes. Her feature, “When the Smoke Clears,” which appeared in Georgia State University Magazine was recognized by the Association of Health Care Journalists in the 2013 Awards for Excellence in Health Care Journalism. Attendees at Health Journalism 2015 might have heard her speak on the panel "Cutting Through the Haze of E-Cigarettes.”

Here, Collins offers some insights into how she researched and wrote that first big story and where her reporting has led her since. While there still is a lot that is unknown about the safety of these products and their use – often referred to as “vaping” – Collins shares some thoughts on how to craft informative stories about the evolving culture, research and regulations surrounding e-cigarettes.

By Sonya Collins

The first time I saw an e-cigarette, a guy sitting next to me at a neighborhood pub in Atlanta was taking a drag on one, and exhaling the most fragrant vapor that smelled of buttery cinnamon buns.

Not too long after that, I was asked to write a feature story on e-cigarettes for Georgia State University’s magazine. The school had a special interest in the topic because the U.S. Food and Drug Administration and the National Institutes of Health had named GSU one of 14 Tobacco Centers of Regulatory Science (TCORS). Led by Michael Eriksen, the dean of GSU’s college of public health, the center would research and ultimately advise the FDA on how “novel nicotine products,” including e-cigarettes, should be regulated.

My assignment was to write a story that would delve into e-cigarettes: what they are, who uses them, and whether they are a friend or foe in the tobacco control movement.

My reporting led me into a vape shop – where nicotine juice for e-cigarettes is made and sold, vaping devices are sold, and, most interestingly, vapers gather. Proponents of e-cigarettes say the devices are more effective smoking cessation devices than the patch or gum because you can vape socially, just like smoking. I found that vapers are even more social around their habit than smokers are. They meet and become friends because of their common vaping. Many of them are e-cigarette activists. They are outspoken on social media and travel to conferences and trade shows. VapeCon was held in Chattanooga, Tenn., last month. This subculture was the most interesting discovery of my reporting. Smokers-turned-vapers trade in their smoking-related friends, identity and paraphernalia for those of vapers.

I don’t see much news coverage about who vapers are. Coverage often focuses simply on whether vaping is harmful to our health, yet there isn’t much data on the health effects of e-cigarettes. We don’t have a fraction of the information on e-cigarettes that we have on tobacco cigarettes, and it will be a long time before we do.

Stories on the e-cigarettes can explore so much more than “are they good or bad?” and reveal the gray areas in the debate. Here are some issues to consider in your reporting on e-cigarettes:

Regulations

Public health professionals who oppose e-cigarettes often cite the lack of regulation, rather than their potential health effects, as a danger of e-cigarettes. Because e-cigarettes do not contain tobacco, they avoid the regulations imposed on tobacco products.

• Access & Exposure: Minors can buy e-cigarettes in some states, though most have taken action to ban sales to minors. Storeowners can display them in plain view of children. People can “vape” (e-cigarettes vaporize liquid nicotine, so it’s not called “smoking”) and see others vaping indoors in public spaces. E-cigarette manufacturers advertise on TV and use the same themes of sex, freedom and independence that cigarette makers once used.

• Formulation: Anyone anywhere can make and sell the flavored liquid nicotine, or “e-juice,” in an e-cigarette. The juice could contain contaminants and inconsistent levels of nicotine. E-juices come in many sweet flavors. Opponents say those flavors are intended to attract children and should be banned. Vapers say that the flavors help keep them away from tobacco. “Adults like flavors, too. If we have to make them taste like tobacco, that would just drive people back to cigarettes,” says Matt Wellman, owner of Steam Cigs, a vape shop in Lawrenceville, Georgia.

• Health claims: Many vapers say e-cigarettes helped them quit smoking completely. But e-cigarette makers cannot use that as a selling point because it is considered a “health claim.” Some people in favor of e-cigarettes say this regulation does a major disservice to the public. “You have a product that could help the public, and you’re not allowed to tell them what it does,” says Michael Siegel, M.D., a professor at Boston University School of Public Health.

• Taxes: Taxes have helped slow cigarette sales. E-cig opponents would like to see the same taxes on e-cigs. Some e-cig supporters, or at least those who want to wait and see if e-cigs prove to be a smoking cessation aid, propose a more modest tax. “I would like to see tax imposed on e-cigarettes only if the tax on cigarettes is much, much higher,” Kenneth Warner, PhD. And professor in the college of public health at University of Michigan, said during a recent Harvard Chan School of Public Health webinar on e-cigarettes. “We want to take e-cigarettes out of the (reach) of kids, but (allow) adult smokers to find these alternative products, relatively speaking, more attractive.”

What’s at stake with regulations?

FDA is gathering information from experts to help determine how it will regulate e-cigarettes. Major tobacco companies as well as small and medium independent businesses make and sell e-juice and vaping devices. Tobacco companies support regulation of e-cigarettes because – many assume – regulations could put independent e-cig makers out of business.

Big tobacco’s ties with e-cigs fuel many public health experts’ opposition to them.

“Opponents say we can’t work with them. They’ve manipulated us before and been found guilty of fraud,” Eriksen said.

Is it black and white?

In the recent Harvard webinar, Warner pointed out the need for a strong middle ground on e-cigarettes as opposed to the two diametrically opposed viewpoints we typically see. “On one side are the traditional forces of public health. They’re focused laser-like on the effects on kids, and they don’t seem to be thinking very much about the potential benefits for adult smokers,” he said. “On the other side, folks think this is the solution to all our problems, and it’s not that either.”

Warner is not alone in his position. Reporters can find physicians and public health professionals who recognize that while e-cigarettes should stay out of the hands of children, they reduce the harm of cigarettes and may have the potential to help people.

“It’s best to quit smoking completely, but 97 percent of people who try are unsuccessful,” Siegel said. “Everything that’s come before this focuses only on the pharmacological aspect of the addiction. This is the first product that also focuses on the behavioral aspect. The hand motion, the throat hit, the holding of the cigarette, even some of the social aspects. You can (vape) with others in a group.”

Some physicians support individual patients’ decision to try e-cigarettes as a cessation aid, even if they won’t recommend e-cigs across the board. Eriksen suggested e-cigs to his father-in-law, who was trying to quit smoking. But he doesn’t recommend them to the public as a safe alternative to smoking. “Getting nicotine without the smoke is good, but is it good enough? That’s what we need to find out.”

What do the data say?

Some data on vapers – such as number of people who tried an e-cigarette for the first time in the last 30 days – can be spun in more than one way. Is an increasing number inherently negative because more people are picking up a habit? Or is it inherently positive because it represents people who are kicking smoking in favor of e-cigarettes? Not all data break down the numbers to that level of detail. Look for studies that say whether new vapers are smokers or non-smokers; whether they are vaping in addition to smoking, in lieu of smoking, or as a way to cut back on smoking.

Hear vapers’ stories

Vapers are easy to find on social media. Many are very vocal about the purported benefits of e-cigarettes. A vaper commented on the e-cig commercial (linked above), “I moved onto something like those (e-cigarettes that are the same size and shape as tobacco cigarettes) about seven years ago, and they helped me almost entirely give up a 30-year smoking habit. I was down from 20 a day to just one or two a week. But when I graduated onto a tank mod (a device that holds more battery charge and more e-juice so you can vape more often and for longer without refilling or recharging) with a decent battery, I ditched cigarettes completely. I'll never smoke again. Anything that helps people get off cigarettes (and) onto vaping is a good thing even if you start with a cig-a-like (e-cig that looks like a regular cigarette).”

Vape shops can lead you to a community of people who believe that e-cigarettes saved their lives. Take the time to hear their stories. But know before you reach out that many vapers feel the media has vilified them and demonized the devices they believe have saved their lives. It might not be easy to earn their trust.

Additional resources

• Staunch e-cig opponent Stanton Glantz debates proponent Michael Siegel on WBUR.

• Michael Siegel’s blog.

• Stanton Glantz’s blog.

• Harvard Chan School of Public Health forum on e-cigarettes.

• FDA’s latest steps on the issue.

• National Institute on Drug Abuse: What is an e-cigarette?

• Most vapers don’t use devices that look like cigarettes because they need to be refilled and recharged often. Here are some other devices.

• Recent review paper on positive outcomes of switching from cigarettes to e-cigs.

• Recent study on positive outcomes when smokers with asthma switch to e-cigs.

Sonya Collins (@SonyaCollins) is an independent journalist covering health care, medicine, and biomedical research. She is a regular contributor to WebMD Magazine, WebMD.com, CURE, Genome, Pharmacy Today, and Yale Medicine. Her stories have also appeared in Scientific American, Georgia Health News, and publications served by the Georgia Public Health News Bureau.