After over ten years of being a pack-a-day smoker, with multiple detours to try to quit, Sam Rogers had finally decided to give a non-traditional method one more try. He committed to a device that is increasing in popularity every day: the electronic cigarette.
These devices, otherwise called e-cigarettes, e-cigs or “vapes,” use a small mechanism called an atomizer that heats nicotine-induced water. The end result is a cloud of vapor that can be inhaled to mimic the act of smoking. For Sam, this mimicked the action that kept bringing him back to the habit.
“The fact you can hear it vaporizing, the fact that you can actually exhale something, those were the big things,” Rogers said. “Frankly, I enjoyed smoking more, but of course I wanted to quit. The benefit of quitting was the kind of thing that pushed me over a little more.”
Although some say that electronic cigarettes cannot be used as smoking cessation devices, others like Sam are proving them to be useful. These supporters claim that they provide the simulated act of smoking to help steer them away from the habit.
Sam began the journey with a simple goal, to at least slow down his smoking habits. He had tried the method in the past and knew that this would be the most manageable route for him. For the first two to three weeks, he would use his electronic cigarette, while smoking every once in a while to keep his sanity. Sure enough, the amount of cigarettes he was smoking dramatically decreased. Eventually he began to notice that tobacco smoke tasted terrible compared to the wide array of flavors that were now available to his convenience. It was that moment when he switched Parliament Lights for strawberries and cream.
Only two days after switching over, Sam began to notice the health benefits. His breathing was improved; he would no longer lose his breath from simple tasks like running a load of laundry. His sense of smell, however, reunited with him in a rather unpleasant manner.
“Within two days I could smell that my car smelled terrible inside from smoking in it for four years,” he said. “You also notice that all your clothes smell like cigarettes, even after washing them.”
Sam experienced mental changes as well. Along with getting rid of the initial burden associated with quitting, he could sleep better now.
“I account a lot of that to the fact that I’m just not smoking anymore,” he said. “Mentally, I am just happier, more proud of myself for doing it.”
The nicotine-induced water, or “e-juice”, is measured milligrams per milliliter of fluid, the highest being 24mg. As a one-pack-a-day smoker, Sam started with 12mg, with the intention of gradually lowering that number and eventually stopping altogether. His plan was to deal with the nicotine addiction alone first, then deal with the physical habit.
“My conclusion from it, similar to a lot of other people, is if you try to quit smoking, you are physically cutting back and dealing with the addiction at the same time,” he said. “A lot of times it’s kind of biting off more than you can chew.”
As they have entered the mainstream, electronic cigarettes sparked a debate. While many believe that they can work as smoking cessation products, others have their doubts. Pamela Clark, research professor at the University of Maryland, College Park, has given careful attention to the topic. With a Ph.D. in Epidemiology and Master of Science in Public Health and Bachelor of Science in Nursing Degrees, she has performed extensive research in the area of alternative tobacco products. She recently expanded her interests toward electronic cigarettes.
So far with her research, Professor Clark has seen that electronic cigarettes can give the same health benefits as traditional smoking cessation techniques.
“It’s the same,” said Clark. “They don’t burn carbon products, therefore they are safer than regular cigarettes. It’s the same as using a patch or anything else. They are a cleaner form of nicotine.” She also says that the nicotine count is also fairly low, about half of what is found in a traditional cigarette.
However, Clark has seen that most people are not using electronic cigarettes to quit smoking. In a study of 25 heavy smokers over the age of 20, she found that only one participant was able to completely kick the habit by using the device. The rest either went back to smoking or ended up using both traditional and electronic cigarettes.
“People are usually using dual use right now. They’re not giving up cigarettes so much as they are substituting electronic cigarettes.”
Another issue that Clark has seen with the device is that it could once again popularize the act of smoking.
“One of the problems with e-cigarettes is that it’s being shown on television. It’s being normalized again. It could actually take over where we left off back in the 70s. There’s a possibility that, within a decade, they will be more popular than regular cigarettes.”
This could be due to how many electronic cigarettes are marketed. Many skeptics claim that they are being marketed as an interesting new habit rather than a method to quit smoking. There is also the issue of how the variety of flavors appeals to the younger crowd.
“Even the big companies are taking a page out of the standard tobacco playbook by bringing in celebrities and present them as cool, something you want to do in a nightclub, something that is very grown up,” said Dave Dobbins, the chief operating officer of Legacy For Health, a non profit organization that specializes in tobacco research and outreach.
Dobbins said that for electronic cigarettes to be declared smoking cessation products, they would need to be marketed that way. In order to do so, they would need approval from the Food and Drug Administration through what is called a modified risk tobacco product application.
“I would strongly encourage them to do that, because it would force the FDA to begin a really careful examination of the population-based health effect,” Dobbins said.
“We want to see a world where, if the e-cigarette exists, it’s primary purpose is to eliminate the 20-pack, convenience store cigarette,” he said. “It’s killing people by the hundreds of thousands every year.”
Sam began smoking like many others have: young and curious. He was 17 years old when he had his first cigarette. After successfully buying a pack of Marlboro Reds for his friend, Sam decided to light one up and give it a try.
“I just found it very interesting,” he said. “I thought that it would be something that I would enjoy, and I really did enjoy it.”
Around the same time, Sam began to notice that everyone around him had started to smoke. His habit grew stronger as he experimented with different brands of cigarettes while bouncing between menthols, lights and bolds. Then before he knew it, he was hooked. A decade-long relationship with tobacco had begun.
Sam went through phases where he knew that he needed to quit. He tried the traditional methods like gum and patches with no success. Both experiences made him immediately go back to smoking within a few weeks. The gum tasted horrible; and the patches made him sick. He discovered that it wasn’t the nicotine fix that he needed to kick the habit.
“What I really liked about it was the physical aspect of it. That’s the part of it I was missing,” he said. “The nicotine is definitely a thing for me, but I’ve quit before at a week at a time or two weeks at a time. It was always that physical aspect that brought me back.”
Sam had never tried electronic cigarettes, until his mother bought him a starter kit as a Christmas present. It was a cartridge-style product, the type that resembles the appearance of a tobacco cigarette. It even had a light at the tip that glowed when activated. He was skeptical but gave it a try.
To his surprise, Sam actually enjoyed the strange new device. It helped cut down his smoking habit. The kit came with a variety of flavored cartridges, his favorite being vanilla and coffee. He didn’t care too much for the tobacco flavoring.
“The tobacco flavors to me last like dip or chew smells,” he said. “A cigarette flavor is ridiculously complex and doesn’t taste like anything else.”
Things were going great. The kit had lasted Sam around three months and his cigarette smoking decreased considerably. When he had a week worth of cartridges left, he decided to go online and order some more. The company shipped from Florida, but it took nearly a month for his order to show up. Once he ran out of cartridges, he returned to tobacco and was hooked again.
“It was working really, really well,” he said. “I got a bunch of momentum up with it, but after they took too long to ship, I lost all that momentum.”
Sam’s smoking continued for a few months until he was finally introduced to a tank-style electronic cigarette. They don’t resemble the appearance of a tobacco cigarette in any way, but they last longer and are open to a larger variety of flavors. The best part for Sam? The tank style could be purchased in local vapor shops, which had just started to make their appearance. This is what helped him quit smoking for good.
According to the Baltimore County Department of Health and Human Resources, the percentage of smokers in the county has dropped from 22 percent in 2000 to 15.6 percent in 2010. The percentages simply refer to the population of cigarette smokers, excluding alternative tobacco users. As a result, the mortality rates for smoking-related diseases dropped. Per 100,000 people, the mortality rate for lung and bronchus cancer dropped from 62.8 to 57.1. The rate for Heart Disease dropped from 250.1 to 201.1.
Smoking bans and an overall change in perception are two factors that have helped contribute to this drop. Since the last survey in 2010, this number has been on a steady decline. However, efforts by the Baltimore County Department of Health and Human Resources to change this perception have proved to be difficult in certain parts of the population.
“We’ve always been able to tell people smoking’s bad for you,” said Dave Goldman, director of Behavioral Health of the Baltimore County Department of Health and Human Resources. “We can look at the number of deaths from cancer and COPD (Chronic Obstructive Pulmonary Disease), but that still doesn’t stop folks from smoking. Nicotine is probably one of the most addictive drugs out there.”
One area of focus that the Department of Health and Resources has given careful attention to is the youth of Baltimore. According to Goldman, the number of tobacco product users under the age of 18 has been on an unpredictable slope in the last decade. Between 2000 and 2006, the number dropped from 21.6 percent to 16.1 percent. Then in 2008, it went back up to 18.8. Finally, in 2010 it was reported at 18.2.
“When people are exposed to it, they’re usually exposed young,” Goldman said. “We’re spending a great deal of time working with the younger people and they’re getting it. So I think were going to continue to see a decline as long as there’s not a new tobacco product out there to make a difference.”
Since electronic cigarettes are not tobacco products, there is no consensus to whether they have contributed to a decline in smokers or tobacco users. There is a lack in scientific studies to declare them as smoking cessation products, since they have only been around for a few years. However, health professionals like Goldman do see a potential in the devices.
“Coming from a pure, public health perspective, I would say that anything that reduces the use of tobacco products is probably a positive,” Goldman said. “Personally, if they are a way of getting someone from drawing down the tar and all the other carcinogens in tobacco, I’m into harm reduction.”
According to an article from Forbe’s magazine, a study published in the medical journal The Lancet showed that “e-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches…” Out of the 292 people who received electronic cigarettes, 21 of them were able to successfully quit smoking. Those who did not quit altogether were reported to have decreased their overall cigarette use.
It has been seven months since Sam has smoked a cigarette. Since he began using electronic cigarettes, Sam has dropped his nicotine level to 3mg, closing in on his goal to drop it to zero. Despite the pride of quitting and the overall health benefits, he will still be first in line to say that he misses tobacco cigarettes.
“All the time,” he says. “It’s like a third of my life that I did it. I have had a lot of memories while smoking a cigarette.”
Today, Sam is the store manager at Kahuna Vapor in Ellicott City, Md. The shop carries tank-style electronic cigarettes and boasts a collection of over 80 different flavors. Their main customer base ranges from people in their late-twenties to fifties looking for a way to quit smoking. Many customers come back to the store to thank the staff personally and talk about their achievements.
As manager, Sam is well aware of the debate over the electronic cigarette. It hasn’t impacted Kahuna Vapor’s business, but the possible ban is still a concern of Sam’s. He agrees that research should be done, but feels that in the meantime a ban is not the right course of action.
“What I would actually like to see is if they were going to do something, license the stores,” he said. “Then it keeps everyone above grade.”
Since Kahuna Vapor opened in December of 2013, Sam claims that only one minor has entered the store in an attempt to purchase something. He refused to sell the product to the “obviously 13-year-old” boy, who simply said “okay” and walked out the store.
“I’m 27 years old. I’m allowed to like butterscotch,” he said. “It’s the same thing with anything else,” He picked up a small bottle of a yellow-hued liquid. “Like strawberries and cream, this one, it’s delicious. Just because kids like the same flavor as adults doesn’t mean that we are targeting kids.”
Sam says that the goal of Kahuna Vapor is not to encourage the use of electronic cigarettes, but to steer people from smoking. He takes a note from his personal experience and urges customers to gradually quit electronic cigarettes by lowering the nicotine count.
“It’s kind of a weird industry because of that,” he said. “We actually want people to eventually stop using it. It will take people a while, but once you’re done, you’re done and it’s great.”