WINSTON-SALEM, N.C. — A familiar puff of smoke is resurfacing inside some Triad restaurants, bars and entertainment venues.
It’s coming from electronic cigarettes, battery-powered devices that heat a liquid nicotine solution in a disposable cartridge and create a vapor that is inhaled.
They produce a vapor that dissipates quicker than the smoke produced by a traditional cigarette and — depending on the sensitivity of one’s nose — has a more limited in-your-face presence.
The popularity of e-cigs is surging. Analyst Bonnie Herzog of Wells Fargo Securities estimated there was $2 billion in overall e-cig revenue last year. She projects up to $10 billion a year by 2017.
Several states, including North Carolina, and large cities have moved to ban the purchase of e-cigs by minors. Some states, such as New Jersey and North Dakota, have established, or are pursuing, a complete ban in public venues.
A gray area has emerged in North Carolina about where — or if — their use is restricted.
There is an important distinction between a venue being tobacco-free, which covers electronic cigarettes, and being smokefree, which doesn’t.
“If a public venue is considered tobacco-free, then electronic cigarettes are prohibited,” said Beth Lovette, health director for the Appalachian District Health Department. State law views e-cigs as a tobacco product.
“However; managers and/or owners of smoke-free venues can choose to restrict/prohibit the use of electronic cigarettes. Electronic cigarettes may be prohibited if a venue revises their smoke-free policy to explicitly include electronic cigarettes.”
Eliminating some of the uncertainty are vaping lounges. Vaping is inhaling the vapor — or “smoking” —e-cigs. Vaping lounges are sprouting up across North Carolina, including in the Triad, as people look for alternatives to smoking cigarettes with the smoking ban in place.
“I’ve not had one single call from a restaurant or the public about electronic cigarette use,” said Lynn Minges, president and chief executive of the N.C. Restaurant and Lodging Association.
“There are still a lot of questions about these products and their standards and safety. There seems to be more we don’t know than we do.”
Where does it fit?
Michael Moore, who uses traditional cigarettes and e-cigs, says he has not attempted to smoke an e-cig in a public setting, although he said he might “because I don’t like being told where I can or can’t use a legal product.”
Moore said he prefers traditional cigarettes for the smoking experience, but said he likes the variety of liquid flavors that the e-cigs offer.
When asked why he continues to smoke traditional cigarettes when there may be a less harmful alternative, Moore said “it’s just a habit. I know what’s in cigarettes. I like to smoke and I am not trying to quit.”
Some venues, including those that were smoking havens before the 2010 public smoking ban went into effect, have responded by taking the equivalent of the “no shoes, no shirt, no service” approach to e-cigs.
“I have done some research into this matter with the larger chain restaurants in Surry County, and each one I spoke with said they prohibit the use,” said Samantha Ange, health director for the Surry County Health and Nutrition Center.
Other venues are allowing customers to use e-cigs indoors, although they say just a limited number are taking advantage.
John Ioannou, the owner of the Omega House restaurant in Winston-Salem, said he has seen “a couple of people ask to use e-cigs. There have been no complaints from other customers.”
Lea Thullberry, general manager of Finnigan’s Wake on Trade Street, said she has not had patrons complain about whether they can smoke an e-cig in her establishment, or why someone is being allowed to use them indoors.
“For right now, we’re not promoting the use of e-cigs and not prohibiting them,” Thullberry said. “We have no stance beyond what the law says is permissible.”
Thullberry said that e-cigs “can be confusing when it’s dark, but it’s rare that we’ve had someone use one indoors.”
“We have three distinct types of customers — the Sunday brunch, the 6 to 9 p.m. dinner crowd and the late-night crowd, so if there was demand to use e-cigs indoors, we likely would have to set three different policies,” she said.
Colby Kirk, general manager of Recreation Billiards in downtown Winston-Salem, said he may have 10 patrons, out of an average of 450 to 500, smoke an e-cig throughout the course of a busy Friday or Saturday night.
“We’ve allowed e-cigs indoors here about as long as when they began to become popular,” Kirk said. “I really haven’t received complaints from other patrons about a smell, in part because some people are just in the habit of going outside to smoke.
“There are a lot of people in this town trying to quit smoking, and some are turning to e-cigs.”
Kirk said his business has gained customers since the smoking ban went into effect.
“There were some people quite upset by the ban, but it seemed to go away pretty quickly,” he said.
There is no shortage of opinions about the potential harm or benefit from e-cigs as the industry, advocacy groups and consumers wait for the Food and Drug Administration to decide how it will regulate e-cigs for product safety, minimum legal age for use, flavors, marketing and retail availability.
The FDA has been studying potential regulations since 2009. A draft was submitted to the U.S. Office of Management and Budget in December. Congress must approve the regulations in order to give FDA authority to enforce them.
Anti-tobacco advocates pushing for the ban of online e-cigs sales say it is necessary to keep the products out of the hands of minors. Some consider e-cigs — as well as smokeless tobacco and dissolvable tobacco products — as potential gateways to traditional cigarettes.
Others believe that e-cigs might be slightly more effective than nicotine patches in helping people quit smoking.
Bill Godshall, an industry analyst and executive director of SmokeFree Pennsylvania, has said he is concerned that the FDA may try to ban e-cigs in what he considers a “misguided attempt to apply the quit-or-die approach to all tobacco products.”
“The marketplace is getting more and more competitive,” said Scott Ballin, past chairman of the Coalition on Smoking or Health. “I don’t like some of the aggressive tactics being taken, but FDA still can’t come up with something to have a serious discussion. Until then, I guess a little of the Wild West exists.”
John Spangler. a professor of family and community medicine at the Wake Forest University School of Medicine, said there is “likely not a large immediate second-hand effect of electronic-cigarette vapor.”
“The amount dispersed into the air comes only from the person vaping. Much of the nicotine has already been absorbed in the person’s lung. Also, there is no side stream vapor, whereas with cigarettes, a lot of the most toxic smoke is the nonfiltered smoke from the burning cigarette end.
“Having said that, we do not know what will eventually happen to the nicotine that settles in the environment.”
N.C. Rep. Donny Lambeth, R-Forsyth, said he does not “get the sense” that addressing e-cig use in public venues is a legislative priority for the forthcoming short session, but potentially for the long session in 2015.
“There has been and will continue to be some discussions related to e-cigs,” Lambeth said.
Forsyth and Wake Forest Baptist medical centers prohibit the use of tobacco products — which includes e-cigs — on their campuses. On most days, both hospitals have individuals huddled on the sidewalks just off campus where they smoke.
“This policy applies to staff, faculty, patients, volunteers, vendors, contractors, students, trainees and visitors,” Wake Forest Baptist spokesman Mac Ingraham said.
Novant Health Inc. spokeswoman Jeanne Mayer said the system “has made tremendous progress since going tobacco-free on its campuses, and the appearance of smoking may cause confusion.”
“For those who desire nicotine replacement, other options are available that do not have the appearance of smoking. We have not had significant complaints about this policy.”
Electronic cigarettes are prohibited inside the Greensboro Coliseum Complex facilities, said Andrew Brown, public relations manager for the complex. In September, the Greensboro complex signed a five-year deal with Wake Forest University to manage nonuniversity events at Joel Coliseum and the university’s athletics stadiums.
“Our facility conducted research when e-cigs were coming out, and the consensus we reached from other facility reviews was that the consumer does not know the difference between seeing someone with an e-cig versus someone with a regular cigarette, which causes a concern,” Brown said.
“There is a vapor that is emitted from an e-cig. The pin light, regardless of the color, is also on display and can be construed as a lighted cigarette in the dark. These are all distractions for patrons who are entering what has been determined and signed as a smokefree facility.
“Also, our event staff cannot spend valuable patron service time determining which smoking device someone is using.”
Brown said customer feedback has been that they “expect and appreciate this consistent approach.”