By Rose Hoban
Usually, just a handful of people show up to meetings of the Orange County Board of Health, if they show up at all. But last week’s open meeting in Hillsborough on whether or not to include electronic cigarettes in the county’s ban on tobacco in restaurants, bars and public buildings drew several dozen people and provided emotional testimony both for and against the proposal.
The board heard, at times, emotional testimony from more than a dozen Orange County residents, along with a presentation on an online survey and a review of the science around e-cigarettes.
In the end, county Health Director Colleen Bridger chose to hold off on a decision, citing the incomplete science on e-cigarettes, until the U.S. Surgeon General publishes a long-awaited report sometime later this year.
“I’d really like our government to come out and say something before putting my board out on a limb,” Bridger said.
Bridger also cited her concern that in the wake of the General Assembly’s controversial decision to preempt a Charlotte city ordinance on the use of bathrooms by transgender people, lawmakers in Raleigh might also move to preempt her board if they moved to put e-cigarettes under the county’s bar and restaurant tobacco ban.
“I don’t think we do anything without worrying about the legislature coming in and preempting us,” she said.
It’s happened before
There’s precedent for legislative preemption of county smoking bans: That’s what happened in 1993, when Democrats still held sway in Raleigh.
Several municipalities in the state, Asheville among them, had moved to ban smoking from restaurants and bars. State legislators passed a law forbidding local governments from passing any smoking ordinances stricter than state law.
That ban was only overturned in 2009.
More recently, the state has been roiled in controversy over HB2, passed during a special session in March of this year. The law overturns a Charlotte city ordinance that would allow transgender people to use the bathroom of their choice, and also preempts municipalities from passing anti-discrimination laws that are stronger than a state standard.
The specter of HB2 was raised last week by several opponents of the proposed e-cigarette ban.
“Local boards making ordinances that deal with private business … is something I’ve heard a lot about recently,” said Jason Joyner, the lobbyist for the North Carolina Vaping Council. “I certainly would not like to see draconian-level policies come back from Raleigh because of a good faith effort made in Orange County.”
Harm reduction
Currently, state law classifies e-cigarettes as a tobacco product, which means the devices are forbidden in public schools, state and county buildings and vehicles and other state-run buildings, such as UNC athletic facilities, where tobacco products are banned.
While state law bans smoking in restaurants and bars, now it’s up to counties to decide whether or not to extend that ban to e-cigarettes.
More than 150 people had responded to a survey on whether or not to ban e-cigarettes in Orange County’s eating and drinking establishments. According to Bridger, more than 81 percent of those respondents supported the ban.
But Bridger said she’s sympathetic to people who have used e-cigarettes to wean themselves from smoking tobacco, a strategy known as harm reduction.
Many vapers have not weaned themselves from nicotine, which has negative health effects, but the harm-reduction argument holds that at least they’re not breathing in cancer-causing products of combustion, such as tar and soot, and are thus reducing negative health effects.
Most of those who testified in opposition to the proposed ban were vapers who have quit smoking. Several of them choked back tears as they told of smoking-related health problems for themselves and family members that have diminished now that they’re vaping.
“The day my mom died, I swore to her I’d quit. And now, two years later, I can say I’m smoke free,” said Amy Stevens. “If you can’t smoke in restaurants and bars, it won’t devastate me, I’ll continue to vape.
“But if there is a place I can go and they say, ‘Yes, we have these four tables over here where we’ll allow you to do it,’ that will be a place where I will go. That’s where I will take my husband on our date nights. It will allow us to go out and stay away from the smokers.”
Stevens’ husband, Ben, among others, testified that vaping had “saved my life.”
Emerging science
The science around vaping, however, is unclear. One thing that is clear is there has been a more than 880 percent increase in the number of North Carolina kids who have tried vaping since 2011.
But the U.S. has been slow to regulate the liquids used by vapers.
The contents of the liquids vary widely, complicating research. Rob Tarran, director of the Tobacco Center of Regulatory Science at UNC-Chapel Hill, told the board that his researchers have found e-cigarettes have “significantly different effects in the lung.”
“These changes appear consistent with immune compromise, so an increased chance of getting infections,” Tarran said.
Tarran also drew a comparison between the testing performed on medicines, such as asthma inhalers, and e-cigarettes, noting medications have to undergo “rigorous toxicology and clinical testing” before being released onto the market.
In contrast, the liquids used in e-cigarette devices have had none of this sort of scrutiny.
“Their effects for inhalation are largely unknown,” he said, both for people vaping and those around them.
It was this uncertainty that eventually won the evening.
“Because the science is new, because the science is emerging, because there’s lots of disagreement about the science, I would feel more comfortable if we looked at what the Surgeon General had to say about the science surrounding e-cigarette use,” Bridger told the board after all the presentations were done.
She reminded the board that the only thing they were allowed to consider in their decision-making process is the scientific evidence.
“Let some national vetting of this science occur before you take any action,” Bridger said.
Afterward, she reiterated her concerns about the state legislature overriding a board decision made on the basis of incomplete science.
“There is the risk of the General Assembly saying, ‘Well, they’re just being politicians and that’s not what they’re supposed to do, so we’re going to just abolish them,’” Bridger said.
“So that’s why we just want to be super, super safe on that.”
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