SIOUX CITY | Paul Jensen puffed on a metal cylinder, sampling various flavors of e-juice – liquid nicotine – at Vi E-Cig and Vape Lounge on a recent Friday afternoon. Behind the counter, three workers exhaled clouds of vapor, filling the store with a fruit-scented haze.
They were smoking electronic cigarettes, battery-operated devices that deliver heated nicotine -- the dependency-causing drug in tobacco -- through vapor rather than smoke. The devices are flooding the market, with sales of $1.7 billion in 2013, according to bloomberg.com.
Although Iowa, Nebraska and South Dakota ban smoking in public places, none of those states has laws prohibiting vaping -- the common term for smoking e-cigarettes -- in public. Like most other states, they leave it up to businesses to set their own policy on whether to allow vaping.
Southern Hills Mall prohibits vaping except to test e-cigarettes at the Overstock Ecigs kiosk, said Laura Forbes, of the mall's public relations firm, Bandy Carroll Hellige. Mall management made the decision, Forbes said.
Some worry that vaping in public glamorizes smoking, a perception health and government officials have worked for decades to combat. Smoking is the leading risk factor for lung cancer and the No. 1 cause of preventable death and disease in the U.S., according to the national Centers for Disease Control and Prevention.
Smoking kills more than 480,000 Americans each year, and secondhand smoke causes more than 7,300 lung cancer deaths among U.S. nonsmokers each year, the CDC says.
Jensen, 58, of Sergeant Bluff, said that after 30 years as a pack-a-day cigarette smoker, e-cigs helped him kick his habit where nicotine patches and gum had failed. It was the hand-to-mouth motion and the sensation of inhaling that made the difference.
Jensen said he now can breathe better and no longer has a cough.
"You do have the nicotine, but you can cut back to slowly wean yourself off," Jensen said as he browsed the e-juice options at Vi E-Cig and Vape Lounge on Jan. 16.
HEALTH, MARKETING CONCERNS
Although billed as an alternative to smoking, the CDC and the U.S. Food and Drug Administration do not include e-cigarettes among smoking-cessation options.
In fact, vaping has raised health concerns of its own. Brian King, senior scientific adviser in the CDC’s Office on Smoking and Health, said e-cigarette emissions are not simply harmless vapor but can contain nicotine and other toxins.
“Exposure to nicotine can harm adolescent brain development and can be toxic to fetuses," King said in a statement in December. The standard for protecting the health of children and bystanders should be clean air, free of toxic secondhand smoke as well as ENDS (electronic nicotine delivery systems) aerosol.”
"We don’t know enough about e-cigarettes," said Becky Carlson, health educator for the Siouxland District Health Department. "So at this point we’re saying that since we don’t know enough it’s not a good idea to use them."
Studies show that some e-cig users also continue to smoke traditional cigarettes, Carlson said. She is also concerned about e-cigarette advertising that touts an array of e-juice flavors, such as chocolate, strawberry, cotton candy and coffee.
“Because of the types of flavors they have, it would seem as though it is being marketed towards kids,” Carlson said.
The percentage of U.S. middle and high school students who use e-cigarettes more than doubled from 2011 to 2012, according to CDC data.
“It has the potential to be a problem in that the flavors are made to taste good,” said John Truemper, assistant manager at Vi E-Cig and Vape Lounge. “But what that is going to take is strict adherence to the 18-and-over law.”
Iowa, South Dakota and Nebraska passed laws last year banning the sale and possession of e-cigarettes to minors under the age of 18 and requiring e-cig retailers to obtain a tobacco license. Of the three states, only South Dakota defines e-cigarettes as a tobacco product.
MORE REGULATION MAY COME
Tighter regulation is in the air, as the FDA proposed a rule in April that, if approved, would define e-cigarettes as a tobacco product because their nicotine is derived from tobacco. The FDA regulates the sale and distribution of tobacco products. The new rule would require a pre-market review and approval of e-cigarette products by the agency.
Spokewoman Jennifer Haliski said the FDA is reviewing public comments and research about the proposed regulations before making a final decision.
Retailers worry that federal regulation will lead states to ban vaping in public, a move Patrick Gill, owner of Madhouse Vapor in Sioux City, said isn't warranted. Gill said there has been enough preliminary research to prove that secondhand vapor isn't harmful.
“Banning vaping in public would be an irresponsible policy for the state to pass,” Gill said. “For the state to jump the gun it would be showing a disregard for established research.”
Truemper said self-regulation by businesses and common courtesy are the best policies.
“We encourage people to use basic politeness,” Truemper said. “If you’re in a restaurant, ask one of the waitresses or a manager if they mind (vaping). If you’re in somebody’s car, ask them if they mind.”
The Associated Press contributed to this report.