Clearing the smoke around teen e-cigarette use

No one says publicly that they want teens to start using e-cigarettes. Nor do most argue about statistics that show that youth have been flocking to this funky alternative to tobacco.

The controversy in many state legislatures centers on what to do about it.

Last year, for the first time, more U.S. teens used e-cigarettes than smoked, 17 percent vs. 14 percent, according to a University of Michigan study, making it clear that state-enforced age limits alone don't work.

Thus far, the Food and Drug Administration has opted not to act. So some states, including Indiana, are trying piecemeal solutions to keep vaping out of young hands, from increasing taxes to closer regulation of the industry.

In Indiana, an effort to tax the products went nowhere. A measure that would increase strictures of so-called vape shops is moving through the Indiana General Assembly right now. The question is whether it would produce the desired effect.

Vape shop owners argue they are not the problem and that too much regulation would only limit access for former smokers who have replaced their nicotine habit with vaping.

One shop owner told The Star he has no interest in the youth market. At the Indy Vapor Shop on the Westside, the first in Indiana, owner Mike Cline displays a sign announcing no sales to anyone under age 18 and rarely does one cross the threshold. In the five years his shop has been open, he's denied service to fewer than 10 teens because of age.

"Really I think the idea of minors trying to buy from vape shops is way overblown," Cline said. "We don't do sales to minors."

Someone, however, is selling to minors.

In 2013 more than a quarter of a million middle and high school students who had never smoked tried e-cigarettes, according to a Centers for Disease Control and Prevention study that appeared in August. That number had tripled since 2011.

Still, most students don't head to vape shops, many agree. Instead, they can pick them up at gas station convenience stores, raising health concerns.

Concerned about what we don't know

E-liquids in sweet flavors, such as candy cane or bubble gum, may draw youth, as will delivery systems that can resemble a variety of other products, such as video game controllers, pens or soda cans, said Earnest Davis, a tobacco health educator for the Marion County Public Health Department.

Some may not realize that when they partake, they're doing something akin to smoking.

"A lot of youth high schoolers that I talk to, say, 'I'm not smoking cigarettes; I'm just using a flavored e-juice,'" Davis said. "Right now, they're just in a wow factor…. It's one of the scarier things we're seeing, that everyone thinks it's cool."

Health officials say that they are particularly concerned not just with what we know about e-cigarettes but also about what we don't know.

E-cigarettes do not contain tobacco, but the liquids involved can contain a number of other products, including formaldehyde and metals such as nickel, lead and chromium, whose effect on health is not known, said Dr. Aasha Trowbridge, a family medicine physician with Franciscan St. Francis Health.

"What we do know is that e-cigarettes release chemicals; they're not harmless," said Trowbridge, also medical director of the Aspire Tobacco-Free Program. "We know enough to say that the products that are released with burning the liquid are certainly of concern."

Consuming nicotine in any form, including e-liquids, can be addictive and have detrimental effects on brain development, Trowbridge said.

What concerns Trowbridge most, however, is that many of her young patients tell her they have experimented with e-cigarettes, which suggests they may be more likely to start smoking.

The CDC study published earlier this year found that teens who had never smoked, but had vaped, were twice as willing to try conventional cigarettes.

"That is one of my greatest concerns; are we introducing a product that may not have been something a child would have looked at before and would now say, 'Hey let me try this,'" Trowbridge said. "It is a perfect gateway drug to conventional cigarettes…. We're giving our teenagers and youth one more way to be introduced to tobacco."

For some, a way to quit smoking

Supporters of vaping point to other research that suggests that teens who do experiment with e-cigarettes do not partake regularly. In addition, none of the studies has asked whether teens actually use nicotine products when they vape, said Gregory Conley, president of the American Vaping Association, based in New Jersey.

The fruity flavors may sound designed to appeal to teens, but they also have adult fans, said Conley, who credits a watermelon-flavored vapor product with his own success quitting tobacco. He cites studies that show that 60 to 70 percent of adult vapers use fruity or sweet flavors.

Cline, who opened his own vape shop six years ago, claims vaping has helped many a smoker kick that bad habit. Cline said he has not smoked conventional cigarettes since he started vaping. Over time, he's gradually weaned down the nicotine strength of what he vapes.

While Cline said he's not averse to some tweaks to the law to protect minors and other consumers, he's wary of going too far.

"We're trying to reach a level that we as an industry can comply with and support and at the same time protect the consumer," he said. "We do believe that regulation is both needed and necessary, we just don't want to be regulated to the point where we can't do business."

'I see it as very similar to cigarettes'

In Indiana, only the bill increasing regulations on the industry progressed. It would give the state the ability to check whether stores sell to minors.

Attorney General Greg Zoeller at the start of this legislative session had proposed a number of measures, including taxing the products and including e-cigarettes in the state's smoking ban.

Tobacco's history and the lack of solid data on the health effects of e-cigarettes prompted him to call for the actions on e-cigarettes, Zoeller said.

"Frankly I see it as very similar to cigarettes in the past," he said. "I do think that these things should not be seen as socially acceptable. There's unknown risks here."

Health officials like Davis agree that it would be a shame if e-cigarette use continues to rise among teens at the same time as conventional cigarette use finally falls.

"We worked so hard to eradicate the use of traditional cigarettes among youth, just to have it replaced by something else," he said.

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.