By Jane Hoback

Meet Bob. The 17-year-old Denver high school senior represents a prime target market for the booming e-cigarette industry.

Bob and his friends use e-cigarettes when they’re hanging out after school and on weekends. Kids who own the electronic devices, known as vapes, pass them around to their friends.

“Whenever we hang out in groups, the vapes start to come out and everybody shares them,” said Bob, who asked that his name not be used to protect his privacy. “It’s something extra to be doing while you’re hanging out. There’s a social aspect to it. And people enjoy the nicotine.”

Use of electronic cigarettes – called vaping – among middle school and high school students tripled from 2013 to 2014, according to a study released in April by the Centers for Disease Control and Prevention.

The data show that e-cigarette use among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from 660,000 to 2 million students. Use by middle school students rose from 1.1 percent in 2013 to 3.9 percent in 2014, from 120,000 to 450,000 students.

The CDC also reported that from 2011 to 2014, cigarette smoking among high school students fell from 15.8 percent to 9.2 percent.

“We want parents to know that nicotine is dangerous for kids at any age,” said Dr. Tom Frieden, the CDC’s director. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction and lead to sustained tobacco use.”

A 2013 study by the Colorado Department of Public Health and Environment, the agency’s first look at e-cigarette use by high school students, showed that 15 percent of Colorado high school students had tried e-cigarettes. The Colorado study also reported that cigarette use among high school students was 10.7 percent, down from 11.9 percent in 2008, which is not considered statistically significant.

Jill Bednarek, head of state and community tobacco policy initiatives at the CDPHE, said the 2015 study will contain more detailed data about e-cigarette use among teens.

The increase in e-cigarette use has sparked calls for federal regulation of the products from a number of medical and health groups, and the Food and Drug Administration has proposed rules it hopes to make final this summer.

But e-cigarette organizations and even some health groups say there’s no evidence that e-cigarettes are harmful or that they are a gateway to cigarette smoking. And they argue that the devices can be an effective way to stop smoking cigarettes as well.

“The data is clear. As teen experimentation with vaping has grown over the last three years, youth smoking has experienced the largest decline in the history of the (CDC) survey,” said Gregory Conley, president of the American Vaping Association. “This dramatic fall in teen smoking should be part of the conversation.

“While no vaping or smoking by teens is obviously the ideal, we do not live in a perfect world,” Conley said. “There remains no evidence that e-cigarettes are acting as gateway products for youth.”

E-cigarettes were introduced to the U.S. market in 2007. Today, more than 450 products are on the market, and sales are expected to top $10 billion by 2017. The most basic devices consist of a battery that powers a heater, an atomizer and a cartridge that contains various amounts of tobacco-based nicotine as well as flavoring. The vaporized nicotine is combined with propylene glycol, which the user inhales and exhales.

Bob said neither he nor many of his other friends own vapes, which can start at about $75 and go up to about $200. “It can get pretty expensive,” he said. Among his friends who do own the devices “a lot of them are really into it. They know a lot about them and fix them up to work the way they want. They use all this terminology – a sort of lingo.”

He’s noticed a big increase in the number of people who vape over the last couple of years.

“Somebody would get a vape and wind up sharing it with their friends. Then other people will buy them and share them. They’re becoming much more popular among different groups,” Bob said. The people he knows who vape range from those who vape “all the time” to others – and he includes himself in this group – who only vape once in a while.

Bob said cigarette smoking among most of his friends “is pretty rare. I’m definitely put off by the smell of cigarettes and I think a lot of my friends are, too. It’s pretty gross. The smell of vapes is much more appealing. There are flavors like watermelon and mango. It’s almost like coming up with the flavors for Dum Dum lollipops. A lot of kids have their own special blends. Everybody seems to have their own preference.”

He did say while some of his friends both smoke cigarettes and vape, most see vaping as “less harmful than cigarettes. The nicotine gives you a nice buzz for a short time, but I don’t think anyone I know is addicted.”

Potentially harmful chemicals

On the other hand, he said he has read about studies that show e-cigarettes contain formaldehyde and other chemicals. “But they still seem less harmful than cigarettes.”

Researchers at the Johns Hopkins Bloomberg School of Public Health reported that the vapor can contain particulates, formaldehyde and organic compounds as well as free radicals known as toxins that are found in cigarette smoke and in air pollution, though at a much lower rate than in cigarettes.

A study published in December by researchers at National Jewish Health in Denver linked the liquid used in e-cigarettes to a higher risk of respiratory viral infections, whether the liquid contained nicotine or not. Researchers took cells from the airways of young healthy subjects who did not smoke cigarettes and exposed them to the vapors from e-cigarettes. The cells showed a strong inflammatory response and the risk of viral infection in the cells rose significantly, the researchers said.

But because e-cigarette use is new, there are few long-term studies about their effects. Previous studies have shown that teens become addicted to substances such as nicotine more quickly than adults.

“The primary concern is that we don’t have enough data to support the impacts – either long-term impacts or the cessation claims by the industry,” said Amy Lukowski, clinical director of health initiatives at National Jewish Health. “And it’s a risky situation to put a product where you really don’t have data in the hands of kids who are in critical brain development periods.”

The brain isn’t fully developed until the age of 25 and scientists say decision-making, impulse control and planning are among the last things to mature, making teens more susceptible to the effects of nicotine and other addictive substances. “So with e-cigarettes, they’re introducing a substance that is not regulated,” Lukowski said. “We don’t know what’s included. It’s the wild wild West out there right now.”

The American Lung Association pointed to studies showing a wide range of nicotine levels in e-cigarettes, chemicals including an ingredient used in antifreeze, and high levels of formaldehyde and benzene in various products.

It criticized what it called “aggressive industry marketing tactics targeted at youth – including the use of candy flavors and the glamorization of e-cigarette use.”

The lung association is among 31 medical and health organizations that sent a letter to President Barack Obama in April calling for the FDA to finalize rules proposed over a year ago to regulate e-cigarettes as well as several other tobacco products. The groups, including the American Heart Association, the American Academy of Pediatrics and the American Cancer Society Cancer Action Network, said the regulation is “long overdue. Further delays will only serve the interests of the tobacco companies which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.”

Tobacco giants Lorillard, Phillip Morris, Reynolds American and Altria all have launched e-cigarette brands.

A study by North Carolina-based nonprofit research group RTI International showed that youth exposure to television advertising for e-cigarettes jumped more than 250 percent from 2011 to 2013. More than 80 percent of the ads in 2013 were for a single brand: blu eCigs, owned by Lorillard.

Still no federal regulations

In April 2014, the FDA proposed a rule that would extend its authority to regulate additional tobacco products including e-cigarettes. As with cigarettes now, e-cigarettes and other new products would be required to register with the FDA and submit product and ingredient listings, adhere to minimum age restrictions to prevent sales to underage youth, include health warning labels, not distribute free samples or sell in vending machines, and only market products after FDA review.

The agency has held a series of public workshops concluding with one in June and has been accepting public comment on the issue. It plans to make the rules final by this summer.

“The FDA remains concerned about the significant increase in e-cigarette usage among youth,” said FDA spokesman Michael Felberbaum. “The agency is committed to moving forward expeditiously to finalize the proposed rule. When finalized, the rule will represent a significant first step in the FDA’s ability to effectively regulate tobacco products and as we learn more about these products, the agency will have additional opportunities over the long term to make a positive difference in the public health burden of tobacco use in this country.”

The FDA said it currently supports more than 50 research projects addressing various aspects of e-cigarettes – from toxicity and addiction to marketing and cessation effectiveness.

While there currently are no federal regulations, Colorado and other states have banned the sale of e-cigarettes to anyone under 18. In addition, cities such as Greeley, Lakewood, Fort Collins, Edgewater, Louisville, Golden and Commerce City have banned e-cigarettes wherever cigarettes are prohibited. Denver does not prohibit their use, although they are not allowed at Denver International Airport.

“We don’t believe anybody should start smoking (e-cigarettes), especially young people. They are a nicotine delivery device,” said R.J. Ours, Colorado government relations director at the American Cancer Society Cancer Action Network. “We are very supportive of the laws that prohibit them.”

Ours said the agency has been working with local communities to get regulations on the books. The state legislature, on the other hand, is not considering any similar measures.

“It’s a matter of education,” Ours said. “We’re quantifying and qualifying the facts for the legislature.”

He said the society also is working with the state health department on education and outreach programs that use tobacco control grants. “We’re in a place where we do have some resources to work on these issues,” he said.

Despite the state law, Bob said his friends have no trouble buying the devices and cartridges at local vape shops, which are growing in number as the devices become more popular.

“Those places rarely card you,” Bob said. “And if they were to start carding, there would still be other resources.”

The devices also are available for sale at a variety of online sites.

Bednarek said the CDPHE is beginning to monitor compliance with the ban on sale to underage youth as well as encouraging more local communities to prohibit the devices. The department also is working on proposals for retail licensing of non-cigarette tobacco products.

For Bob and his friends, e-cigarettes are “definitely a mixed bag as to whether people think they’re dangerous. Some people say, ‘Well, it’s just not good for you,’ and others think it’s completely harmless. I think it’s somewhere in the middle: better than cigarettes but still not really good for you.”