An alarming trend is rapidly emerging, fed by a smoke screen of misinformation, clever marketing ploys and widespread ignorance.
I'm referring to the growing use of electronic cigarettes by kids, a development that has health officials, educators and policy makers scrambling to catch up. One of their biggest tasks is to inform unwitting parents about the potential dangers of these insidious products and the possibility that their children might already be experimenting with them.
It's a tough battle, given the significant head start by makers and merchants of e-cigarettes. Although state law prohibits sales to kids, this emerging industry has become expert at targeting young people with slick advertising, links to technology and personalized products. The business has also benefited from a regulatory structure that has struggled to stay abreast of the fast-changing landscape.
It also doesn't help that some celebrities have given e-cigarettes lots of free publicity by touting them as a safe and easy way to kick the regular cigarette habit, a blithe championing of unfounded industry claims.
"We're running the risk of getting young people hooked on these products at an early age," said Stacy Deeble-Reynolds, a prevention coordinator at the Orange County Department of Education.
E-cigarettes are battery-operated devices that look like pens — they're sometimes called hookah pens — and give off vapor from heated liquid. Despite their benign appearance, they resemble regular cigarettes in that they're basically delivery systems for nicotine and other potentially harmful chemicals.
However, because their production is largely unregulated, e-cigarettes vary widely in dosage, and even those products touted as nicotine-free might contain traces of the drug.
Despite industry claims, there is no proof that the vapor from e-cigarettes is safe or that the electronic products can help people
Because the products are so new, no independent longitudinal studies are available yet to demonstrate the long-term effects of e-cigarette use, said Dr. Helene Calvet, deputy health officer at the Orange County Health Care Agency.
"Up until now, most of what people are hearing has been what the industry has been saying," she said.
But one fact is indisputable. Nicotine "is one of the most addictive" drugs, said Dr. Marc Lerner, the Orange County Department of Education's medical officer, who has been working with Deeble-Reynolds to get the word out about e-cigarette risks.
It's a big job. In August 2012, there were about two dozen so-called "vape" shops that specialize in e-cigarette products in all of Orange County, Deeble-Reynolds said. By last October, that number had mushroomed to more than 200, and industry advertising has ramped up significantly.
Many of these shops mix their own "e-juice" formulations with ingredients acquired from China and elsewhere, meaning there's no standardized level of nicotine or other toxins from one product to the next.
Meanwhile, research shows that use among youths is increasing rapidly.
A study by the federal
Deeble-Reynolds has visited many vape shops to conduct research, and what she's seen is disturbing. Although sales to minors are illegal, many products seem designed in a very calculated fashion to appeal to youths.
For example, they come in a wide variety of enticing flavors, many of which are instantly recognizable to kids, such as gummy bear, sweet and tart, and other candy-themed concoctions. Merchants also add to the attractiveness of e-cigarettes by offering ways users can customize them — for instance, adding the type of jeweled details that many girls use to accessorize their phones.
And the fact that these devices are electronic gives businesses opportunities to design crafty ways to tie them to other technology. E-cigarettes can be recharged by plugging them into phones and designed to buzz alerts when other e-cigarettes are near, thus encouraging social networking tied around the devices.
They can also be programmed to notify users when they are near e-cigarette retailers — an ingenious way to keep users hooked by reminding them that another fix is close by.
E-cigarettes are also easier to conceal than traditional cigarettes because they look like pens and don't burn. When I met with Deeble-Reynolds recently, she had just heard from a school counselor who had confiscated three of the devices the previous day. Yet it's likely that the majority are going undetected.
And she's continually dismayed by the misperceptions that prevail, as evidenced by a call she received from a mother who was considering buying her son an e-cigarette for Christmas.
Officials must also contend with a patchwork of inconsistent municipal ordinances and school district enforcement, and with keeping grant money available for ongoing educational efforts. Deeble-Reynolds is hoping that the widely followed California Healthy Kids Survey, which this year includes questions about e-cigarettes for the first time, will lend some weight to her efforts, which include an upcoming series of community seminars.
"We're trying to be proactive," she said. "I have the ability to push the information out."
It's time for the rest of us to pay attention.