“The technology and hardware is the same,” said Adam Querbach, head of sales and marketing for Romman Inc. of
Sales of e-hookahs have grown “exponentially” in the last 18 months, Mr. Querbach said.
Public health authorities worry that people are being drawn to products that intentionally avoid the term “e-cigarette.” Of particular concern is use among teenagers, many of whom appear to view e-cigarettes and e-hookahs as entirely different products when, for all practical purposes, they are often indistinguishable.
Indeed, public health officials warn that they may be misjudging the use of such products — whatever they are called — partly because of semantics. A survey by the
The C.D.C. is sending a tobacco-use survey to 20,000 students nationwide that asks about e-cigarette experimentation but does not identify the devices by other names. The state of
Brian King, senior adviser to the Office on Smoking and Health at the C.D.C., said the agency was aware of the language problem. “The use of hookah pens could lead us to underestimate overall use of nicotine-delivery devices,” he said. A similar problem occurred when certain
Other health officials are more blunt.
“Asking about e-cigarettes is a waste of time. Twelve months ago, that was the question to be asking,” said Janine Saunders, head of tobacco use prevention education in Alameda County in
In October, Ms. Saunders convened a student advisory board to discuss how to approach “e-cigs.” “They said: ‘What’s an e-cig?’ “ Ms. Saunders recalled, and she showed what she meant. “They said: ‘That’s a vape pen.’ “
Health officials worry that such views will lead to increased nicotine use and, possibly, prompt some people to graduate to cigarettes. The
The emergence of hookah pens and other products and nicknames seems to suggest the market is growing well beyond smokers. Ms. Zacks was among more than 300 Bay Area high school students who attended a conference focused on health issues last month on the campus of the
Ms. Zacks said the devices were popular at her high school here. “E-cigarettes are for people trying to
James Hennessey, a sophomore at Drake High School in San Anselmo, Calif., who has tried a hookah pen several times, said e-hookahs were less dangerous than e-cigarettes. He and several Drake students estimated that 60 percent of their classmates had tried the devices, that they could be purchased easily in local stores, and that they often were present at parties or when people were hanging out.
“E-cigarettes have nicotine and hookah pens just have water vapor and flavor,” said Andrew Hamilton, a senior from Drake.
Actually, it is possible for e-cigarettes or e-hookah devices to vary in nicotine content, and even to have no nicotine. Mr. Querbach at Romman said that 75 percent of the demand initially was for liquids with no nicotine, but that makers of the liquids were expanding their nicotine offerings. Often, nicotine is precisely the point, along with flavor.
Take, for example, the offerings of a store in
It is also possible to buy disposable versions, whether e-cigarettes or hookah pens, that vary in nicotine content and flavor. At King Kush, the Atmos ice lemonade-flavored disposable electronic portable hookah promises 0.6 percent nicotine and 600 puffs before it expires.
Emily Anne McDonald, an anthropologist at the University of California, San Francisco who is studying e-cigarette use among young people, said the lack of public education about the breadth of nicotine-vapor products was creating a vacuum “so that young adults are getting information from marketing and from each other.”
“We need to understand what people are calling these before we send out large surveys,” Dr. McDonald said. Otherwise the responses do not reflect reality, “and then you’re back to the beginning.”