As the popularity of e-cigarettes continues to grow, public health officials across the country and here at home are calling for more research and stricter regulation on their use.

“We really are in the Wild West of e-cigarettes because it has not been regulated at all by the FDA up to this point,” says Melva Fager Okun, Senior Adviser with Prevention Partners, a Chapel Hill-based non-profit focused on healthy workplaces and institutions.

Last week a trio of public health agencies released reports critical of the burgeoning e-cigarette industry. The Centers for Disease Control, World Health Organization and the American Heart Association issued calls for tighter controls on how the products are used, packaged and marketed.

E-cigarettes or personal vaporizers use atomizers to heat a liquid mixture of glycerin, propylene glycol and nicotine that users inhale. Often the mixture is artificially flavored, and Okun says it’s these flavors that have public health advocates especially worried.

“If you look at the over 7,000 flavors that these e-cigarettes come in, you can see they are definitely trying to appeal to youth,” says Okun. “They are candy flavors, they are cookie flavors and they are alcoholic beverage flavors.”

The use of e-cigarettes, called vaping, has skyrocketed in recent years to become a billion dollar industry.

Teens and young adults seem particularly drawn to vaping, as it is often marketed as safer than traditional tobacco. In North Carolina, use of e-cigarettes by teens has risen five-fold in the past two years.

Okun says much of the concern about e-cigarettes stems from evidence that they encourage traditional tobacco use as well. She cites a report from the CDC showing first time vapers were twice as likely to smoke tobacco within the year.

“I see it as a tremendous threat to the good progress that we had been making, and my great concern especially is that youth, who might not have even thought of picking up a cigarette, are now thinking about picking up e-cigarettes.”

The trend has gained ground locally as well. Okun says she’s seen an increase in retail shops selling vaporizers in Chapel Hill and Carrboro.

“I can hardly think of small shopping malls that now don’t have a designated tobacco and vapor product shop. I am very concerned.”

The federal Food and Drug Administration is considering extending its regulatory authority to include e-cigarettes. If that happens, the products will be subject to many of the same restrictions as traditional cigarettes.

In the meantime, organizations like schools, hospitals and businesses are trying to figure out how to regulate the use of e-cigarettes on their premises.

“In hospitals and patient rooms cigarettes have been long gone. Now people are pulling out e-cigarettes and staff is very confused,” says Okun. “It’s taking their time and effort now to address something they haven’t thought about in years, and they’re not sure what to do.”

Prevention Partners is hosting a free educational webinar on the topic of e-cigarettes on September 10. You can find out more here.