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 Food and Drug Administration is preparing to issue regulations that would give the agency control over e cigarettes, which have grown explosively virtually free of any federal oversight. Sales of e cigarettes more than doubled last year from 2012, to $1.7 billion, according to Wells Fargo Securities, and in the next decade, consumption of e cigarettes could outstrip that of conventional cigarettes. The number of stores that sell them has quadrupled in just the last year, according to the Smoke Free Alternatives Trade Association, an e cigarette industry trade group.

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 University of California, Berkeley. Many students talked about wide use of e hookahs or vaping pens saying as many as half of their classmates had tried one but said that there was little use of e cigarettes.

Ms. Zacks said the devices were popular at her high school here. E cigarettes are for people trying to quit smoking, she said, explaining her understanding of the distinction. Hookah pens are for people doing tricks, like blowing smoke rings.

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 San Francisco called King Kush Clothing Plus, where high school students say they sometimes buy their electronic inhalers. On a counter near the back, where tobacco products are sold, are several racks of flavored liquids that can be used to refill e cigarettes or hookah pens. The flavors include cinnamon apple, banana nut bread, vanilla cupcake, chocolate candy bar and coconut bomb. They range in nicotine concentration from zero to 24 milligrams about as much as a pack of 20 ordinary cigarettes but most of the products have some nicotine. To use the refills, it is necessary to buy a hookah pen, which vary widely in price around $20 and upward.

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.

Cvs vows to quit selling tobacco products – nytimes.com

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On Wednesday, Walgreens said it had been assessing its sales of tobacco products for some time. We will continue to evaluate the choice of products our customers want, while also helping to educate them and providing smoking cessation products and alternatives that help to reduce the demand for tobacco products, according to a statement released by the company. Although CVS ranks first in overall sales and pharmacy sales among the nation s drugstores, according to analysts, Walgreens is the largest in the number of stores.

Rite Aid, another large chain, said in a statement it continually reviewed product mix to make sure it suits the needs and desires of customers.

As for driving away customers to competitors, Troyen A. Brennan, the executive vice president and chief medical officer for CVS, said It s obvious that the average person will just find somewhere else to buy cigarettes. What we re thinking about is if others want to emulate this business decision we ve made, then over time that will make cigarettes less available and scientific literature does suggest that a reduction in the availability of cigarettes reduces smoking.

Dr. Brennan, together with Steven A. Schroeder of the Smoking Cessation Leadership Center at the University of California, San Francisco, wrote an op ed article making the case for eliminating tobacco products from drugstores in The Journal of the American Medical Association published online on Wednesday.

Some 18 percent of American adults smoke, down from 42 percent in 1965. In places like New York City, which has used a combination of steep taxes on cigarettes and bans on smoking in most places to discourage smokers, the decline is even greater, down to 14 percent.

But health experts remain concerned because the rate of decline has stagnated over the last decade, and some 480,000 deaths each year are linked to smoking. From 1999 to 2003, for example, the smoking prevalence among high school girls dropped 37 percent, according to the Centers for Disease Control, but from 2003 to 2007, the decline was only 2.3 percent.

This month, a group of seven advocacy organizations including the American Heart Association and the Campaign for Tobacco Free Kids called on governments to take steps to reduce smoking rates to less than 10 percent over the next decade and ensure no American is exposed to secondhand smoke within five years.

We have seen the decrease in initiation of smoking plateau, particularly among some populations of young people, and we ve been working very hard on those populations that have been stubbornly hard to reduce but we need to redouble our efforts, said Risa Lavizzo Mourey, the chief executive of the Robert Wood Johnson Foundation. Decreasing the availability of tobacco products as CVS is doing is an important and bold step toward making it harder for people to get access to these harmful products.

Coincidentally, the F.D.A. announced on Tuesday the start of a national education program aimed at preventing smoking among youth. The ads, which will be distributed across social media platforms, try to show teenagers the toll that smoking takes on the body in memorable ways, such as a young man who uses a pair of pliers to pull a stained tooth from his mouth to buy a pack of cigarettes.

A shortage of primary care doctors and expanding access to health care coverage under the Affordable Care Act is turning drugstore chains into big players in the nation s health care system. Consumers routinely get flu shots in drugstores, for instance, and clinics staffed by nurse practitioners or physician assistants and offering basic care for common ailments like strep throat or pink eye are popping up everywhere from Walgreens to Walmart.

A report last year by Accenture predicted such so called retail clinics were poised to grow at a rate of 25 to 30 percent over the next few years, which would swell the number to 2,800 in 2015, from 1,400 in 2012.

CVS s 800 MinuteClinics already account for most of such outlets, and Mr. Merlo said the company hoped to add another 700 for a total of 1,500 by 2017. For that reason, he said, the decision to stop selling tobacco products was really more of a discussion about how to position the company for future growth.

The company estimated that the decision would erase 17 cents in earnings per share of stock annually, but that it had identified ways of offsetting the impact on profits. (The earnings hit this year will only be 6 cents to 9 cents a share while the company works through its remaining inventory of tobacco products.)

The company hopes to make up some of the lost revenue and income with a smoking cessation program that it is starting this spring with the goal of getting half a million Americans to stop smoking. Helena Foulkes, executive vice president for CVS, said This is the kind of offering we can bring to clients like insurance plans and companies, many of which will pay for such a program.