It's called "vaping" - puffing on an electronic cigarette.
Actor Johnny Depp vaped in "The Tourist," and actress Katherine Heigl used an electronic cigarette a while back on "The David Letterman Show."
Electronic cigarettes, made of plastic and metal, have no tobacco. A battery heats a solution that contains propylene glycol (approved by the FDA as a food additive) to create a vapor that users inhale. The solution, contained in a disposable cartridge, is available in dozens of flavors and with various levels of nicotine.
They don't stain teeth or fingers, and there's no smoke. It's no wonder people are turning to e-cigs as a way to quit smoking - despite warnings from medical experts who caution against their use.
"I think people have the perception that e-cigarettes are harmless," said Dr. Gale Burstein, Erie County health commissioner. "We don't know the long-term health effects on people who use e-cigarettes. We also don't know the effects of secondhand vapor. It's still a public health issue."
Medical experts have questioned the effectiveness of e-cigarettes as a tool to quit smoking. E-cigarettes remain unregulated, and they lack the scientific scrutiny required if they were under the jurisdiction of the Federal Drug Administration. Without solid clinical studies and because e-cigarettes are relatively new, they should be used with caution, say members of the medical community.
"We don't know enough about e-cigarettes to recommend them," said Richard O'Connor, associate professor of oncology in the Department of Health Behavior at Roswell Park Cancer Institute. "They may be helpful to some people. The caveat to that is the absence of manufacturing standards and regulations. The other issue is there have not been any good clinical trials, which is the gold standard for knowing whether something works for smoking cessation."
Proponents argue that enough anecdotal evidence exists to support the efficacy of e-cigarettes as a tool to quit smoking. A spring 2011 study published in the American Journal of Preventive Medicine determined that electronic cigarettes may help smokers quit.
What's a vaper to do?
"You just hit it whenever you get the urge at certain times of the day," said Kelly Randles, 34, who turned to e-cigarettes last September. "It's totally different from a cigarette, because you don't have to finish the whole thing. You take a couple of puffs, put it down and do whatever you were doing."
Electronic cigarettes were first marketed in China in 2003. They did not become readily available in the United States until 2006. Today, about 2.5 million Americans use e-cigarettes, the Tobacco Vapor Electronic Cigarette Association reported. Most use them as a replacement for cigarettes, according to a survey published earlier this year by the University of Alberta, School of Public Health.
Randles - the mother of two boys, ages 11 and 13 - considers the e-cigarettes she buys from Vapor Trail in South Buffalo as a healthier option than the Marlboro cigarettes she used to smoke.
"That's the whole point. I get the Marlboro flavor, non-menthol," Randles said.
Vapor Trail co-owner Andrew Osborne, 29, said he quit smoking for 18 months only to start back up. Now he uses e-cigarettes as an alternative to regular cigarettes.
"Nicotine does something for you," said Osborne. He compares it caffeine.
Growing concerns that children and teenagers may use electronic cigarettes as a prelude to tobacco cigarettes have prompted Gov. Andrew Cuomo to ban the use of electronic cigarettes within 100 feet of entrances to public or private schools. The legislation became effective Sept. 5. A second provision - banning the sale of e-cigarettes to anyone under 18 years old - goes into effect Jan. 1.
Health Commissioner Burstein said e-cigarettes are particularly attractive to underage smokers, and not only because they have flavors like salt water taffy and bubble gum.
"Just the marketing of something electronic is very attractive to children and teenagers," she said. "As a pediatrician, I'm worried this may be another venue for teenagers to start inhaling something that may be toxic."
The lesser evil
Kurt Bella, 52, of Amherst, says he started smoking when he was 15. Over the years, he developed a three-pack-a-day habit that has today left him disabled by Chronic Obstructive Pulmonary Disorder.
"My daughter was concerned over my smoking, because I was constantly getting sinus infections, which led to asthma attacks. I used to wheeze quite heavily, and for Father's Day a couple of years ago she bought me electronic cigarettes," he said.
Bella, a former collision shop worker and convenience store manager, said he was skeptical at first.
"I thought it was all a crock," he said. Today, Bella uses Juicy Vapor e-cigarettes in the five-stripe gum flavor. He has weaned himself from nicotine by gradually reducing the amount mixed in the solution. "I have cut down drastically on their use, but whenever I feel the urge for a cigarette I just use it, and the urge is gone," he said.
Michael G. MacLean, associate professor in the Department of Psychology at Buffalo State College, is an addictions expert. He said overcoming an addiction is a gradual process.
"If you can get past a couple of weeks, the physical withdrawal is done, and that's a major milestone," MacLean said, "but then you'll still have a physical reaction when you encounter certain cues. You may have no nicotine in your system, but if you smoked when you were drinking and you go to a place where you drink, you actually have this physical craving.
"In general, if you can go 90 days without smoking - and this goes for most addictions - then the odds are you won't relapse."
Brad McNamara is co-owner of Juicy Vapor. His business in the Town of Tonawanda includes a well-appointed lounge for customers to use their e-cigarettes.
McNamara quit smoking in 2008, when he started using e-cigarettes with nicotine. In 2010, he cut the nicotine, and now uses them for flavor.
"We go overboard on flavors," said the burly McNamara, who rides for the Patriot Guard Riders. "We have vanilla, tobacco, coffee. We have a pizza flavor that tastes like Totino's pizza rolls. Our grape is like generic Tops brand soda. We have red wine, white wine, bourbon, whiskey, beer, even a marijuana flavor."
O'Connor of Roswell may have more questions than McNamara has flavors.
"Do e-cigarettes get people to quit? Do they discourage them from starting? Or do they attract new people into the pool?," O'Connor asked. "Do they attract kids? Do they bring former smokers back into nicotine use, and then bring them back to cigarettes? The greater question is whether introducing these products reduces the amount of smoking overall."