An Illinois regulatory proposal, which the House approved 105 10 this month and now moves to the Senate, would enable the Illinois Department of Public Health to set specifications for the packaging of e cigarette liquid, or e liquid, refills.

E cigarettes have raised concerns recently after national statistics from the Centers for Disease Control and Prevention showed an increase in the number of calls to poison centers related to the devices. The CDC found that calls to poison centers went from one in September 2010 to 215 this past February. Calls related to regular cigarettes fluctuated, ranging from 301 to 512 per month.

About half of the calls related to e cigarettes from September 2010 to this February involved children age 5 and younger. About 42 percent of the calls involved people age 20 and older.

“The rise in e cigarette popularity doesn’t explain why e cigarettes account for 41.7 percent of combined cigarette and e cigarette (calls last February) when e cigarettes account for only 1 to 2 percent of the market,” said Tim McAfee, director of the CDC’s Office on Smoking and Health.

The Illinois Poison Center experienced similar trends in e cigarette related calls. After receiving 22 calls in 2012 and 23 in 2013, the center this year had already received 15 calls by March 31, operations director Carol DesLauriers said. At that rate, DesLauriers expects to receive 60 calls this year.

“Right now, it’s just numbers,” she said. “But I think it does tell us that we need to be vigilant about preventing them from going up further if possible.”

E liquids, which consist of varying concentrations of nicotine in liquid form mixed with flavoring and other chemicals, can cause acute nicotine toxicity if ingested, inhaled or absorbed into the skin or eyes. Effects of exposure most commonly reported by callers included vomiting, nausea and eye irritation.

Health officials are also concerned about e liquids that come in fruit and candy flavors such as strawberry, chocolate and bubble gum that may appeal to children.

State Rep. Robyn Gabel, D Evanston, who proposed the bill, said lawmakers have been “waiting for (FDA regulations) to happen for a while now” and noted that the European Union passed regulations, including childproofing requirements, on Feb. 26. If the FDA does come up with regulations, they will supersede state regulation, she said.

“No child should be put in danger because of an e cigarette,” Gabel said.

Many manufacturers and retailers already sell e liquid refills in what they consider to be childproof containers. Sealed, prefilled or disposable cartridges would be exempt from regulations.

A hot debate over e-cigarettes as a path to tobacco, or from it – nytimes.com

Brand cigarettes – brand cigarettes manufacturers, suppliers

Nicotine may have some adverse health effects, but they are relatively minor, said Dr. Neal L. Benowitz, a professor of medicine at the University of California, San Francisco, who has spent his career studying the pharmacology of nicotine.

Another ingredient, propylene glycol, the vapor that e cigarettes emit whose main alternative use is as fake smoke on concert and theater stages is a lung irritant, and the effects of inhaling it over time are a concern, Dr. Benowitz said.

But Dr. Siegel and others contend that some public health experts, after a single minded battle against smoking that has run for decades, are too inflexible about e cigarettes. The strategy should be to reduce harm from conventional cigarettes, and e cigarettes offer a way to do that, he said, much in the way that giving clean needles to intravenous drug users reduces their odds of getting infected with the virus that causes AIDS.

Solid evidence about e cigarettes is limited. A clinical trial in New Zealand, which many researchers regard as the most reliable study to date, found that after six months about 7 percent of people given e cigarettes had quit smoking, a slightly better rate than those with patches.

The findings were intriguing but nothing to write home about yet, said Thomas J. Glynn, a researcher at the American Cancer Society.

In Britain, where the regulatory process is more developed than in the United States, researchers say that smoking trends are heading in the right direction.

Motivation to quit is up, success of quit attempts are up, and prevalence is coming down faster than it has for the last six or seven years, said Robert West, director of tobacco studies at University College London. It is impossible to know whether e cigarettes drove the changes, he said, but we can certainly say they are not undermining quitting.

The scientific uncertainties have intensified the public health fight, with each side seizing on scraps of new data to bolster its position. One recent study in Germany on secondhand vapor from e cigarettes prompted Dr. Glantz to write on his blog, More evidence that e cigs cause substantial air pollution. Dr. Siegel highlighted the same study, concluding that it showed no evidence of a significant public health hazard.

That Big Tobacco is now selling e cigarettes has contributed to skepticism among experts and advocates.

Cigarettes went into broad use in the 1920s and by the 1940s, lung cancer rates had exploded. More Americans have died from smoking than in all the wars the United States has fought. Smoking rates have declined sharply since the 1960s, when about half of all men and a third of women smoked. But progress has slowed, with a smoking rate now of around 18 percent.

Part of the furniture for us is that the tobacco industry is evil and everything they do has to be opposed, said John Britton, a professor of epidemiology at the University of Nottingham in England, and the director for the U.K. Center for Tobacco and Alcohol Studies. But one doesn t want that to get in the way of public health.

Carefully devised federal regulations might channel the marketing might of major tobacco companies into e cigarettes, cannibalizing sales of traditional cigarettes, Dr. Abrams of the Schroeder Institute said. We need a jujitsu move to take their own weight and use it against them, he said.

Dr. Benowitz said he could see a situation under which the F.D.A. would gradually reduce the nicotine levels allowable in traditional cigarettes, pushing smokers to e cigarettes.

If we make it too hard for this experiment to continue, we ve wasted an opportunity that could eventually save millions of lives, Dr. Siegel said.

Dr. Glantz disagreed.

I frankly think the fault line will be gone in another year, he said. The evidence will show their true colors.