Thursday, Nov. 17 was the American Cancer Society’s Great American Smokeout, an event to encourage smokers across the nation to quit using tobacco products.

Nationally there are an estimated 40 million Americans who smoke cigarettes, and globally, smoking is the number one cause of preventable disease, according to the American Cancer Society.

Mei Lin has been the owner of Discount Tobacco and Gifts on Court Street in Washington Court House since May 2015. The store offers patrons a variety of tobacco products, from cigarettes to smokeless tobacco, including chew, snuff and e-cigarette vaporizer pens.

E-cigarettes are battery powered, hand-held devices that vaporize an e-liquid base — glycerin or propylene glycol, an antifreeze — combined with a nicotine additive extracted from tobacco. Artificial flavorings are common in e-liquids, and Lin said some of the most popular flavorings in her store are the fruit flavors: Fruity Tutty, Cherry, Blueberry. The liquid is vaporized through a heating element and inhaled, rather than smoked, from the device.

Lin said that today about 20 percent of her customers come into the store for e-cigarette vaporizer pens and e-liquids.

“Some people just want to try, so they buy it and then they come back to cigarettes. Some people try it and stay with it, they say it’s cheaper and healthy,” said Lin.

Lin said the prices on cigarette packs have risen twice this year. Most recently she said the price of a pack of Marlboro’s rose 9 cents.

Fred Howe, a retired worker from Showa, lives in Washington Court House and was stopping by Lin’s store to buy his tobacco products.

“I’m on chew,” the 65-year-old, who smoked cigarettes 20 years ago, said. “It’s a little cheaper. These (chew) are $4.27 for two packs. A pack of cigarettes is five, six, eight bucks.”

Howe said he has never tried an e-cigarette vaporizer pen. “Those are after my time,” Howe said.

Lin said the price of one bottle of the e-liquid base, the combination of antifreeze, liquid nicotine and artificial flavoring, can be as low as $3.99 a bottle and is the equivalent of one carton of cigarettes. She said some, not all, of the e-liquids contain nicotine.

“Thirty-six milligrams is our highest amount of nicotine” Lin said. She said the store also carries e-liquid with zero milligrams of nicotine for people who want an alternative to nicotine. Overall the store offers about 20 different brands of e-liquid in almost a hundred different flavors.

“They say they like the flavor and they save money. I think money is important for the market. Or it’s healthy, they have a cough from smoking cigarettes,” Lin said.

Earlier this year, the Food and Drug Administration began to regulate the sales of e-cigarettes and e-liquids to minors under the Family Smoking Prevention and Tobacco Control Act. In September the FDA began issuing warning letters to retailers who weren’t checking IDs on sales to anyone who appeared to be under the age of 27.

“We’re helping protect the health of America’s youth by enforcing restrictions that make it illegal to sell tobacco products to minors – including e-cigarettes, e-liquids and cigars. Retailers play a vital role in keeping harmful and addictive tobacco products out of the hands of children and we urge them to take that responsibility seriously,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “It’s clear from these initial compliance checks that there’s a need for strong federal enforcement of these important youth access restrictions.”

According to the Office of the Surgeon General, more than 1,200 people die everyday from smoking.

A study at The Ohio State University Comprehensive Cancer Center was published Nov. 1 and found that people under the age of 35 do not view e-cigarettes to be as harmful to the lungs as cigarettes. About 44 percent of people surveyed think smoking e-cigarettes is healthier than smoking cigarettes. This comes at a time when the rates of smokeless tobacco — chew and e-cigarettes — are increasing, according to the Office of the Surgeon General.

But doctors and researchers aren’t so sure about the health impact of e-cigarettes on the lungs. Studies on the e-liquids have found that they contain chemicals known to be toxic to the lungs and body. A study published in the journal Environment Health Perspectives found that the chemical diacetyl is found in e-liquids.

Diacetyl is the same chemical found in cigarettes that causes severe respiratory diseases, according to studies published in International Journal of Occupational and Environmental Health.

Diacetyl is also a flavoring chemical linked to a respiratory disease known as “popcorn lung,” named after workers in a microwave popcorn-processing plant who inhaled airborne diacetyl used in butter flavoring while working in the facility, according to a study published by the National Institute of Occupational Safety and Health (NIOSH) Division of Respiratory Disease Studies.

The researchers who found diacetyl in e-liquids and published their study in the journal Environment Health Perspectives said that urgent action is needed to further study the effects of e-cigarettes and e-liquids on the lungs.

“The truth is there is just so much we don’t know about these new products,” said Dr. Peter Shields, a thoracic oncologist and deputy director of The Ohio State University Comprehensive Cancer Center.

To see what happens when a person uses e-cigarettes, researchers at The Ohio State University Comprehensive Cancer Center are putting tiny cameras into the lungs of volunteers and are taking samples from the lungs to check for changes they can’t see with the cameras.

People who smoke cigarettes and use smokeless tobacco say they are worried about the health consequences. Annually, diseases from smoking costs the United States $300 billion a year, according to the Centers for Disease Control.

Forty-year-old Timothy Eggleton of Washington Court House said he has tried cigarettes here and there, but said he never stuck with it. Instead, the Navy veteran said, “I chew Skoal. Two cans a day. Snuff.”

“It’s really a bad habit to start — they both are — there’s really no alternative, except for the vape,” Eggleton said. He said he tried the e-cigarette vaporizer pen, but “couldn’t latch on to it. It was too strong. That’s when it first started coming out and I just gave up on it. I should probably try it again.”

And while he is worried about the health effects of chewing tobacco — lip, lung and throat cancer — he said, “I can’t quit. I’m a veteran so I went through the VA and the smoking cessation class they got, which is real good, they give me the patches. I wore the patch for a couple months. It works. It takes away the cravings. I went 10 days without chewing or anything and it was tough but I did it, but you know, I had the patch on. I went back to chewing as soon as I could.”

D.B., a 62-year-old woman who lives in Washington Court House, was at a gas station buying Marlboro Menthol 100s. She said she began smoking when she was 15 or 16-years-old.

“It was just the cool thing to do at the time. It’s not cool anymore. It costs too much. They’re about $6.20 a pack now. When I started they was like, 28 cents, so, a bit different now,” said D.B. “It’s not a good thing. Not for the people around me. I don’t smoke around the grand-kids.”

She said she tried to quit but, “It’s just like going on a diet, you know, you try and something happens and you get all stressed out, so, there you go, right back to it.”

She said she is worried about developing a breathing issue. “I don’t have one yet, but I’m sure, sooner or later, it will kick in.”