RENO, NV - While the numbers of Americans who smoke has dropped considerably in the 50 years since the first Surgeon General's Report, cigarettes still kill about a half million of us a year and 16 million live with smoking related problems.
The new report calls for a goal of reducing the number of smokers to 10 percent over the next decade. That's twice the percentage of Nevadans who now light up.
But it also calls for more attention to a growing alternative--e cigarettes.
These devices still deliver nicotine, but in a smokeless cloud of vapor.
And they are catching on. The number of Middle and High School students using them doubled between 2011 and 2012.
People turn to them as a healthier alternative. That's one reason why the Sierra Smoke Shop on Glendale in Sparks is busy these days.
Among the customers, Christine Beradi, who smoked for 15 years. She's been using the e cigarette for about a year now.
"I mean the doctor even said it's alright to continue doing this,' says Beradi, who made the switch worried about her health.
U.S. Navy vet Martin Hruz is a newcomer to the e cigarette. A two pack a day smoker, he's already down to smoking just a couple a day.
"It's better on my lungs. I can feel it.
Although they're still getting a dose of nicotine with each puff. They aren't getting the smoke and with it a lot of carcinogenic substances.
"Nobody's saying it's good," says Sierra Smoke Shop owner Randall Fox who switched to the e cigarettes seven years ago. "The facts aren't there to support that and they never will be. But as a reduced harm device, but as a reduced harm device it's quite the product."
Kristen Power of the Nevada Cancer Coalition isn't so sure.
"Safer does not mean safe," she says noting there's been very little research on the health effects of the devices, but says some indicate there may be more that's harmful in that vapor than nicotine.
She does allow that the vapor is not the hazard posed by second hand smoke.
The Surgeon General's report takes no stand on the health benefits including whether the e cigarettes which allow a user to gradually reduce the amount of nicotine in their cartridges, could be used as an aid to those seeking to kick the habit altogether.
Power is skeptical about that use, so is Fox.
"Very seldom will it work that way," he says. "Most are going to use this as an alternative, not as something to help them quit.".
Fox may not suggest his e cigarettes as a means of quitting altogether, but some of his customers are using it that way.
Chandra Fassett started using e cigarettes about 10 months ago after 17 years as a smoker.
"I started out with the highest dose of nicotine and now I'm on the lowest dose."
And eventually headed to zero?
"Eventually absolutely none."
And she says it's made a big difference in her health, pointing out she's dropping by the smoke shop after a workout which included a three mile run.
In any case the e cigarette phenomenon shows no sign of slowing.
Governments will be considering age limits, taxes and whether to include them in no smoking regulations.
They will be looking to public health officials for guidance. At the moment though everyone is playing catch up and have few answers.
"There's very little research about e cigarettes," says Power. "There's still arguments going on whether they are a tobacco device or a device for delivering medication."
There will be plenty of pressure to provide those answers. Some cities have already included e cigarettes in their no smoking ordinances and Power's group may follow suit here in Nevada.
She also expects a law limiting the age of those who can buy e cigarettes.
Fox doesn't sell to minors. In fact, those under 18 are banned from his store although he says he has some 16 and 17 year old customers he will sell to if accompanied by a parent.
He'd support an age limit too and says he wants his business regulated and believes there should be more research.
He doesn't think his product should be lumped in with others banned from some public places by the state's Clean Air Act.
"That should be up to the individual business,"