Updated at 9:09 p.m. to specify that vaping can include the use of e-cigarettes and other devices.

AUSTIN — Texas lawmakers expressed frustration Tuesday over the rise of vaping devices among youth and the lack of federal and state regulation, despite a new law that raised the smoking age to 21 in September.

“We don’t know where they’re being made,” Republican Sen. Lois Kolkhorst of Brenham, chairwoman of the Senate Health and Human Services Committee, said during a hearing. “We don’t know what’s in them, and there is no real requirement on labeling.”

The use of electronic smoking products, referred to as vaping, has sparked an outbreak of associated lung injuries, according to the federal Centers for Disease Control.

Forty-seven deaths nationwide, including one in Texas, and 2,290 cases of lung injury have been connected to vaping, according to the CDC’s latest data from November.

“It’s just out of control,” said Republican Sen. Charles Perry of Lubbock, vice chairman of the committee.

The FDA began setting up a process to regulate e-cigarettes and similar devices in 2016 and manufacturers have been required to submit applications to remain on the market by May 2020. But this means there are currently no products pre-approved by the FDA, Kolkhorst said.

With 109 cases reported as of Dec. 3, North Texas leads the state in the number of lung injuries associated with vaping, according to the Department of State Health Services. The department also reported the first vaping-related death in the state in North Texas in October.

Southeast Texas reported the second-highest number of injuries with 40 cases, and Central Texas added 25 to the statewide total of 210, according to the department.

The department has not identified why North Texas has more cases than other regions, Chris Van Deusen, department spokesman, said in an email.

Dr. Philip Huang, the director of Dallas County’s Health and Human Services department, said North Texas’ high case numbers may be the result of robust collaboration among health care providers in the area in tracking and reporting lung injury cases.

But Huang also noted the severity of the cases. In Dallas County, 14 of the 46 cases confirmed or thought to be associated with vaping have been reported among individuals under 18.

“These are previously normal, healthy teenagers,” he said. “There are now young kids that are being intubated and put on mechanical ventilation. That’s why the seriousness of this really can’t be overstated.”

The CDC and Federal Drug Administration are still investigating the cause of the lung injuries, but have identified the use of vitamin E acetate in some products as a “chemical of concern.”

Vitamin E acetate is added to some vaping products as a thickening agent, particularly those that use tetrahydrocannabinol, the active ingredient in marijuana. When taken as a supplement or applied to the skin, vitamin E acetate does not usually cause harm, but the CDC warns that studies have shown it can be harmful when inhaled.

Associated lung injuries have affected people ranging in age from 13 to 78, but most have been under 35. Of the 1,906 reported cases as of Nov. 5 that have age data, the CDC said:

15% were under 18

38% were 18-24

24% were 25-34

23% were 35 or older

As the number of cases in Texas rises, the department is expanding its outreach, especially in schools, Van Deusen said.

“We continue to add information on vaping to our existing tobacco education and prevention programs, and we’re expanding the amount of materials we distribute to schools,” he said.

The Department of State Health Services has partnered with Texas State University to provide schools with information to encourage youth to avoid smoking, said Dr. Manda Hall, associate commissioner of community health improvement for the department. It has also partnered with the University of Texas to create an awareness campaign among college students, she said.

But Sen. Beverly Powell, a Burleson Democrat, said during Tuesday’s hearing that the state needs to reach more students more quickly to ensure they know the dangers of vaping.

“We need a much more aggressive, much more specific program,” she said.

The committee also discussed the implementation and enforcement of Senate Bill 21, which raised the smoking age from 18 to 21 this year. Members of the state or U.S. military forces are exempt.

The law lowered the maximum fine for underage people caught with tobacco products from $250 to $100 and allows them to expunge their record when they turn 21. It maintained a Class C misdemeanor and a fine of up to $500 for those caught selling cigarettes and e-cigarettes to people below 21.

The state comptroller’s office has been using information from permits obtained to sell tobacco to conduct inspections for illegal sales of cigarettes to minors, said Joshua Thigpen of the account maintenance division. But the office has had trouble tracking down retailers who specifically sell e-cigarettes.

“Taxpayers who sell e-cigarettes do not have any permitting requirements other than a sales tax permit,” he said. “Because of this, we are unable to identify retailers who only sell e-cigarette products to conduct our compliance inspections.”

Sen. Nathan Johnson, a Dallas Democrat, suggested requiring a separate permit for e-cigarette retailers. He lamented lawmakers’ failure to pass a bill banning vaping during the last legislative session. Other senators discussed raising the price of e-cigarettes, requiring a prescription for them or banning their flavors to discourage youth from seeking them.

But vape shop owners and consumers warned lawmakers that these regulations could hurt their businesses and people who use e-cigarettes to try to quit smoking.

“This is a life-saving tool for our adult smokers,” said Steve Belcher, who owns Mid Cities Vapor in North Richland Hills. “I don’t even let people under the smoking age in my store.”