North Texas leads the state in the number of severe lung injuries associated with vaping.
There are now 210 Texas cases of severe lung disease in people who report vaping before seeing symptoms, according to the Texas Department of State Health Services.
Of the Texas cases, 109 are in North Texas.
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The median age of Texas patients is 22 and a quarter of patients are minors.
The legal age for purchasing and smoking tobacco was raised this year in Texas to 21 but a recent study shows that 1 in 5 high school seniors vape. There is no statewide license so anyone can sell e-cigarettes.
The increase in cases comes as lawmakers work to identify the main challenges in preventing youth vaping, NBC affiliate KXAN reported.
On Tuesday, testimony legislators discussed in the Texas Senate Health and Human Services Committee how young Texans are dodging the rules, KXAN reported.
"With the vaping, a kid can actually just kind of go to the side, take a puff and he and she can be very creative in how they blow it out," said Eric Mullens, principal at Hempstead High School. "Sometimes they can yawn or cover it with their clothing, so it’s very easy to hide."