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The newest and most popular vaping product is the JUUL, which is a small, sleek device that resembles a computer USB flash drive. Its subtle design makes it easy to hide, which helps explain why it has become so popular among middle and high school students.

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-Teens
-Parents/ Family
-Teachers
-School Administrators
-E-Cig Stores

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-Battery Powered Device
-Filled with liquid that contains nicotine
-Options for different flavors
-Heats to convert liquid into vapor
-No actual burning of tobacco
-Addictive because of nicotine

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"More than 3 million middle and high school students used e-cigarettes in 2015, up from 2.46 million in 2014."

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Nick started smoking cigarettes when he was 11, maybe 12, and he kept at it for years.

"Until my parents got fed up with it," says Nick, now 18, a high school senior who lives near Helen, GA. "Also, it got to the point where I couldn't taste or smell anything."

So he stopped smoking and started "vaping" -- he gave up traditional cigarettes and for the past year he's used electronic cigarettes (e-cigarettes).

"It's the lesser of two evils," Nick says.

But is it, really?

More and more organizations are concerned about their health effects. Although there have been studies showing they are less harmful, there are many that point out serious harm.

"Safer is not the same as safe," says Brian King, deputy director for research translation in the CDC's Office on Smoking and Health.

"Nicotine is a prime ingredient in these devices," he says. "Studies show nicotine is more addictive than heroin and cocaine. And there's a growing body of evidence that nicotine can harm the developing adolescent brain."

At the same time, the number of teens using e-cigarettes has soared.

"High school students are using e-cigarettes at a greater rate than adults," King says.

ENDS Users

In response to this trend, the FDA has rewritten its tobacco rulebook. It now regulates electronic nicotine delivery systems, or ENDS.

Some examples of ENDS include:

These products use a flavored liquid that typically contains a third to half the nicotine found in a regular cigarette. The fluid heats into a vapor that the user inhales, simulating the act of smoking.

Eye-Opening Stats

While smoking has gone down among teens, overall tobacco use has remained steady. It's because vaping has become common.

More than 3 million middle and high school students used e-cigarettes in 2015, up from 2.46 million in 2014.

In 2015, e-cigarettes were the most commonly used tobacco product among students in middle and high school for the second straight year.

In 2011, less than 2 in 100 high school students said they used e-cigarettes. By 2015, 16 out of 100 had.

The sale of vaping supplies to minors is banned across the country. But teens have no trouble buying the stuff online.

Continued

'A Huge Concern'

A lot of kids experiment with or use vaping products because they believe it's harmless. For most, the flavors are the lure.

Vaping liquids can be made to taste like candy, fruit, ice cream, or other foods and drinks. Many contain nicotine, which is bad enough on a body because it's addictive. But some of the chemicals used for e-liquid flavoring also put your health at risk.

For example, Harvard University researchers found diacetyl, a flavoring chemical, in most of the e-cigarettes and e-liquids tested.

Diacetyl has been linked to a respiratory disease called bronchiolitis obliterans. Also known as "popcorn lung," it first appeared in workers who inhaled artificial butter flavor in microwave popcorn processing facilities.

"This is potentially volatile stuff," King says. "The flavorings in these products are a concern. The bottom line here is, e-cigarette aerosol is not harmless."

Nick, the high school student in Georgia, agrees. "You've got companies using chemicals like diacetyl to make them taste better. That's not right."

There are other issues linked e-cigarette use. They can irritate your lungs or make asthma worse. They may also make a teen more likely to take up smoking.

"They may not be burning carcinogens when they use an e-cigarette," says Jonathan Popler, MD, a pediatrician with Children's Healthcare of Atlanta, "but are delivering nicotine to the body."

The evidence is clear, Popler says: "Teens who use these products are more likely to become smokers later on."

"From a public health standpoint, that's a huge concern," King says.

When It's Not Tobacco

There have been media reports of teens vaping other drugs, such as alcohol. Popler hasn't seen any signs that his patients do that. But Nick has heard about it, and he's not impressed.

"It's like chugging alcohol and it's just as stupid," Nick says. "You're skipping the filtration system in your body and that can lead to alcohol poisoning much faster than drinking."

Pot is also part of the trend. "We do hear a lot about people vaping marijuana," Popler says. That's illegal and unsafe, too.

Continued

Risks Down the Road

The e-cigarette trend in the U.S. is only about 10 years old, so there's still a lot of data to collect.

As for Nick, he's now old enough legally buy his own vaping supplies.

"These e-cigarettes don't work off combustion, so at least I'm not getting all that tar," he says. "I know it's not good for me, but it's not as bad as regular cigarettes. Right now, I'm OK with that."

He knows he's taking a chance.

"We still don't know the long-term effects of e-cigarettes on the human body," he says. "The unknown is what scares me most."

Sources

SOURCES:

Gov.uk: "E-cigarettes around 95% less harmful than tobacco estimates landmark review."

FDA: "Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS)."

Cleveland Clinic: "Teen Use of E-Cigarettes Has Strong Link to Smoking."

Society for Science and the Public, Science News for Students: "Teen vaping soars past cigarette use."

Harvard University School of Public Health: "Chemicals linked with severe respiratory disease found in common e-cigarette flavors."

Society for Science and the Public, Science News for Students: "Teen data find vapers often become smokers."

Nick, high school student, Helen, GA.

Brian King, deputy director for research translation, Office on Smoking and Health, CDC.

Jonathan Popler, MD, pediatric pulmonologist, Children's Healthcare of Atlanta.

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Nick started smoking cigarettes when he was 11, maybe 12, and he kept at it for years. "Until my parents got fed up with it," says Nick, now 18, a high school senior who lives near Helen, GA. "Also, it got to the point where I couldn't taste or smell anything."

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FDA's largest enforcement action to date gave warnings and fines to 1,300 retailers and requested plans to prevent teen vaping from five manufacturers

smithsonian.com

Earlier today, the Food and Drug Administration announced the launch of its largest coordinated enforcement effort in history, sending warning letters and fines to more than 1,300 retailers to combat the "epidemic" of e-cigarettes sales to minors.

"I use the word epidemic with great care," FDA commissioner Scott Gottlieb said in a statement. "E-cigs have become an almost ubiquitous-and dangerous-trend among teens. The disturbing and accelerating trajectory of use we're seeing in youth, and the resulting path to addiction, must end."

Since 2014, e-cigarettes have been "the most commonly used tobacco product among both middle school and high school students," according to the 2017 National Youth Tobacco Survey, which is published by the FDA and the Centers for Disease Control and Prevention.

But the number of teens using e-cigarettes is believed to have jumped significantly since that last survey. While 2017 numbers listed more than 2 million middle school and high school students as e-cigarette users, Laurie McGinley at The Washington Post interviewed people familiar with preliminary data from the most recent survey, which is not yet published, who say the latest data reflects a 75 percent jump in high school students using e-cigarettes in 2018, an indicator of just how widespread "vaping" has become.

In the agency's statement, the FDA rolled out significant new steps to face the problem. Today's action included sending warning letters to retailers that were caught selling the products to underage customers during an undercover enforcement blitz that took place over the summer. Fines ranging from $279 to $11,182 were issued to retailers for repeated offenses. Twelve online companies were also delivered warning letters for selling teen-friendly vaping products.

Most significantly, the agency called on the five leading e-cigarette manufacturers, Vuse, blu, Juul, MarkTen XL, and Logic, which collectively represent 97 percent of the industry, to file plans to limit sales to underage consumers within 60 days. If the plans don't significantly reduce the number of underage smokers, the agency says it will take steps to pull flavored e-cigarette products that appeal to teens off the market.

The debate over e-cigarettes is complex. The product is a small electronic device that converts a "juice," typically propylene glycol mixed with nicotine and flavors, into an inhalable vapor. The flavors include almost any taste imaginable, including cheesecake, bourbon, gummy bears and Fruit Loops. The nicotine-spiked juice is often marketed as a way for smokers to wean themselves off the real thing since they can control the levels of nicotine in their vape juice. But vaping is not healthy for those who don't already smoke. A recent study indicates that, besides leading to a nicotine addiction, vaping may be exposing teens to chemicals linked to cancer. Another study from National Academies of Sciences, Engineering, and Medicine earlier this year found that nicotine levels in e-cigs can be higher than in traditional tobacco products and can make users more likely to use the real thing.

Sheila Kaplan and Jan Hoffman at The New York Times report that in the past, Gottlieb has supported e-cigarettes for their potential to help adult smokers quit and considered them a critical piece of an ambitious plan to reduce traditional smoking revealed last year. But he now says the alarming rise in underage vaping caught public health officials by surprise and preventing teen smoking outweighs its benefit to adult smokers. "[T]he youth risk is paramount," he said in his staff comments. "In closing the on-ramp to kids, we're going to have to narrow the off-ramp for adults who want to migrate off combustible tobacco and onto e-cigs."

One company in particular, Juul, has been singled out for its popularity among teens. In just three years, reports McGinley at the Post, the brand has captured 70 percent of the vaping market with its streamlined appearance and social media presence particularly appealing to adolescents. Juul has been under scrutiny by the FDA since April for its marketing practices. The company tells the Times' Kaplan and Hoffman that it has stepped up its monitoring of its retailers and polices the way its products are presented on social media and elsewhere. In a statement, the company says it will comply with the FDA request and is "committed to preventing underage use of [its] product."

In an interview with the Post, Matthew Myers, president of the leading advocacy organization Campaign for Tobacco-Free Kids, calls the FDA's action a "fundamental turning point."

"This is potentially the most important step FDA has taken to curtail youth use of e-cigarettes," he continues. However, Myers warns that it will only be effective if the agency requires manufacturers to immediately undergo a premarket review, assessing the risks of the products. That step was initially scheduled to take place this August, but the timeline was pushed back to 2022 in order to give the FDA and the industry more time to prepare.

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FDA Cracks Down on Underage Use of E-Cigarettes

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smithsonian.com Earlier today, the Food and Drug Administration announced the launch of its largest coordinated enforcement effort in history, sending warning letters and fines to more than 1,300 retailers to combat the "epidemic" of e-cigarettes sales to minors. "I use the word epidemic with great care," FDA commissioner Scott Gottlieb said in a statement.