Months after the Food & Drug Administration finalized rules that treat e-cigarettes like traditional cigarettes and cigars, including banning the sale to minors, a new report from the U.S. Surgeon General suggests the regulations may be too little too late, as use of the alternative tobacco products has skyrocketed among younger consumers, posing a public health threat.
E-cigarette use among youth and young adults now constitutes a “major public health concern,” U.S. Surgeon General Vivek Murthy said in the report, calling on regulators to enact tougher restrictions to keep the products — which include e-cigarettes, vapes, mods, vape pens, and other devices — out of the reach of the country’s youngest consumers.
As the first comprehensive federal review of the public health impact of e-cigarettes on youth and young adults, the report [PDF] found that use of the devices increased about 900% among school students from 2011 to 2015. In fact, in 2015, one in six students said they had used an e-cigarette in the past month.
“These products are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco, and hookahs,” Murthy said in the report.
And that’s reason for concern, health officials say, because there are still a lot of unknowns related to long-term use of the products, while the short-term use effects are becoming more clear.
“Research on e-cigarettes is ongoing, and the e-cigarette marketplace continues to evolve,” the report states. “Even so, a sufficient body of evidence justifies actions taken now to prevent and reduce the use of e-cigarettes and exposure to secondhand aerosol from e-cigarettes, particularly among youth and young adults.”
The report notes that health officials know aerosol from e-cigarettes isn’t harmless — it can contain harmful and potentially harmful ingredients, including nicotine.
For example, the report found that most e-cigarettes contain nicotine, which, according to the Surgeon General can cause addiction and harm to the developing adolescent brain.
“Compared with older adults, the brain of youth and young adults is more vulnerable to the negative consequences of nicotine exposure,” the report states.
Related from Consumer Reports: Studies Find 2 Ways E-Cigs Are More Likely to Lead Teens to Smoke Cigarettes
While the report did not make a direct correlation to the idea that e-cigarettes serve as a gateway to traditional cigarettes, it does suggest that vaping is “strongly associated with the use of other tobacco products among youth and young adults, including combustible tobacco products such as cigarettes.”
Additionally, the report found that there is sufficient evidence that secondhand aerosol exhaled into the air by e-cigarette users can expose others to potentially harmful chemicals.
The report also addressed the ways in which e-cigarettes and other alternative products are marketed to younger consumers.
Related: President Obama Signs Bill That Will Require Child-Resistant Packaging For Liquid Nicotine
A Centers for Disease Control and Prevention report released in January found that as e-cigarette ad spending increases so does the use of the devices by teens.
According to that report the industry has rapidly increased marketing spending from $6.4 million in 2011 to $115 million in 2014. During that same time period, e-cigarette use in the past 30 days increased from less than 1% to almost 4% among middle school students and from less than 2% to 13% among high school students.
On Thursday, the U.S. Surgeon General’s report found that most companies have targeted their marketing toward things that youth will be attracted to, including promoting flavors and using a wide variety of media channels viewed by young consumers.
“Themes in e-cigarette marketing, including sexual content and customer satisfaction, are parallel to themes and techniques that have been found to be appealing to youth and young adults in conventional cigarette advertising and promotion,” the report states.
In light of the new findings, the report issues a Call to Action to prevent e-cigarettes use and related harms among young people. Recommendations include:
• continuing to regulate e-cigarettes at the Federal level to protect public health,
• raising and strongly enforcing minimum age-of-sale laws for all tobacco products, including e-cigarettes,
• incorporating e-cigarettes into smoke-free policies,
• regulating e-cigarette marketing,
• sponsoring high-impact media campaigns to educate the public on the harms of e-cigarettes among young people, and
• expanding research efforts related to e-cigarettes.
In order to achieve these recommendations, Murthy notes that health officials must take a multipronged approach that incorporates parents, school officials, tobacco companies, and others in “protecting our nation’s young people from the consequences of e-cigarette use.”
“We need parents, teachers, health care providers, and other influencers to help make it clear that e-cigarettes contain harmful chemicals and are not okay for kids to use,” Murthy said.
Editor's Note: This article originally appeared on Consumerist.