Vaping has grown in popularity in recent years – but not among the people for whom it was intended. Instead of adults who try to stop smoking, young people who have never picked up a cigarette now steam in record numbers.

According to a new Vital Signs report published by the Centers for Disease Control and Prevention, 4.9 million high school students and high school students used tobacco in 2008, an increase of 3.6 million in 2017. E-cigarettes were the most popular tobacco product. in children and adolescents.

The report follows a survey by the National Institutes of Health from 2018 on alcohol consumption among American adolescents. It found the number of high school seniors who said that they formed nicotine in the past 30 days since 2017 doubled – from 11 percent to nearly 21 percent. That was the largest increase ever recorded in a substance in the 43-year history of the research. And it meant that a quarter of students from the 12th class now, at least now and then, use a nicotine device that is so new that we have no idea what the long-term health effects of using will be.

The extremely rapid uptake of nicotine delivery devices by young people is one of the reasons why Scott Gottlieb, director of the Food and Drug Administration, asked for stronger regulations on Monday. "Based on a growing number of evidence, I fear that the youth trend will continue in 2019, forcing us to make some tough decisions about the regulatory status of e-cigarettes," he said in a statement. "The signs we see are not encouraging."

The reason for the concern: Nicotine is a highly addictive substance and can immediately cause harmful side effects in the developing brain and bodies of young people. There are indications that exposure to nicotine may stimulate the developing brain to become more sensitive to drug use disorders later on. Trying to stop nicotine can lead to severe withdrawal symptoms, such as nervousness, restlessness, anxiety, drowsiness and fatigue.

There are also strong indications of a possible long-term effect: that vapen can stimulate children to smoke. "After years of progress in reducing cigarette smoking for young people, today's report … shows a stall to reduce the use of cigarettes in youth and possibly even a revival among high school students," Matthew Myers, Chairman of the Campaign for Tobacco Free Children, said in a statement. (That's because smoking in high school went from 7.6 percent in 2017 to 8.1 percent in 2018.)

"The children who use e-cigarettes are children who have rejected conventional cigarettes, but do not see the same stigma associated with the use of e-cigarettes," Gottlieb added. "But now, after exposure to nicotine via e-cigs, they will smoke earlier."

This is perhaps only the beginning. Like the cigarette industry before, vets companies have found effective ways to market their goods for young people. The way they design and pitch their products has a double fist: they are both high-tech and highly addictive. That is the rest of the regulators who have struggled to keep up and are a big question mark about what dirty nicotine could mean for the health outcomes of this new generation.

The way nicotine is sold has changed

To understand the wave of youths among young people, you need to understand Juul, the popular – and controversial – e-cigarette, many of which claim that the evaporation of nicotine goes viral.

The stated mission of the company is "to improve the lives of the world's one billion adult smokers." Created by two former smokers and graduates of the Stanford design (one of which also worked as a design engineer at Apple), the duo wanted to make a device that looked sleek and attractive:

If they could not find an attractive alternative to cigarettes, [James Monsees and Adam Bowen] recognized a pioneering opportunity to apply industrial design to the smoking industry, which had not evolved materially in more than a hundred years.

So they designed an e-cigarette that could easily be mistaken for a USB stick and in the palm of the hand.

But here's the thing: the device is not only smooth, but the pods contain as much nicotine as one to two packs of cigarettes. Juul also contains three times the permitted nicotine content in the European Union. That is why Juul can not be sold there.

So the appeal of Juul – with its high-tech design – is "aggravated by its addictiveness," said Michael Eriksen, Dean of the School of Public Health at Georgia State University and a former director of the Centers for Disease Control and Prevention & # 39; s Office on Smoking and Health, "and I think that explains the speed of admission."

In 2017, the US market grew 40 percent to $ 1.16 billion, with much of that growth driven by Juul.

Starting in March, Juul accounted for more than half of all e-cigarette sales in the US retail market, according to Nielsen data. Since it has only been on the market since 2015 and hundreds of other devices are available to consumers, Juul's market share is enormous.

Marketing nicotine explicitly to the youth is not new. In the nineties, when Eriksen was a witness expert for the Federal Trade Commission's crackdown on Big Tobacco's marketing of cigarettes to young people, he explained that tobacco manufacturers such as Reynold and Marlboro were targeting their ads to young people. "They consolidated themselves around the images of the cowboy, [signaling] independence, "he said.

But what is new, said Eriksen, is "this combination of innovation, social media spread, and the fact that it is unfortunately addictive at the same time."

A recent analysis of Juul's early ads, from Stanford, showed that Juul used social media influencers and advertisements that were deliberately targeted at young people.

An unscientific study of high school students and teachers confirmed Juel's virality. "I do not recall a fad, legal or illegal, in this way," said Meg Kenny, the assistant head of the school at the Burr and Burton Academy in Manchester, Vermont, who worked in education for 20 years. April. Students at her school were Juuling in bathrooms, in the classroom and on the bus. Because it was against the rules of the school, they also hid the devices in ceiling tiles and in their braces and undergarments.

Supervisors struggle to keep up

The wave of teen-age has left addiction specialists with the question of how young people who want to stop can best be helped. It also ensures that health regulators react to the trend in a cramped and slow manner.

This is the mystery: it is true that e-cigarettes have potential to help adult smokers find a less lethal alternative. Therefore, they are generally considered as possible tools to limit damage. Regulators, however, struggled to find a balance between limiting the acceptance of e-cigarettes in minors and helping smokers quit. In the meantime, juvenile evaporation exploded.

In July 2017, the FDA left the compliance deadline for the regulation of e-cigarette products until 2022. This gave the industry another five years to submit public health applications that show that their products are safe alternatives to conventional cigarettes and that they were not unnecessarily focused on minors.

Gottlieb set the delay as a way to give manufacturers the time to keep up with the new laws, while ensuring that smokers had access to cigarette alternatives that could save their lives. But some health advocates saw it in a different way: as a giveaway for the animal industry and an opportunity for e-cigarette manufacturers to further expand their market share among children at a time when the use of e-cigarettes by teenagers has overshadowed conventional cigarette use.

It turns out that those lawyers might have been right. "I do not want anyone to think that I'm against the harm-reduction potential of these adult devices," said Surgeon General Jerome Adams on Politico & # 39; s Pulse Check podcast in December, in which he explains his call for new regulations that can curb the youths, including taxes and vaping bans in the home. "But 3 percent of adults use these devices – [and] 20 percent of high school students use these devices. "

More recently, the FDA has taken action against the use of Juul and the use of e-cigarettes for teenagers – but has not changed the compliance deadline. In April, the FDA took the unusual step of requiring Juul Labs to submit documents about its marketing and research and what it knows about Juul use among young people.

In May, the agency followed by sending requests for information to four other e-cigarette makers who also appear to be sold to young people.

In November, the agency said it would restrict the sale of flavored e-cigarettes in stores and online – although it would not be immediately ban-vape in physical retailers, a move that was generally expected after FDA leaked reports news.

And some wish the FDA would go further. "The mass marketing of cigarettes, a very sophisticated, addictive and faulty nicotine delivery system that annually kills more than 7 million people worldwide, is an abuse of corporate power and a violation of human rights," says Laurent Huber, Executive Director of ASH, a non-profit organization against tobacco, in November. "Ban on menthol is a step in the right direction, but it's time to go a step further and take cigarettes from the market to prevent millions of unnecessary deaths."

I checked back with Meg Kenny, the assistant head of the school at the Burr and Burton Academy in Vermont, about Juuling on her campus. She says that it seems to have cooled down this winter. While 95 percent of the disciplinary violations at school related to Juul last fall and spring, 50 percent was this fall.

Perhaps the awareness and the hard action have an impact. Or perhaps the Juulers have switched to cigarettes or are they better at hiding the habit. We will give a preliminary answer to the next year's youth tobacco surveys.

For more information about Juul and e-cigarettes, read our explanation, listen to the episode of May 3, 2018 Today, explained, and look our Vox video here.