E-cigarettes have become the most commonly used tobacco products among teens and young adults in the US, the US surgeon general said Thursday, as he called for prevention efforts to “protect our nation’s young people from being harmed by these products.”

The safety of e-cigarettes, which contain nicotine and may contain other chemicals, has been a topic of heated debate, with manufacturers insisting they’re safe and public health groups insisting they are dangerous and are often a gateway to tobacco use by youth.

“It’s essential that we address the alarming rate at which young people are using these new tobacco products,” Surgeon General Dr. Vivek Murthy said Thursday.

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Regardless of safety issues, there is no doubt that e-cigarettes are growing in popularity. E-cigarette use has grown 900 percent among high school students from 2011 to 2015, according to the surgeon general.

In his report Thursday, Murthy said it was “crucial” that progress made in reducing conventional cigarette smoking among youth and young adults “not be compromised by the initiation and use of e-cigarettes.”

Talia Bronshtein/STAT Source: CDC: Youth and Tobacco Use

The surgeon general offered up several recommendations to curb e-cigarette use among youth, including asking educators and health care providers to boost their efforts to raise awareness among teens about the harms of e-cigarettes. He also suggested local governments implement smoke-free air policies that ban the use of both e-cigarettes and traditional tobacco products in certain public places. State and local governments should also enforce licensing of retail supplies.

Talia Bronshtein/STAT Source: CDC: Youth and Tobacco Use

Murthy said he’d also like to see the FDA — which has regulatory authority over e-cigarettes as a tobacco product — continue to keep a close eye on the manufacturing, marketing, and distribution of e-cigarettes. Back in May, the FDA issued a sweeping set of tobacco guidelines that will regulate electronic cigarettes, cigars, and other products for the first time. The rule also prohibits the sale of e-cigarettes to anyone under the age of 18.

In particular, the surgeon general is keeping a close eye on how those products are promoted.

“Many e-cigarette companies are using strategies employed by the traditional cigarette industry,” Murthy said, such as glamorizing products to make them more appealing to teens. “These strategies are working to reach kids,” he warned.

A new rule by the FDA bans sale of e-cigarettes to anyone under the age of 18. Hyacinth Empinado/STAT

Health and Human Services Secretary Sylvia Mathews Burwell echoes the surgeon general’s concerns — and the need to act urgently.

“We have more to do to help protect Americans from the dangers of tobacco and nicotine, especially our youth,” Burwell said. “[This] is creating a new generation of Americans who are at risk of nicotine addiction.”

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