Nicotine experimentation could become nicotine addiction for youth who never used any other tobacco products, USC study suggests 
 
 A new USC study debunks the popular belief that electronic cigarettes are merely a substitute for cigarettes among teens. Instead, the study suggests that some teens who never would have smoked cigarettes are now vaping. 
 
 E-cigarettes, which entered the U.S. market in 2007, vaporize liquids that may or may not contain nicotine. In 2011, about 1.5 percent of high schoolers had vaped in the past 30 days, according to the National Youth Tobacco Survey. Four years later, that number skyrocketed to 16 percent. 
 
 A USC study of 5,490 high school juniors and seniors shows tobacco use among teens in Southern California is on the rise. 
 
 In 2014, about 14 percent of 12th-graders said they had either smoked or vaped in the previous 30 days. A decade earlier -- before e-cigarettes were sold in the United States -- 9 percent of surveyed teens in this age group reported that they had smoked, said Jessica Barrington-Trimis, lead author and a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine of USC. 
 
 "If teenagers who vape are using e-cigarettes instead of cigarettes, we would have expected to see the decline in smoking rates continue through 2014," Barrington-Trimis said. "But what we've seen is a downward trend in cigarette use from 1995 to 2004 but no further decrease in cigarette smoking rates in 2014. The combined e-cigarette and cigarette use in 2014 far exceeded what we would have expected if teens were simply substituting cigarettes with e-cigarettes. The data suggest that at least some of the teens who are vaping would not have smoked cigarettes." 
 
 The study, published on July 11 in the journal Pediatrics, followed five groups of high schoolers who graduated in 1995, 1998, 2001, 2004 and 2014. Researchers collected the history of tobacco use in an individually administered questionnaire. 
 
 Cigarette use is the largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans annually, according to the Centers for Disease Control. 
 
 "An important question in the rapidly evolving landscape of youth tobacco product use is whether e-cigarettes are replacing cigarettes," said Rob McConnell, the study's senior author and professor of preventive medicine at Keck Medicine of USC. "However, use of e-cigarettes by youth who would not otherwise have smoked results in exposure to the hazards of inhaled vaporized liquids and flavorings in e-cigarettes and may result in exposure to nicotine that can damage the adolescent brain." 
 
 USC is one of 14 U.S. research institutions that received National Institutes of Health funding to establish the Tobacco Centers of Regulatory Science. 
 
 What the numbers suggest 
 
 The National Youth Tobacco Survey has reported a long-term decline in teen smoking rates followed by a leveling off between 2014 and 2015. 
 
 The USC study found that the number of 12th-graders in Southern California who had smoked in the past 30 days dropped from 19 percent in 1995 to about 9 percent in 2004 and then leveled off, with the rate of smoking just under 8 percent in 2014. 
 
 But when cigarettes and e-cigarettes were combined, some 14 percent of high school seniors in 2014 said they had smoked or vaped in the last 30 days. 
 
 "Because e-cigarettes are perceived as less harmful and less dangerous than combustible cigarettes, another concern is that teens may be introduced to nicotine use via e-cigarettes," Barrington-Trimis said. "In California, where smoking rates are among the lowest in the country, the increase in vaping, possibly followed by increases in smoking, could erode the progress that has been made over the last several decades in tobacco control." 
 
 A perilous experiment 
 
 In fact, older teens who experiment with electronic cigarettes are six times more likely to try regular cigarettes within about a year when compared to those who have never vaped, reported Barrington-Trimis and her USC colleagues in a study published last month in Pediatrics. 
 
 Although some e-liquid providers say their products do not contain nicotine, this industry has not been regulated until just recently. The U.S. Food and Drug Administration announced plans to regulate all tobacco products -- including e-cigarettes, cigars and hookah tobacco -- in May. Last month, California became the second state, behind Hawaii, to raise the age of tobacco purchase -- including e-cigarettes -- from 18 to 21. 
 
 "E-cigarettes may be recruiting a new group of kids to tobacco use," Barrington-Trimis said. "E-cigarettes may be safer than regular cigarettes for adults who are transitioning from smoking to vaping, but for youth who have never used any other tobacco products, nicotine experimentation could become nicotine addiction." 
 
 ### 
 
 The study was supported by the National Institutes of Health National Cancer Institute and the Food and Drug Administration Center for Tobacco Products (P50CA180905). ||||| Photo 
 
 Many teenagers who never would have smoked cigarettes are now “vaping” with flavored e-cigarettes, leading to a new generation using nicotine at rates not seen since the 1990s, a new study suggests. 
 
 The study, released Monday in the journal Pediatrics, tracked the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014. E-cigarettes do not burn tobacco, but are battery-operated inhalers that heat up and vaporize liquid containing flavors and nicotine, a practice known as vaping. The liquids used in vaping range in taste from traditional tobacco and menthol flavors to fruity and sweet combinations like gummi bear, banana bread and cotton candy. 
 
 When e-cigarettes came on the market in 2007, some public health experts hoped that they would serve as a substitute for traditional tobacco products and lead to declines in tobacco use. 
 
 But the data from the latest study, conducted by researchers at the University of Southern California, tell a different story. E-cigarettes do not appear to have made a dent in regular cigarette use — the number of high school seniors who reported smoking tobacco in the past 30 days has largely plateaued. In 2004, the number of 12th graders who reported smoking tobacco in the past 30 days was 9 percent; in 2014 that number was just under 8 percent. 
 
 But the rate of teenagers using nicotine — either through tobacco cigarettes or e-cigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th-grade smoking rates were 19 percent. 
 
 The numbers suggest that rather than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes instead have enticed an entirely new group of teenagers to use nicotine. While the study focused on California teenagers, researchers say the numbers are consistent with national trends. 
 
 “Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” said Jessica Barrington-Trimis, the lead author of the study and a postdoctoral scholar research associate in the department of preventive medicine at the U.S.C. Keck School of Medicine. All of the teenagers that were expected to be using cigarettes in 2014 are using them, she said, “and then there is a whole group of kids using e-cigarettes on top of that.” 
 
 The amount of nicotine in the liquids used with e-cigarettes — often called “vape juice” — varies, and users can purchase liquid with no nicotine or nicotine content ranging from 3 milligrams per milliliter to 18 milligrams per milliliter or even higher. While earlier studies have suggested that some teens are using nicotine-free vaping liquids, researchers say the majority of teens appear to be using nicotine-infused liquid in their e-cigarettes. 
 
 Dr. Jonathan Winickoff, professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, who wrote an accompanying paper in Pediatrics, said this is the first study of e-cigarette use in adolescents to show such a strong longitudinal sample with such a drastic effect. 
 
 “We had a trend of decreasing nicotine use,” said Dr. Winickoff. “What the e-cigarette has done is halted that decrease in its tracks…. We don’t want a fifth of our high school students graduating with nicotine addiction.” 
 
 While e-cigarettes do appear to be safer than smoking tobacco, they are not risk free. Nicotine disrupts neurotransmitter activity and is highly addictive, particularly in a developing brain. And the liquids contain solvents, formaldehyde and other ingredients that pose health risks when inhaled. 
 
 While it’s true that there are nicotine-free vaping liquids, the e-cigarette industry is not regulated, which makes it hard to know what ingredients are actually in any given product. Though the Food and Drug Administration recently took jurisdiction over e-cigarettes, it will be years before any regulations are put into effect. Currently, many products continue to be made in China with little — if any — oversight by the United States. 
 
 “The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product,” Dr. Winickoff said. “When the product is labeled as no nicotine, they’ve found nicotine. So kids don’t know what they’re getting, and as a pediatrician it really scares me.” 
 
 Not everyone agrees that e-cigarettes pose a significant risk to teenagers. Dr. Michael Siegel, professor of community health sciences at the Boston University School of Public Health, countered that many teenagers say they are using e-cigarettes that contain only flavorings and no nicotine, and therefore are not getting addicted. 
 
 “E-cigarette use among teenagers is a largely social phenomenon,” he said. “The fact that you tend to see teenagers doing this in groups, not out in the cold vaping alone, suggests that e-cigarettes are not addictive.” 
 
 But there is a growing body of research showing that e-cigarettes do serve as a gateway to traditional tobacco products. Last month, the U.S.C. researchers also reported in Pediatrics that adolescents who vape are six times more likely to smoke cigarettes in early adulthood as nonusers. 
 
 “Once kids get hooked on e-cigarettes, they are more likely to go on to become cigarette smokers,” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. ||||| The use of electronic cigarettes by high school students tripled from 2013 to 2014 — a surprising boom that threatens to wipe out hard-won gains in the fight against teen smoking, a new government report says. 
 
 The percentage of American high school students who smoked traditional cigarettes on a regular basis dropped from 15.8% in 2011 to 9.2% in 2014, according to a study by a team from the Centers for Disease Control and Prevention. 
 
 But that drop has been more than offset by increases in e-cigarette use, which increased from 1.5% of high school students in 2011 to 13.4% in 2014, the study says. 
 
 E-cigarettes are now the most popular tobacco product used by both high school and middle school students, the federal data show. 
 
 As a result, overall tobacco use by high school students — including the use of cigars, pipes, hookahs, bidis, snus and other smokeless tobacco — has remained essentially flat, with nearly 1 in 4 students using some kind of tobacco product. 
 
 Among them is Dean Wilson, an 18-year-old who attends Polytechnic High School in Long Beach. Though he has tried regular cigarettes, he said he prefers “vaping” with e-cigarettes because they are new and trendy, and because they come in a variety of appealing flavors. 
 
 He also believes they are less dangerous than traditional cigarettes. “They supposedly have less nicotine,” he said. 
 
 Fellow student Jose Sanchez said he wouldn't use any type of cigarette because he has asthma and smoking would interfere with his ability to play soccer. But he has certainly noticed his classmates using the electronic devices. 
 
 “They're a lot more popular now,” he said. “People want to fit in.” 
 
 With their colorful designs and candy-store flavors, e-cigarettes — battery-powered devices that heat a nicotine solution into a vapor — seem perfectly designed to get kids and teens hooked on nicotine, many public health experts say. The Food and Drug Administration defines e-cigarettes as a tobacco product because they use nicotine. 
 
 Some experts fear e-cigarettes are becoming a “gateway drug” that makes young people more inclined to try traditional cigarettes, cigars or other dangerous products. 
 
 “They're like cigarettes on training wheels,” said UC San Francisco tobacco researcher Stanton Glantz. 
 
 The new study, based on data from the National Youth Tobacco Survey and released Thursday in the CDC's Morbidity and Mortality Weekly Report, doesn't prove that hypothesis. But it isn't exactly reassuring either. 
 
 The CDC study backs up a Monitoring the Future report released in December by the University of Michigan, which found that twice as many eighth- and 10th-graders had used e-cigarettes in the previous month than had smoked traditional cigarettes. E-cigarettes were also more popular among 12th-graders, 17% to 14%. 
 
 The Michigan report was the first to show that e-cigarettes had become teens' tobacco product of choice. 
 
 Their appeal extends to students in middle schools, the new CDC study shows. In 2014, 3.9% of students in grades six through eight were using e-cigarettes. That was well above the 2.5% rate for traditional cigarettes and for hookahs. 
 
 Among the high school crowd, hookahs were the second most popular form of tobacco, with 9.4% of students reporting current use. Regular cigarettes came in third, with a 9.2% use rate, followed by cigars at 8.2%. 
 
 Altogether, 24.6% of ninth- through 12th-graders were regularly using some kind of tobacco product in 2014. 
 
 That equates to more than 3.7 million teens. An additional 910,000 middle school students were regular tobacco users in 2014, or 7.7% of kids in this age group. 
 
 The speed with which electronic cigarettes have swept through schools has alarmed the nation's health experts. In 2011, when the CDC first tracked their use, only 1.5% of high school students said they had used the devices in the previous 30 days. That rate tripled to 4.5% by 2013 before tripling again last year. 
 
 Glantz said he was particularly troubled because “the epidemic was building from the bottom up.” 
 
 Unlike traditional smoking, a habit that has trickled down from adults to kids, e-cigarettes seem to be gaining the strongest foothold with the youngest users and expanding upward, he said. 
 
 He added that psychology studies suggest that many kids who pick up e-cigarettes would never have tried traditional cigarettes. 
 
 “This is explosive growth,” he said. “If we were talking about the spread of any other toxic chemical it would be a public health crisis.” 
 
 Michael Siegel, a professor of community health sciences at Boston University's School of Public Health, said that public health advocates were drawing the wrong conclusion from the study. 
 
 “The CDC should be celebrating that we're seeing a decline in youth smoking,” he said. 
 
 If vaping is a gateway to smoking regular cigarettes, he added, the data would have revealed an increase in their use. 
 
 “We're getting kids off tobacco,” he said. “That's the goal.” 
 
 The FDA has been trying to regulate e-cigarettes since 2009, first as medical devices and later as tobacco products. But legal challenges, a lack of clear-cut data on their health effects and other hurdles have slowed the effort. 
 
 “These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health,” said Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products. 
 
 Last year, the federal agency said it intended to ban e-cigarette sales to minors and require manufacturers to put health warnings on the devices, as is required for traditional cigarettes. These rules have not yet been implemented because the FDA is still reviewing public comments. 
 
 The FDA's proposal did not include other restrictions that might limit e-cigarettes' appeal to young people, such as restrictions on advertising and flavorings. ||||| CLOSE Teen vaping is reaching epidemic levels and FDA is considering regulation to curb it. One proposal would be banning flavoring of e-cigarette liquids. USA TODAY 
 
 In this April 23, 2014, file photo, a man smokes an electronic cigarette in Chicago. (Photo: AP) 
 
 Food and Drug Administration Commissioner Scott Gottlieb on Wednesday declared youth vaping an "epidemic," and said the agency will halt sales of flavored electronic cigarettes if the major manufacturers can't prove they are doing enough to keep them out of the hands of children and teens. 
 
 The FDA says it's giving manufacturers of Juul, Vuse, MarkTen XL, Blu and Logic 60 days to submit “robust” plans to prevent youth vaping. If the agency doesn’t think their plans go far enough, it could order their products off the market. Those five brands make up more than 97 percent of the U.S. market for e-cigarettes, FDA says. 
 
 The FDA is "reconsidering our overall approach" after a review of preliminary data on youth vaping, Gottlieb told USA TODAY. 
 
 "Teenagers are becoming regular users, and the proportion of regular users is increasing," says Gottlieb, a physician. "We’re going to have to take action." 
 
 "No one can look at the data and say there’s no problem," he says. 
 
 More: To juul or not to juul? That's what you should be talking to your teen about 
 
 More than 2 million middle school, high school and college students use the battery-powered devices to heat liquid-based nicotine into an inhalable vapor. E-cigarettes are by far the most popular tobacco product among teens: Nearly 12 percent of high school students and 3 percent of middle school students used the device in the past 30 days, according to the 2017 National Youth Tobacco Survey. 
 
 Some parents want the FDA to go farther. 
 
 Kelli Cogan says her 15-year-old son was able to get free Juul cartridges online last year by using his father's name and birth name and having them shipped to a different address. The Ohio woman says the company offered to block her husband's name from ordering, but she didn't think that was sufficient. 
 
 Juul spokeswoman Victoria Davis says the company now requires an age-verified signature on delivery and has made other changes to protect against distributing e-cigarettes to children under the legal vaping age in their states. 
 
 That's not enough for Jon Ahles of St. Paul, Minnesota. 
 
 "I have two teenagers that are now vape addicts," he says. "The first thing that the FDA needs to do is ban nicotine. These kids do not have a chance."​​​​​ 
 
 The FDA's new approach is much faster than the rule-making process the agency announced in March. That was quickly criticized as too little, too late by public health advocates. 
 
 The brands will no longer be largely immune from regulations simply because they were already on the market in August 2016 when the FDA announced e-cigarettes would be regulated like other tobacco products. 
 
 Companies whose products were ordered off the shelves would have to show they have a net positive public health benefit before resuming sales. 
 
 The FDA also announced the results of its largest enforcement effort yet against e-cigarettes. The agency targeted more than 1,300 online and brick-and-mortar retailers with warning letters or civil penalties for selling to minors. Officials said 131 of the retailers will have to pay penalties. 
 
 Gottlieb told USA TODAY last month that the FDA was weighing the benefits of e-cigarettes in helping adults quit smoking against the risk to young people who become addicted to tobacco through vaping. 
 
 Many adults prefer flavored e-liquid when they are trying to quit. But Gottlieb now says he's prepared to make vaping less attractive to adults if it reduces the harm to teens. 
 
 Gottlieb said the agency could also target "cartridge-based products," such as the USB-sized Juul, which is favored by teens and sold in convenience stores. Adults tend to use bulkier "open tank" vaping products, he said. 
 
 Food and Drug Administration Commissioner Scott Gottlieb, a physician, Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrators Seema Verma at a press briefing on the administration new drug pricing proposals on May 14, 2018 (Photo: JAYNE O'DONNELL, USA TODAY) 
 
 A spokeswoman for Vapers United, a group that promotes vaping as a way to quit smoking, said the FDA's moves could send people back to cigarettes. 
 
 "The FDA needs to be very cautious about the adverse effects that flavoring bans or excess regulation could have on this trend – smokers using vapor as a way to stop consuming cigarettes and move towards a healthier lifestyle," spokeswoman Liz Mair said. 
 
 The companies targeted by FDA struck a conciliatory tone. 
 
 JUUL Labs CEO Kevin Burns said the company "will work proactively with FDA in response to its request." 
 
 "We are committed to preventing underage use of our product, and we want to be part of the solution in keeping e-cigarettes out of the hands of young people," he said in a statement. 
 
 A spokesman for Phillip Morris parent Altria, maker of the MarkTen XL, said the company welcomed the FDA action. 
 
 We "look forward to sharing our thoughts about how to prevent and reduce youth use, an issue we have focused on for decades," spokesman David Sutton said. 
 
 
 
 "We strongly believe kids shouldn’t use any tobacco products and take a number of steps to prevent kids from getting access to all tobacco products," he said. 
 
 Anthony Hemsley, Logic's head of corporate affairs, said the company will work with the FDA "to demonstrate that Logic markets its product only to adults." 
 
 R.J. Reynolds Vapor, maker of Vuse, said it supports "eliminating youth usage of all tobacco products." 
 
 Fontem Ventures, owner of the Blu brand, said it welcomes "the opportunity to demonstrate, and work with the FDA to further strengthen, our youth access prevention policies and procedures. We will continue to work with regulators in the US and elsewhere to implement best practices in all our commercial activities." 
 
 In the past, Burns has warned that restricting flavors “will negatively impact current adult smokers” who want to switch from smoking to vaping. 
 
 He said the company would support “reasonable regulation” to restrict advertising and the naming of flavors such as cotton candy and gummy bear that target children. 
 
 Vaping can also help younger smokers quit. 
 
 Spencer Re of Napa Valley, Calif., says he started vaping five years ago as a senior in high school. That led him to start smoking in college. Cigarettes eventually “completely replaced vaping," he said. When he wanted to quit, he says, he turned back to e-cigarettes. 
 
 Juul has mounted an aggressive advertising campaign, including full-page ads in newspapers, targeting parents with messages about teen vaping. 
 
 The FDA said Wednesday for the first time that some be e-cigarettes might be on the market illegally. Officials said they're investigating some manufacturers for violating rules that require regulators' approval to introduce new products after August 2016. They would not say which companies they are investigating. 
 
 The American Lung Association, the American Academy of Pediatrics and other health groups sued the FDA in March over a delay announced last year in the deeming regulations from August 2018 to 2022. 
 
 Gottlieb said last month that even the 2022 deadline would be a challenge for some manufacturers to meet, so they had "better start now." 
 
 "What we’re living through now are the unintended consequences" of Gottlieb's decision to move the compliance date, says Robin Koval, CEO of the Truth Institute. "Congress gave FDA all the authority and FDA has all the tools they need to regulate this market and they need to do this quickly." 
 
 She's heartened by Gottlieb's new stance on vaping, but worries that giving companies the chance to tell regulators how they plan to prevent teen vaping is like "asking the proverbial fox to guard the henhouse." 
 
 Re says he can't stand the taste of tobacco and cream flavors, so he vaped only fruity flavors. 
 
 He thinks the idea that vaping is a "forbidden substance," more than the flavors, is what makes it more attractive to teens. 
 
 Psychologists worry that vaping in youth signals mental health problems. 
 
 Melissa Sporn, a Fairfax County, Virginia, child psychologist, said teen patients are "self medicating" with e-cigarettes. Usually, she said, it's because they are anxious or depressed. 
 
 "it’s a numbing of those feelings," she said. 
 
 Jack Cao, co-owner of Vapor Solutions DMV is shown at his store in Falls Church, VA. (Photo: Jack Gruber, USA TODAY) 
 
 Jack Cao, who co-owns a chain of vape shops in California, Texas and Virginia, questions whether a ban on the sale of flavored e-liquid would have much impact. 
 
 If stores such as his could not sell flavored e-liquid, he said, it would only encourage a new industry of flavors that users themselves would mix with unflavored liquid. 
 
 Still, he's been bracing for tougher FDA regulations that could dramatically reduce if not eliminate his vaping business. 
 
 He has started a tee shirt business in the back of his Falls Church, Virginia, shop. 
 
 If you are interested in connecting with people online who have overcome or are currently struggling with health problems mentioned in this story, join USA TODAY’s ‘I Survived It’ Facebook support group. 
 
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 (FILES) In this file photo taken on April 18, 2016 smoked cigarettes are seen in an ashtray in Centreville, Virginia. (Photo: PAUL J. RICHARDS, AFP/Getty Images) 
 
 Cigarette smoking has reached the lowest level ever recorded among U.S. adults – and the youth smoking rate dropped even farther, the federal government reported Thursday. 
 
 About 14 percent of U.S. adults, or 34 million people, smoked cigarettes everyday or some days in the previous month, down from 15.5 percent in 2016, according to the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Cancer Institute. The new rate represents a 67 percent decline since 1965. 
 
 About 10 percent of people aged 18 to 24 years smoked cigarettes in 2017, down from 13 percent in 2016. 
 
 That would be heralded as a public health success if so many young people weren't become addicted to nicotine through electronic cigarettes, or vaping. 
 
 Nicotine use overall reflects this: About 20 percent of U.S. adults used a tobacco product last year, through e-cigarettes, chewing tobacco, cigarettes, cigars and hookah. 
 
 Cigarette smoking is the top preventable cause of death and disease in the United States, and is the biggest tobacco-related health problem. 
 
 About 16 million Americans have a smoking-related illness, and about 480,000 die each year. Eliminating smoking in America would eventually eliminate about a third of all cancer deaths, according to the National Cancer Institute. 
 
 David Ashley, a former official of the FDA and CDC, says the new numbers suggest "tobacco control efforts are still on the right track." 
 
 But smoking still has a strong grip on the disadvantaged and other groups, federal data show. More than 40 percent of adults who reported "serious psychological distress" used tobacco. About 27 percent in the LGBTQ community reported tobacco use. 
 
 “The persistent disparities in adult smoking prevalence described in this report emphasize the need for further research to accelerate reductions in tobacco use among all Americans," says Dr. Norman Sharpless, director of the National Cancer Institute. 
 
 Former FDA and CDC official David Ashley, a professor at Georgia State University’s School of Public Health, right, is shown on a teen vaping panel Nov. 1, 2018, sponsored by the advocacy group Truth Initiative. To his right is Dr. Milagros “Mila” Váscones-Gatski. She is a substance abuse counselor for Arlington Public Schools, and to her right is Cornell University student Jack Waxman, who started a group opposed to vaping at his school. (Photo: Davon Harris) 
 
 Vaping was supposed to help smokers transition away from cancer-causing tobacco, and so reduce the smoking rate. Vapers use e-cigarettes to inhale water vapor that contains nicotine. 
 
 But the practice has also drawn alarming numbers of non-smoking teens. 
 
 FDA Commissioner Dr. Scott Gottlieb has said preliminary government data show teen vaping has reached "epidemic" levels. 
 
 He said in September that his agency would demand the major e-cigarette manufacturers prove they are doing enough to keep them out of the hands of children and teens. 
 
 He has threatened to halt sales by manufacturers who fail to comply. An announcement is expected in mid-November. 
 
 Ashley, now a professor at the Georgia State University School of Public Health, says data show that more than 80 percent of smokers who take up e-cigarettes don’t use them regularly. 
 
 These smokers either reject vaping and return to smoking exclusively or use both traditional and e-cigarettes – which dramatically reduces the benefits, Ashley says. 
 
 He says current trends raise "serious concerns." 
 
 "Whether vaping will help reduce or will increase smoking from a population health standpoint is still to be determined," he says. "More needs to be done to reduce the addictiveness of cigarettes and increase the effectiveness of e-cigarettes for helping smokers switch completely to achieve a more substantial public health benefit." 
 
 If you are interested in connecting with people online who have overcome or are currently struggling with health problems mentioned in this story, join USA TODAY’s ‘I Survived It’ Facebook support group. 
 
 CLOSE The JUUL vaporizer's sleek design makes it both wildly popular and hard to spot. USA TODAY 
 
 
 
 
 
 
 
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– With the debut of vaping in the US in 2007, there was hope that teens who smoked would replace old-school cigarettes with e-cigarettes, curbing tobacco use. But a new USC study in the journal Pediatrics has found teens who never would have smoked regular cigarettes are experimenting with vaping. Another USC study finds older teens who try vaping are six times more likely to try a tobacco-filled cigarette than non-vapers, per a press release. "E-cigarettes may be recruiting a new group of kids to tobacco use," says Jessica Barrington-Trimis, lead author of both studies. While e-cigs may seem safer than tobacco, if they come pumped with nicotine (some don't), kids can get addicted. The New York Times notes chemicals in the vaping liquid may be harmful; WebMD adds long-term effects are unknown. Using participants from USC's Children's Health Study, scientists followed 5,490 teens who graduated high school in select years between 1995 and 2015, asking them via questionnaire about their tobacco use. It's true that rates among Southern California teens who said they had smoked over the past 30 days fell significantly from 1995 to 2004 (19% to 9%), and slightly more in the decade after that (a bit less than 8% by 2014). But when teens were asked to include e-cigarettes in their assessments, the smoking rate jumped back up to 14% in 2014. And that's got scientists worried, especially with the prevalence of e-cigarettes that come in kid-friendly flavors such as cotton candy. "E-cigarettes may be safer than regular cigarettes for adults who are transitioning from smoking to vaping, but for youth who have never used any other tobacco products, nicotine experimentation could become nicotine addiction," Barrington-Trimis says.