THE ISSUE

U.S. Surgeon General Jerome Adams issued a rare and severe advisory on Tuesday: “(I) am emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use. The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is a cause for great concern. We must take action now to protect the health of our nation’s young people.”

We appreciate the surgeon general seizing upon the gravity of this moment, and we hope his urgent message doesn’t get lost in the holiday hubbub.

The use of e-cigarettes by our young people is an epidemic.

We’ve been urging action on this issue since at least 2015, when we wrote: “Concern is growing over the rising popularity of e-cigarettes among young people at a time when cigarette smoking is declining.”

To be clear: Most e-cigarettes contain nicotine, which has documented health risks, and, additionally, multiple studies suggest that teens who vape are more likely to try regular cigarettes.

This topic is very much in the news these days:

On Monday, the results of an annual federal survey on teen smoking, drinking and drug use indicated that twice as many high school students used e-cigarettes this year as last year — an unprecedented jump in the 44-year history of the survey. Experts attributed the jump, according to The Associated Press, “to newer versions of e-cigarettes, like those by Juul Labs Inc. that resemble computer flash drives and can be used discreetly.”

“They can put it in their sleeve or their pocket. They can do it wherever, whenever,” Trina Hale, a junior at South Charleston High School in West Virginia, told the AP. “They can do it in class if they’re sneaky about it.”

On Tuesday, the surgeon general released the aforementioned advisory and a multimedia presentation on SurgeonGeneral.gov. (More about that in a moment.) In an interview, Adams singled out Juul, which now controls an estimated 75 percent of the U.S. e-cigarette market via its marketing of their product as a “high-tech gadget for hip, attractive young people,” the AP wrote. Each Juul cartridge, or pod, has as much nicotine as a pack of 20 cigarettes. And Adams warns that Juul’s liquid nicotine mixture “is specially formulated to give a smoother, more potent nicotine buzz.”

The potent buzz can promote nicotine dependence after just a few hits, Adams said. And that easy dependence can lead to a devastating lifelong habit.

On Thursday, tobacco titan Altria (formerly Philip Morris) spent nearly $13 billion on a 35 percent stake in Juul, moving into the nicotine-based vaping market and realigning for a future in which, according to CEO Howard Willard, “smokers overwhelmingly choose non-combustible products over cigarettes.”

A new battle

History repeats itself, it seems. After decades of decline in smoking by Americans and major court victories against tobacco companies, a similar battle against e-cigarettes is now upon us.

And our teenagers are on the front lines. One key skirmish has already been won, at least. Last month, Juul — in anticipation of proposed restrictions by the Food and Drug Administration — shut down its Facebook and Instagram accounts and ended in-store sales of its flavored pods, which critics say were a direct pitch to young people, even though federal law bars the sale of e-cigarettes to those under 18.

But an uphill battle remains. About 3.6 million U.S. teens are now using e-cigarettes — that’s 1 in 5 high school students and 1 in 20 middle-schoolers — the federal government says.

Adams’ advisory materials on the surgeon general website include some good and commonsense advice about how to steer children away from e-cigarettes. He writes: “The good news is that we know what works to effectively protect our kids from all forms of tobacco product use, including e-cigarettes.”

Here are some strategies that Adams highlights:

— Parents should learn about the different shapes and types of e-cigarettes, set a good example by being tobacco-free and talk to their children about why e-cigarettes are harmful.

— Educators should “develop, implement, and enforce tobacco-free school policies and prevention programs that are free from tobacco industry influence, and that address all types of tobacco products, including e-cigarettes.”

— Health professionals should ask specifically about e-cigarettes when screening patients for the use of tobacco products and should educate patients about the risks of all tobacco products for young people. (Nicotine use “can impact learning, attention and memory, and it can prime the youth brain for addiction,” Adams says.)

— Local and state governments should assure that laws governing smoke-free environments include e-cigarettes and they should aggressively enforce laws banning retail sales of e-cigarettes to minors.

We urge state government to fund programs to prevent teens from starting the vaping habit. It would certainly be appropriate to deploy funds from the 1998 Tobacco Master Settlement Agreement for this initiative.

This is an issue everyone needs to come together on, before the underage e-cigarette epidemic gets worse.

Nicotine is dangerous and addictive, no matter what form it comes in. The difficult truth is that we failed to nip children’s use of e-cigarettes and vaping products in the bud. But, with some concerted effort, we can stub it out before it gets much further.