U.S. surgeon general warns of teen risks from e-cigarettes

WASHINGTON (AP) — The government's top doctor is taking aim at the best-selling electronic cigarette brand in the U.S., urging swift action to prevent Juul and similar vaping brands from addicting millions of teenagers.

In an advisory Tuesday, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take "aggressive steps" to keep children from using e-cigarettes. Federal law bars the sale of e-cigarettes to those under 18.

For young people, "nicotine is dangerous and it can have negative health effects," Adams said in an interview. "It can impact learning, attention and memory, and it can prime the youth brain for addiction."

Federal officials are scrambling to reverse a recent explosion in teen vaping that public health officials fear could undermine decades of declines in tobacco use. An estimated 3.6 million U.S. teens are now using e-cigarettes, representing 1 in 5 high school students and 1 in 20 middle schoolers, according to the latest federal figures.

Separate survey results released Monday showed twice as many high school students used e-cigarettes this year compared to last year.

E-cigarettes and other vaping devices have been sold in the U.S. since 2007, growing into a $6.6 billion business. Most devices heat a flavored nicotine solution into an inhalable vapor. They have been pitched to adult smokers as a less-harmful alternative to cigarettes, though there's been little research on the long-term health effects or on whether they help people quit. Even more worrisome, a growing body of research suggests that teens who vape are more likely to try regular cigarettes.

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Employee at Cloud 10, an e-cigarette store in Simi Valley, CA, demonstrates the type of smoke, with no smell, comes out of an electric cigarette. Sales are Booming at this store.

(Lynne Gilbert via Getty Images

A customer exhales vapor while smoking an electric cigarette at the Betamorph E-Cigs store in Albuquerque, New Mexico, U.S., on Saturday, Dec. 10, 2016. Sales in the U.S. vapor-device market are projected to rise by 21% annually through 2020, based on Euromonitor Passport data.

(Sergio Flores/Bloomberg via Getty Images)

An e-cigarette store in Simi Valley, CA, called Cloud 10, displays various types of electric cigarettes juice flavors for sale. Sales are Booming at this store.

(Lynne Gilbert via Getty Images)

Indonesian teenager exhaling smoke from Electric Cigarettes (e-cigarettes) as seen in Medan, North Sumatra, Indonesia on December 5, 2014 night. Electric cigarettes (e-cigarettes) are increasingly popular in Indonesia, especially among teenagers. In fact, cigarettes are actually more harmful than regular cigarettes with an increasing number of patients with poisoning after using electronic cigarettes and nicotine liquid continues to increase. The World Health Organization (WHO) notes, electronic cigarette brand has been produced in 466, 8,000 taste, spending budget of US $ 3 billion.

(Photo by Ivan Damanik/NurPhoto) 

Gdynia, Poland 29th, Dec. 2015 Polish Ministry of Health plans to ban electronic cigarettes sales to persons under the age of 18, restrictions on advertising and promotion and to introduce to them technical requirements. The new Tobacco Control law will come into force in the 2nd quarter of 2016. Pictured: Lady smokes electronic cigarette.

(Michal Fludra/Corbis via Getty Images)

Kiradech Aphibarnrat of Thailand smokes an electric cigarette during day two of the World Cup of Golf at Kingston Heath Golf Club on November 25, 2016 in Melbourne, Australia.

(Photo by Quinn Rooney/Getty Images)

Electric cigarette 'juice' w/various flavors.This is at Cloud 10 in Simi Valley, CA This brand is the most popular at this store. Santa Monica just passed the law no e-cigarettes allowed anywhere. Business is booming at this location.

(Lynne Gilbert via Getty Images

Mitchell Baker who works at the Vapour Place a vaping shop in Bedminster, exhales vapour produced by an e-cigarette on December 30, 2016 in Bristol, England. Recent figures released by the e-cigarette industry has claimed that there as many as 1700 vaping shops across the country, with two new ones opening each day catering for the estimated three million vapers in the UK. The popularity of e-cigarettes has boomed in the last ten years, as it is seen by many as a healthier alternative to traditional cigarettes, however some critics say the devices can carry the same risks as smoking especially as the long term affects are yet to be known.

(Matt Cardy/Getty Images)

E-cigarette merchandise is displayed for sale at the Vapour Place a vaping shop in Bedminster, on December 30, 2016 in Bristol, England. Recent figures released by the e-cigarette industry has claimed that there as many as 1700 vaping shops across the country, with two new ones opening each day catering for the estimated three million vapers in the UK. The popularity of e-cigarettes has boomed in the last ten years, as it is seen by many as a healthier alternative to traditional cigarettes, however some critics say the devices can carry the same risks as smoking especially as the long term affects are yet to be known.

(Photo by Matt Cardy/Getty Images)

A reveller dressed in a Father Christmas costume smokes from an electronic cigarette device as he takes part in Santacon outside Euston Station on December 10, 2016 in London, England. Santacon is an annual parade taking place in cities around the world and sees revellers dressed in Father Christmas costumes take to the streets to spread seasonal cheer.

(Photo by Jack Taylor/Getty Images)

Flavored vape juice bottles are displayed for sale at the Betamorph E-Cigs store in Albuquerque, New Mexico, U.S., on Saturday, Dec. 10, 2016. Sales in the U.S. vapor-device market are projected to rise by 21% annually through 2020, based on Euromonitor Passport data.

(Sergio Flores/Bloomberg via Getty Images)

A woman smokes an electronic cigarette during the Vapexpo 2015 Moscow, at Sokolniki Exhibition Center on December 05, 2015, in Moscow, Russia.

(Photo by Sefa Karacan/Anadolu Agency/Getty Images)

This picture taken on November 19, 2015 shows bottles of concentrated flavors displayed at a vape shop in Kuala Lumpur. Vaping' is soaring in popularity in Malaysia, the largest e-cigarette market in the Asia-Pacific region, but authorities are threatening to ban the habit in for health reasons -- a move that has sparked anger from growing legions of aficionados.

(MOHD RASFAN/AFP/Getty Images)

A man smokes an E-Cigarette in the Vape Lab coffee bar, on August 27, 2014 in London, England. The Department of Health have ruled out the outlawing of 'e-cigs' in enclosed spaces in England, despite calls by WHO, The World Health Organisation to do so. WHO have recommended a ban on indoor smoking of e-cigs as part of tougher regulation of products dangerous to children.

(Photo by Dan Kitwood/Getty Images)

This picture taken on November 19, 2015 shows a worker (R) inspecting a coil, the metal heating element in an e-cigarette that produces vapour from e-juices, at a vape shop in Kuala Lumpur. Vaping' is soaring in popularity in Malaysia, the largest e-cigarette market in the Asia-Pacific region, but authorities are threatening to ban the habit in for health reasons -- a move that has sparked anger from growing legions of aficionados.

(MOHD RASFAN/AFP/Getty Images)

A woman smokes an electronic cigarette during the Vapexpo 2015 Moscow, at Sokolniki Exhibition Center on December 05, 2015, in Moscow, Russia.

(Photo by Sefa Karacan/Anadolu Agency/Getty Images)

A customer smokes an E-Cigarette at Digital Ciggz on January 28, 2015 in San Rafael, California. The California Department of Public Health released a report today that calls E-Cigarettes a health threat and suggests that they should be regulated like regular cigarettes and tobacco products.

(Photo by Justin Sullivan/Getty Images)

E-Cigarettes are sold at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. The Department of Health have ruled out the outlawing of 'e-cigs' in enclosed spaces in England, despite calls by WHO, The World Health Organisation to do so. WHO have recommended a ban on indoor smoking of e-cigs as part of tougher regulation of products dangerous to children.

(Photo by Dan Kitwood/Getty Images)

In this photo illustration, a man smokes an E-Cigarette at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. The Department of Health have ruled out the outlawing of 'e-cigs' in enclosed spaces in England, despite calls by WHO, The World Health Organisation to do so. WHO have recommended a ban on indoor smoking of e-cigs as part of tougher regulation of products dangerous to children.

(Photo by Dan Kitwood/Getty Images)

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Adams singled out Silicon Valley startup Juul. The company leapfrogged over its larger competitors with online promotions portraying their small device as the latest high-tech gadget for hip, attractive young people. Analysts now estimate the company controls more than 75 percent of the U.S. e-cigarette market.

The surgeon general's advisory notes that each Juul cartridge, or pod, contains as much nicotine as a pack of cigarettes. Additionally, Adams states that Juul's liquid nicotine mixture is specially formulated to give a smoother, more potent nicotine buzz. That effect poses special risks for young people, Adams says.

"We do know that these newer products, such as Juul, can promote dependence in just a few uses," Adams said.

Juul said in a statement that it shares the surgeon general's goal: "We are committed to preventing youth access of Juul products."

Last month, San Francisco-based Juul shut down its Facebook and Instagram accounts and halted in-store sales of its flavored pods. The flavors remain available via age-restricted online sales. That voluntary action came days before the Food and Drug Administration proposed industrywide restrictions on online and convenience store sales of e-cigarettes to deter use by kids.

Adams recommends parents, teachers and health professionals learn about e-cigarettes, talk to children about the risks and set an example by not using tobacco products.

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The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.

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