By Jamie Ducharme
December 18, 2018

With teen vaping rates at an all-time high, U.S. Surgeon General Jerome Adams took the rare step Tuesday of issuing a public health advisory to address the “epidemic” of youth e-cigarette use, and propose prevention strategies ranging from better education to legal restrictions on the products’ 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,” Adams said in the advisory. “We must take action now to protect the health of our nation’s young people.”

E-cigarettes, which are legally available only to those older than 18, create an aerosol by heating a reservoir of typically nicotine-packed liquid. The full health impact of their use is not clear, but research has shown that they put young people at risk of nicotine addiction and use of other tobacco products, making them a source of concern for public health officials and lawmakers alike — especially since their use is soaring among teenagers.

Federal data for 2018 released Monday, the day before Adams’ advisory was issued, showed that nearly 40% of high school seniors had used an e-cigarette during the prior year. Use among all high school students, according to federal data, increased by 78% between 2017 and 2018, meaning about 20% of high school students currently vape.

In light of these numbers, Adams in his advisory — which singled out top manufacturer Juul by name — urged parents, teachers and doctors to learn about vapes and try to keep them out of kids’ hands. In addition, he called on states, communities, tribes and territories to consider implementing indoor e-cigarette bans, taxing the sale of e-cigarettes and restricting their availability to young people at retail stores.

The Food and Drug Administration (FDA), a vocal opponent of youth e-cigarette use, is already working on the last point. In November, the agency issued new regulations that severely restricted the sale of flavored e-cigarettes — which are thought to be especially appealing to kids and teenagers — at all-ages retail stores such as gas stations and convenience stores. It has also been working with leader manufacturers, such as Juul, to understand why these products are so appealing to young people.

Juul in November vowed to stop selling most of its flavored pods in retail stores, and wiped its U.S. Facebook and Instagram accounts, which have been criticized for appealing to youth users. In a statement provided to TIME, spokesperson Victoria Davis said the company “shares a common goal with the Surgeon General and other federal health regulators — preventing youth from initiating on nicotine. We are committed to preventing youth access of Juul products. We cannot fulfill our mission to provide the world’s one billion adult smokers with a true alternative to combustible cigarettes if youth use continues unabated.”

The new surgeon general’s advisory is only the fourth in 10 years and the second issued so far in Adams’ term, following one in April on the need to expand use of opioid-overdose-reversing naloxone. The announcements are reserved for pressing public health issues. As such, Adams used the advisory to underscore the importance of wide-ranging prevention efforts that span the health, education and regulatory arenas.

“We must take aggressive steps to protect our children from these highly potent products that risk exposing a new generation of young people to nicotine,” Adams said. “To achieve success, we must work together, aligning and coordinating efforts across both old and new partners at the national, state, and local levels. Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes.”

Write to Jamie Ducharme at jamie.ducharme@time.com.

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