When news hit that middle and high school student use of electronic cigarettes has tripled, alarm bells rang. After all, the numbers had doubled the previous year, and further sign of e-cigarettes steaming into the mainstream was that the Oxford Dictionaries 2014 word of the year was \u201cvape\u201d \u2014 the term for an e-cigarette. The annual report of the National Youth Tobacco Survey (NYTS) draws wide news interest. The NYTS is a questionnaire filled out by 22,000 middle and high school students about their tobacco use. The attention primarily focuses on whether they\u2019ve used tobacco in the past 30 days. The glaring and essential question in the survey that remains unanswered: Were those youths vaping with nicotine-laced liquid or simply flavored fluid? E-cigarettes include a vial of fluid that heats by battery to create vapor to be inhaled and exhaled \u2014 hence the term \u201cvaping.\u201d But not all \u201cjuices\u201d contain nicotine, and the level of the known carcinogen varies. \u201cThe NYTS does not ask students whether they use e-cigarettes that have flavorings with nicotine in them,\u201d said Brittany Behm, a spokesperson for the Centers for Disease Control and Prevention (CDC). \u201cThat is a question we may consider in the future.\u201d Seminal Tobacco Study Alarming After two generations of trying to prevent youths from starting the addictive habit of smoking, teen smoking\u2019s at a historic low. And for the first time, this year\u2019s survey, published by the CDC and the Food and Drug Administration\u2019s (FDA) Center for Tobacco Products\u2019 Morbidity and Mortality Weekly Report, found that use of e-cigarettes surpassed use of all tobacco products. Overall tobacco use remained the same. The report labels any use on at least one day in the prior 30 days as \u201ccurrent use.\u201d That number for high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014 \u2014 up from 660,000 to 2 million high school youths. Perhaps most stunning was tobacco use among middle school students, who reported that, on at least one day in the prior month, their use \u201cmore than tripled from 1.1 percent in 2013 to 3.9 percent in 2014 \u2014 an increase from approximately 120,000 to 450,000 students,\u201d according to the CDC\u2019s study results. A Call to Action The director of the FDA\u2019s Center for Tobacco Products says that the new findings show public health officials need to up their game. \u201cIn today\u2019s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened,\u201d Mitch Zeller, JD, director of the FDA\u2019s Center for Tobacco Products, says in a prepared response to the findings. \u201cThese staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.\u201d Anti-smoking advocates talked about the need for public education campaigns and parental attention to what their kids may be doing without knowing its potential health risks. \u201cWe want parents to know that nicotine is dangerous for kids at any age, whether it\u2019s an e-cigarette, hookah, cigarette or cigar,\u201d said CDC director Tom Frieden, MD, MPH. \u201cAdolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.\u201d Smoking is blamed for nearly a half-million premature deaths and diseases every year, and the quit rate remains disturbingly low. About 90 percent of all smokers tried their first cigarette as a teenager, and three of every four teen smokers kept smoking as adults, according to the 2012 U.S. Surgeon General\u2019s Report. A Positive Take on the Data Michael Siegel, MD, professor in the Department of Community Health Sciences at Boston University School of Public Health, has 25 years of experience in the field of tobacco use reduction. A frequent critic of the federal government\u2019s smoking cessation efforts, He reads the data positively. Dr. Siegel, who worked two years for the CDC\u2019s Office on Smoking and Health and testified in the landmark lawsuit that resulted in a historic $145 billion verdict against the tobacco industry, doesn\u2019t dispute the latest survey numbers. Yet he argues in his weekly blogs that the NYTS falsely concludes that all e-cigarette use is the consumption of nicotine. Siegel asserts that the CDC fails to see what he calls \u201can apparent connection\u201d between the drop in youth smoking and the rise in e-cigarettes. He also notes that the actual numbers, despite the rapid increase, are still relatively small. Researchers in an April 2015 Healthline article were asked the question, \u201cDoes switching to e-cigarettes make your body any healthier?\u201d The jury, they said, is still out. \u201cWe just don\u2019t have the data,\u201d said Dr. Jonathan Samet, MD, MS, a pulmonary physician and epidemiologist at the University of Southern California. Dr. Samet, scientific editor of the 2014 Surgeon General Report on smoking, told Healthline: \u201cGetting into issues of long-term harm reduction, it\u2019s something we need to sort through.\u201d One area of concern is the wild variability of the e-cigarette liquid, or juice. It may contain nicotine or not, and there\u2019s no standardization over concentrations yet. The CDC points to other research that counters Siegel\u2019s position on vaping as a gateway to nicotine addiction. Are E-Cigarettes a Gateway to Addiction? Whether or not e-cigarettes might falsely induce juveniles to view them as benign and then get a new generation of youth addicted to a cancer-causing practice is a central point in the ongoing debate over vaping. Could they be a gateway to more powerful and deadly nicotine addiction? What\u2019s more, using e-cigarettes in public places while the final health verdict remains out has prompted cities around the U.S. to ban vaping outside private property. \u201cTwo studies, one from the U.S. at the University of California (UC)-San Diego and another from the U.K. at Kings College London have reported that smokers who use e-cigarettes are less likely to quit smoking cigarettes,\u201d Behm said. The UC-San Diego study, published in the American Journal of Public Health just days before the CDC report, looked at whether California smokers who used e-cigarettes were more likely to quit after one year than smokers who had never used e-cigarettes. It concluded: \u201cSmokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings\u2026need to be confirmed by longer-term cohort studies.\u201d To learn more about preventing kids from using tobacco, visit BeTobaccoFree.gov.