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Considering the plumes of mist we have become accustomed to, it should come as no surprise that electronic nicotine delivery systems are now smoking the nicotine delivery market.

At the same time the use of traditional smoked tobacco products continues to decline, there is a steep upward line representing the use of the electronic delivery systems.

The alarming truth for health advocates is how young the faces are at the end of those devices.

The Center for Disease Control and Prevention, which has called teen vaping an epidemic, reports that 38 percent of high school students and 13 percent of middle school students have tried vaping.

The CDC also reports that more than two million middle and high school students in the United States report using electronic nicotine delivery systems (ENDS) in the past month.

Genesis Health Group pediatrician Elise Bream, M.D., has noticed the increased use of e-cigarettes and vaping by young users. It is a topic she expects to come up more often with young patients and parents.

“This trend has happened so quickly. It’s disturbing,’’ Bream said. “The studies are clear. Teens are not smoking cigarettes as much as they did in the past, but they are still getting the nicotine of smoking and often at much higher concentrations from these devices.

“The concern from the health perspective will continue to be addiction to nicotine and the long-term health effects that might have, particularly if someone moves from inhaled nicotine from these devices to smoking tobacco.’’

The focus of the sharp spike of use by young people is frequently directed at one manufacturer of these devices.

The 2015 market release of JUUL vaping devices (JUUL Labs) aligns with the sharp spike in use of e-cigarettes. JUUL devices quickly took a dominant position in the market.

Bream said teens appear to be attracted to JUUL devices for several reasons:

• The JUUL devices provide a boost of nicotine traditionally provided by smoked tobacco. The nicotine may create a calming feeling or a feeling of relaxation. But a JUUL “pod’’ is delivering power punch of nicotine. One pod can have the nicotine equivalent of one pack of cigarettes.

• The devices are easily accessible. They are available in dozens of outlets in the Quad-Cities. They can also be purchased online.

• JUUL devices and other ENDS can easily be hidden by young users. The JUUL brand devices look like a computer flash drive.

• JUUL has also been hugely effective with its marketing efforts. The company has masked the natural bitterness of the nicotine with flavored juices, including mango, cucumber, crème and fruit flavors. Critics, including the Food and Drug Administration, believe JUUL has directed marketing at young users.

“I think the flavorings are probably a huge appeal to teens who are trying the devices. The flavorings mask the actual taste of the nicotine,’’ Dr. Bream said. “Banning or at least more highly restricting the flavorings would hopefully curb some of the appeal to teenagers in particular.

“The FDA (Food and Drug Administration) is moving more quickly toward limiting the sale of fruity or ‘kid friendly’ flavorings and is also looking at sales to minors and controlling online sales.’’

The vaping industry counters that the devices offer a transition from smoked tobacco to healthier, less intrusive delivery of the nicotine.

Dr. Bream has other reasons for concern, particularly the use by teens.

“I do think that the devices are designed to be difficult to detect,’’ Dr. Bream added. “They are easy to conceal so they can be used at school and home without others being aware of the use.

“When a device looks like a flash drive, which wouldn’t be atypical to have at school, it isn’t easy to detect when it is used. The device can be out in the open without drawing attention like a pack of cigarettes would.’’

Another concern is that the devices can be “hacked’’ to make it possible to use cannabis oil, or CBD, in the device pods to discreetly get the effect of smoked cannabis.

“Ultimately, I think it will be better if the FDA can ban sales rather than restrict sales of these products,’’ Dr. Bream said. “At the very least there should be better control and review of the long-term effects of inhaling nicotine.’’

For additional information, there are many online resources, including the Centers for Disease Control and Prevention e-cigarettes page at www.cdc.gov

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