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By Maggie Fox

Teen vaping has become a significant public health threat, the Surgeon General said Tuesday, and an all-hands-on-deck response is needed to fight it.

A survey released Monday showed 37 percent of seniors have tried vaping, up from just under 28 percent in 2017.

Dr. Jerome Adams released a rare Surgeon General’s advisory calling teen e-cigarette use an epidemic and calling for “aggressive steps” to fight it, including age limits, taxes and restricted sales.

“The new report is truly shocking,” Adams told NBC News.

“And it's why, today, I'm issuing just the fourth Surgeon General's advisory in over 10 years, raising awareness about what is truly an epidemic. And I don't use that word lightly,” Adams added.

“There is an epidemic of use of e-cigarettes going – a 78 percent increase in high schoolers using these products in just the past year. For the first time in over forty years, we've seen a doubling of the rate of use of a substance in just over a year.”

Teen may not realize that e-cigarettes deliver nicotine, sometimes an extremely hefty dose. Juul, the most popular vape product by far among teens, offers no nicotine-free flavors.

“A typical Juul cartridge, or ‘pod,’ contains about as much nicotine as a pack of 20 regular cigarettes,” Adams said in his official statement.

“These products also use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes,” he added.

“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.”

The Food and Drug Administration has announced a series of moves, including proposals that would keep most flavored vape products out of reach for teenagers and efforts to limit online sales. The FDA has tried to enlist the cooperation of e-cigarette companies, but has threatened an outright ban if the efforts don’t work.

While e-cigarettes might help some adult smokers quit using the more dangerous combustible tobacco cigarettes, they’re of no benefit at all to teens, the FDA and Adams say. And studies show that teens who vape are more likely to also try burnt cigarettes.

Nicotine is not only extremely addictive, but it is dangerous in its own right. “Nicotine is uniquely harmful to young and developing brains that can cause learning, attention and memory problems, and it can prime the brain for addiction in the future,” Adams said.

Adams has no regulatory powers. But as Surgeon General, he takes on the official role as the nation's top doctor and adviser on health matters.

“We issue surgeon general advisories at times when there's a significant public health threat and when we need an all-hands-on-deck response to that threat," he said.

Parents need to talk to their children about the dangers of vaping and model healthy behavior, Adams said. But cities, states and counties also need to do their part with laws and regulation, “including e-cigarettes in smoke-free indoor air policies, restricting young peoples’ access to e-cigarettes in retail settings, licensing retailers, implementing price policies, and developing educational initiatives targeting young people,” Adams said.

Governments also need to restrict advertising, he said.

The FDA has proposed a federal age limit of 18 to buy e-cigarette products. The American Heart Association says that's a good start. "But more must be done in the face of rapidly rising e-cigarette use among youth," American Heart Association CEO Nancy Brown said in a statement.

"The FDA’s recent announcement that it plans to restrict marketing and sales of flavored tobacco products must be followed by immediate, concrete action that sends an unmistakable message that the tobacco industry’s relentless targeting of our nation’s children will no longer be tolerated.”

Doctors at the MD Anderson Cancer Center applauded Adams’ statement.

“There is clear evidence that these products are not safe for our young people,” said MD Anderson president Dr. Peter Pisters.

“These are significant actions necessary to curb the disturbing trends we’re seeing with teenager and young adults using these products,” added Dr. Ernest Hawk, who heads the hospital’s cancer prevention wing.

One college is already acting. Skidmore College in New York will ban all use of any cigarettes or e-cigarettes, anywhere on its campus, starting Jan. 1.

“We included e-cigarettes and vaping devices in the policy because nicotine in any form is highly addictive,” said Cerri Banks, dean of students at the college.

Tobacco use has plummeted in the U.S. but still remains the No. 1 cause of preventable deaths, mostly from heart disease, cancer and lung disease.