There was a thick white line running about ten feet from the back of my high school in the 1980's. Its purpose was to designate an area where students who needed to smoke during breaks could go between classes. It was a sign that the school had capitulated to the fact that some high school students would smoke and it was best they do it outside rather than filling up the bathrooms with smoke.

Times have changed and though it has taken the past forty years to curb teenage smoking rates, it has happened. Today's teenagers are well aware of the dangers of smoking thanks to public information campaigns and making it more expensive to smoke. The rate for cigarette smoking of teenagers according to the National Institute on Drug Abuse is under 4% for daily smoking and 23.8% for lifetime use. Both are at historic lows.

The same cannot be said for vaping as the teenage rate of use has skyrocketed over the past couple of years and garnered plenty of media attention. At this point, roughly a third of high school students have vaped. The majority of teen vaping is using flavored juice or nicotine. Around 13% of teenagers' vape THC which is the main psychoactive ingredient of marijuana. It is the illegal THC cartridges that seem to have caused the outbreak of vaping related cardiovascular incidents recently.

Like cigarette companies decades ago, vaping companies enticed teenagers to use their products by offering appealing flavors like mango and watermelon. A recent study in the journal Pediatrics found that teens who vaped flavors other than tobacco and menthol were more likely to maintain their habits six months later. Not only do teens continue to use flavored vapes longer, they will typically take more puffs per use.

This all increases the odds that teenagers who vape will get addicted to nicotine. Nicotine has a negative impact on teens' brain development and vaping also exposes them to toxic chemicals and metals. Frequent vaping increases the odds that teenagers will move on to using cigarettes.

Teen use of vaping is mirroring that of previous generations of teenagers who smoked cigarettes. Public health and governmental organizations initially ignored vaping use among teenagers which allowed companies that produced vaping related products to thrive. Juul is one example of a company that did very well as the vaping market grew. Much of the growth was due to effective advertising and a product that was viewed to be a safe alternative to cigarette smoking.

It is easy to see why teenagers would begin vaping. They get an affect from using nicotine or THC juice which makes is an appealing activity. In a recent survey by Common Sense Media, 80% of all teens reported being exposed to vaping activities daily. A third of teens reported seeing classmates' vaping in school on a daily basis. This level of prevalence creates a norm that vaping is socially acceptable and increases the likelihood that teens will try it.

Social media adds to the perception that vaping is a cool and acceptable behavior. Around 75 percent of teens using Instagram or Snapchat reported seeing posts that included vaping. A lot of the posts regarding vaping are in the form of ads.

There is some good news regarding teen vaping. Many of the ads that teens see on social media are about the risks associated with vaping. Half of the teens in the Common Sense Media survey indicated that vaping was about as harmful as smoking. This is an indication that vaping rates will decrease going forward as more public health and government agencies use tactics similar to those used with smoking regarding its risk and cost to the user. Until then, spend some time talking to your teens about vaping and some of the reasons why they should try to avoid forming the habit.

Dan Florell, Ph.D., is an associate professor at Eastern Kentucky University and has a private practice, MindPsi (www.mindpsi.net). Praveena Salins, M.D., is a pediatrician at Madison Pediatric Associates (www.madisonpeds.com).

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