It is supposed to be undeniable that smoking and using any forms of tobacco is bad for your health. And the rate of smoking cigarettes has been on the decline for years and years now. That said, a new report is showing some very troubling trends about tobacco use, and e-cigarettes in particular, among middle school and high school kids.

The U.S. Centers for Disease Control and Prevention (CDC) has now released additional data from the joint 2018 National Youth Tobacco Survey compiled along with the Food and Drug Administration (FDA). Unfortunately, the data confirm findings from last fall indicating that America’s youth of e-cigarette products is rapidly rising.

According to the updated data, approximately 4.9 million middle and high school students have used some type of tobacco product in 2018 over the trailing 30 days. There is a reason that the CDC calls this “rampant and alarming” in the press release. Only about 3.6 million were considered to be users of some form of tobacco in 2017.

The rise is pointing to e-cigarette use. The CDC showed that over 3.6 million middle school and high school students were current e-cigarette users in 2018. That is up by more than 1.5 million students in just a single year. Equally troubling with the number of users is that e-cigarettes are also being used more frequently and that the use of flavored products more often. Many youth tobacco product users are also using multiple products. The report said:

Among current tobacco users, about 2 in 5 (1.68 million) high school students and 1 in 3 (270,000) middle school students used two or more tobacco products in 2018. The most commonly used tobacco product combination was e-cigarettes and conventional cigarettes among both middle and high school students.

Monday’s report from the CDC also pointed to data from the National Institutes of Health’s Monitoring the Future study showed comparable trends. Its data suggested that e-cigarette use rose from 6.6% to 10.4% among 8th grade students. Those figures rose from 13.1% to 21.7% among 10th grade students, and they rose from 16.6% to 26.7% among 12th grade students.

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Specific data from the FDA’s 2018 National Youth Tobacco Survey points to flavored e-cigarette use being the major contributor. The observation of 2018 versus 2017 said:

Use of any flavored e-cigarette went up among current users from 60.9 percent to 67.8 percent, and menthol use increased from 42.3 percent to 51.2 percent among all current e-cigarette users—including those using multiple products—and from 21.4 percent to 38.1 percent among exclusive e-cigarette users.

Flavors in tobacco products are problematic, as they can be very appealing to youth, and are frequently listed as one of the top three reasons this population uses e-cigarettes. Additionally, kids whose first tobacco product was flavored are more likely to become current tobacco users than those whose first product was tobacco-flavored.

There was also a 48% rise among middle school kids using e-cigarettes in 2018 versus 2017. This was 570,000 kids, a total of 4.9% of all middle school students, who are now are current e-cigarette users.

On top of recent enforcement actions being taken against certain Walgreens and Circle K retail locations from repeatedly selling tobacco products to minors, the CDC release also pointed out that letters have been sent to Altria Group Inc. (NYSE: MO) and JUUL Labs to meet with their leaders over concerns that they do not “seem fully committed to their written promises about the steps they’d take to stop youth use of their products.”

Altria has been investing billions into vaping and cannabis of late, and in some views that has been harmful to the company’s health as well.  JUUL was named three times in the CDC release, versus Altria being called out by name just twice.

There is really no way to sugarcoat these numbers. The statistics are startling.

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