Teen vaping rates are rising once again, the Centers for Disease Control and Prevention reported Thursday - a signal that as kids have returned to school, so has their use of e-cigarettes.
Data from the annual National Youth Tobacco Survey showed that 14.1% of high school students and 3.3% of middle school students said they'd recently used an e-cigarette or other vape. The survey, led by both the CDC and the Food and Drug Administration, was conducted from January through the end of May.
The vast majority of surveyed youth, 84.5%, said they used flavored e-cigarettes, most often in fruity or other sweet flavors.
Linda Neff, chief of the epidemiology branch in CDC's Office on Smoking and Health, said the new numbers show that in 2022, 2.55 million middle and high school students in the United States reporting vaping.
"These numbers confirm that the e-cigarette epidemic in our country is far from over," Neff said. "Our work is far from done."
"What is even more disturbing is the frequency of use," she added. "Among those who currently use e-cigarettes, more than 1 in 4 use them daily."
Frequent use was even greater among high school students. Forty-six percent of older teens said they vaped nearly every day.
"This is powerful evidence that kids aren't just experimenting with e-cigarettes, but becoming addicted to the high-nicotine products now dominating the market," Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement to NBC News.
The new numbers more closely resemble those from before the pandemic. In the early part of 2020, nearly 20% of high school students and 5% of middle schoolers said they'd recently vaped.
The numbers then appeared to take a dip in 2021, but experts cautioned that the apparent downward trend seen during the pandemic may have been an underestimate because of how the data were collected as kids were surveyed at home, remotely. Historically, data for the survey have been collected in schools.
The 2022 data were collected in a hybrid manner, with some respondents in class and others at home.
"Even if they're not directly comparable, they're not unexpected," Robin Koval, president of Truth Initiative, a nonprofit tobacco control organization, said of the new youth vaping statistics. "We have lots of other data that's been pointing in this direction."
A cascade of new products
Most states had already banned the sale of nondisposable e-cigarettes, including Juul, by the time FDA took action in June, when the agency ordered the company to stop selling their products completely. (The ban has since been put on hold as the company has sued the FDA.) Juul was the biggest supplier of vaping products in the U.S.
Two years earlier, in January 2020, the FDA had said that companies that made nondisposable vapes could not sell them in fruity and minty flavors that appeal to kids.
But by only banning nondisposable flavored vapes, the FDA unintentionally opened up a market for flavored disposable products. Those companies are required to seek authorization from the regulatory agency before marketing their products, but often don't.
Now, disposable vapes have become the most popular e-cigarette option among teens, according to the new report.
Among teens who reported vaping, 55.3% used disposable products. Puff Bars, which come in a wide range of flavors, were the most popular among the 13 brands listed in the survey.
On Thursday, the FDA sent a warning letter to the makers of Puff Bars for selling their products without prior authorization. The company has 15 days to respond.
But Puff Bars are only one of many new disposable vape products available. Nearly a fifth of the survey respondents said their brand of choice wasn't listed as an option.
"There's an absolute cascade of new products entering the market every day," Koval said.
'I gag every time I think about it'
The vaping trends are familiar to many young people, who say they routinely see people vaping or at least talking about it in schools and among friend groups.
Sam Rose, 21, of Spartanburg, South Carolina, said he picked up his first vape as a high school freshman. "I was just super intrigued by the little buzz that nicotine gives you," he said. And they tasted good, like mango or other fruits.
Over the next three and a half years, Rose said, he developed a serious addiction to nicotine. He estimates that he spent $9,800 on e-cigarettes throughout high school.
"I gag every time I think about that," he said.
Alyssa Badolato, too, began vaping in high school. "I felt like it was something that I should just be doing because everyone else was doing it," she said.
Both Badolato and Rose are paid ambassadors for the Truth Initiative. Truth Initiative provided NBC News with their contact information.
Badolato, now a 21-year-old senior at Plymouth State University in New Hampshire, said she quickly became addicted to nicotine, and used a variety of products "every single day" throughout high school.
Her addiction severely impacted her ability to perform athletically. "I wasn't as strong. I couldn't run for as long," she said.
Both Badolato and Rose say they've successfully quit vaping through a Truth Initiative program called This is Quitting. It's an anonymous text messaging-based support system. A 2021 study from the Truth Initiative found that the program increased quit rates by nearly 40%, compared to a control group.
Despite some successes, the new report makes it clear that youth vaping has continued to proliferate over the past few years.
"Obviously, a lot of things were put on the back burner" during the pandemic, Badolato said. "Now, I think it's time to get back to guns blazing and tackle this as a public health issue."
Editor's Note: This story was updated to clarify that Tom Rose and Alyssa Badolato are paid ambassadors for the Truth Initiative and that Truth Initiative put NBC News in contact with them.
This article was originally published on NBCNews.com