Recent surveys of U.S. teens have shown record low levels of cigarette use, but the National Youth Tobacco Survey results for 2015 show what can only be described as a disappointing flattening of that downward trajectory, particularly in past 30-day cigarette use by high school students (9.3 percent in 2015 versus 9.2 percent in 2014). Use of any tobacco product within the past 30 days was also stalled, with nearly 5 million middle and high school students reporting tobacco use in the prior 30 days.

The lack of progress in reducing the rate of tobacco use is driven in large part by polyuse, which is the use of multiple tobacco products, including cigarettes, little cigars, hookah and e-cigarettes. Half of the middle and high school students, who were current users of tobacco, reported that they used two or more products – that is 2.3 million young people.

It is also troubling that e-cigarette prevalence continues to expand at the middle and high school levels. It remains to be seen how much of this use is regular rather than experimental use. Nonetheless the increase should be cause for concern and action.

The disappointing results underscore the value and urgency of commonsense regulations in an evolving tobacco landscape. While cigarettes have been subject to regulations that limit when, where and how they can be sold and marketed, the federal government has been too slow to regulate the full array of tobacco products in the same manner, such as flavored little cigars and hookah.

Simply put, teens will use what they can get their hands on, what they can afford, and what is marketed in forms and manners that make them especially appealing – such as flavored tobacco products, including menthol cigarettes. Other research has demonstrated that half of young people who smoke cigarettes report using a menthol cigarette.

Middle and high school students should not be using any tobacco product: end of story. Public education campaigns targeted to youth and young adults, like truth,® are doing their part and taking aim at multiple tobacco products. But we’re fighting with one hand tied behind our back. For public education to fulfill its potential to prevent teen tobacco use and escalation from experimentation to regular use, we need lawmakers at all levels to act on clean air indoor policies, excise taxes and price minimums, flavored tobacco bans and proposals to raise the minimum age of sale of tobacco products to 21.

The glaringly obvious first step is for the Obama administration to issue final deeming regulations that bring all tobacco products under the Food and Drug Administration’s (FDA) authority so they can start issuing product standards and putting limitations in place on youth access for these products across the country. The deeming regulations, which were transmitted to the Office of Management and Budget in October for what should have been a 90-day review period, are the critical next step. Tobacco remains the leading cause of preventable death in the United States with nearly 500,000 deaths per year, and the FDA needs this authority to take aim at the tobacco products that are driving teen use up rather than down. Beyond deeming, the FDA should do more to limit cigarette use, which puts an estimated 5.6 million American young people alive today at risk of tobacco-related death.

Action is needed beyond the nation’s capital. States can follow the lead of Hawaii, which has risen the minimum age for tobacco sale to 21, and Florida, which has lowered their youth smoking rate with comprehensive youth tobacco prevention programs. Cities can emulate Chicago, which has banned flavored tobacco products, including menthol cigarettes, within 500 feet of schools.

The Centers for Disease Control and Prevention and the FDA worked together on the results published today in the Morbidity and Mortality Weekly Report. They have spoken clearly about the disappointing results. Our fondest hope is that our collective disappointment can spur policymakers into action.

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