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In 2016, the Monitoring the Future survey found that use of hookahs has remained steady at high levels since its inclusion in the survey in 2010

These stories are awful," Friedle said

Major tobacco companies, including the e-cigarette giant Juul, have expressed support for efforts to raise the minimum age for tobacco purchase, according to NPR s Kennedy

But if you go to a place like West Virginia, which has the highest smoking rate in the country, the behavior feels completely normalized," Koval says

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This option would leave vaping products with nicotine concentrations that are appealing to young persons, thus maintaining a risk of further vaping uptake by nicotine-naive users, particularly youth