Tyra Nicolay first tried e-cigarettes three years ago when she was a freshman in high school.

The 16-year-old from New Mexico said she was attracted to the product because the cigarette’s flavoring tasted like Jolly Rancher green apple candy.

“I didn’t know e-cigarettes contained nicotine and could be harmful and addictive,” she said.

Tyra eventually quit smoking the electronic devices. Now, she wants all children her age to avoid the marketing lure of that industry.

“I call on my peers to reject all tobacco products, including e-cigarettes,” she said.

Tyra was the opening speaker at a press conference in Washington, D.C., on Thursday, in which U.S. Surgeon General, Dr. Vivek H. Murthy, delivered the first comprehensive federal government review of the public health impact of e-cigarettes on children and young adults.

Murthy said e-cigarettes are harmful to children’s health and can possibly lead them to smoking regular cigarettes.

Murthy unveiled a new website designed by his office that presents facts on e-cigarettes and encourages health professionals, parents, schools, and local governments to take action.

“There are ways for all Americans to take a stand,” he said.

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The case against e-cigarettes

Murthy highlighted figures from the Centers for Disease Control and Prevention (CDC) that indicate use of e-cigarettes among middle school students rose from 0.6 percent in 2011 to 5.3 percent in 2015.

For high school students, it jumped from 1.5 percent in 2011 to 16 percent in 2015.

That’s while smoking of regular cigarettes declined among middle school students from 4.3 percent to 2.3 percent, and among high school students from 15 percent to 9 percent.

Murthy then listed a series of reasons why he thinks e-cigarettes are harmful to youth.

For starters, he said e-cigarettes contain the addictive substance nicotine as well as potentially harmful flavorings and metals such as nickel, tin, and lead.

He noted that brain development continues in children and young adults until age 25. He said nicotine can harm maturing brains.

He said the risks involved include mood disorders, loss of impulse control, and harm to parts of the brain that control attention and learning.

He added the aerosol vapor emitted by e-cigarettes can expose users as well as those nearby to harmful chemicals.

Murthy also said there is “no evidence” yet to support claims that use of e-cigarettes by young people discourages them from smoking regular cigarettes.

He noted three out of five high school smokers also use e-cigarettes, indicating the electronic product could be a “gateway” to regular tobacco use.

Murthy admitted there is need for more research but said he wanted to do something now before it’s too late.

“Instead of waiting for harm to happen and then acting,” he said.

Murthy urged parents, health officials, and educators to talk to children about e-cigarettes. He also encouraged state and local governments to adopt smoke-free policies that include e-cigarettes.

“Our children are not an experiment,” he said. “We know enough about the health risks of youth use of e-cigarettes to take action.”

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Positive, negative reactions

The surgeon general’s report drew quick criticism from supporters of e-cigarettes.

"Sadly, the surgeon general's biased review of the evidence recommends policies without considering the unintended consequences. His proposals will make vastly safer vapor products less accessible and less attractive for adult smokers,” Alex Clark, legislative coordinator for the Consumer Advocates for Smoke-Free Alternatives Association (CASAA), said in an email to Healthline. “We'd all like people, including youth, to make healthier choices, but those choices should be based on honest information, not by frightening the young and taking choices away from adults."

Officials at the R Street Institute, a public policy research organization, had a similar reaction.

“The long tradition of scientifically rigorous messages and reports from the U.S. surgeon general appears to have ended,” R Street Senior Fellow Dr. Edward Anselm said in a statement. “The new report on electronic cigarettes focuses on youth experimentation and completely omits the opportunities for harm reduction these devices offer for adult smokers.”

However, a number of health-related organizations praised the surgeon general’s report. Among them were the American Academy of Pediatrics (AAP) and the American Lung Association.

Dr. Karen Wilson, an executive committee member on the AAP’s Section on Tobacco Control, told Healthline the surgeon general’s concerns on aerosol vapor, nicotine, and product marketing to children are well founded.

“We’re very supportive of the surgeon general’s report,” she said. “We’re gratified he is highlighting concerns we have had.”

Erika Sward, the lung association’s assistant vice president for national advocacy, said the report is a call to action to the Food and Drug Administration (FDA) and others.

“It’s a groundbreaking report that sounds the alarm,” Sward told Healthline.

She added all members of the community from parents to doctors to educators need to take part.

“As a society, we all bear the burden of tobacco,” Sward said.

Read more: E-cigarettes aren’t that bad, British scientists say »