In 2015, Juul burst onto the smoking scene with a lineup of sweet-flavored e-cigarettes small enough to fit in the palm of your hand. Sales skyrocketed, and in a few short years the company—which has expanded its corporate offices into Austin—became a billion-dollar brand with the most popular e-cigarette on the market. The tiny nicotine-delivery systems proved especially popular with teens, who are now taking up vaping in droves.

Unsurprisingly, these devices have made their way into Austin’s schools. In 2017, just 1 percent of the city’s middle and high school students thought vaping was the most serious problem on campus. Now, the percentage has jumped to 35, far surpassing concerns about issues like alcohol, harassment, and violence. “Dealing with vaping—it’s like trying to catch a ghost,” says Michele Rusnak, administrative supervisor for health and physical education at the Austin Independent School District (AISD).

AISD began teaching about the risks of vaping a couple years ago as part of its health curriculum, but actually keeping it out of schools can be a daily challenge, Rusnak says. Vaping devices like those made by Juul (designed to look like small flash drives) are easy to hide and, until this fall, came in sugary flavors such as fruit medley and crème brûlée—a dangerous pairing that have boosted their appeal among young people. There are even special clothes that are marketed specifically for their discreetness, including hoodies with drawstrings that double as a smoke delivery system.

To date, AISD doesn’t have exact numbers on how many students have been caught vaping in school. But anecdotally, Rusnak says confiscated vaping devices keep piling up. Looking ahead, the district has developed a new disciplinary code specifically for vaping, which should make it easier to gauge the size and scope of this growing problem.

“Thankfully, the district already had a strong coordinated school health program in place to start pushing out education to students and families,” Rusnak says. “But I don’t think we’re fully trained on all the tools kids are using or all the effects vaping can have … The [vaping] industry is growing so fast it’s hard to keep up.”

The worrisome trend took on a new urgency earlier this year, as vaping-related illnesses broke out across the country. In Texas, as of mid-October, state health officials reported 147 confirmed and probable cases of vaping-related pulmonary disease (including one death), with a quarter of cases among teens younger than 18. Nine of those confirmed cases were in Travis County, all among residents ages 16 to 39 years old. “Until we know what’s happening, our recommendation is to not use vaping or e-cigarette products at this time,” says Mark Escott, medical director and health authority at Austin Public Health.

This outbreak is rightfully grabbing headlines, but Escott stresses that it’s only one of two “real crises” related to vaping. The second piece of the puzzle is what Rusnak and her AISD colleagues are witnessing in real time: massive spikes in youth vaping that could get a whole new generation hooked on nicotine, a powerfully addictive stimulant that can be particularly harmful to developing brains. “Driving down youth smoking to historic lows has been one of the greatest public health victories in the modern era,” Escott says. “So we’re very concerned that vaping will end up being a gateway back to cigarettes.”

The latest research backs this claim. Between 2000 and 2017, according to the Centers for Disease Control and Prevention, the nation’s high school smoking rate dropped a whopping 73 percent. But in early 2019, the agency reported that surges in youth e-cigarette use had already “erased” years of progress.

Nationally, more than 3 million high school students used e-cigarettes in 2018—a 78 percent increase from the previous year. In Texas alone, more than 330,000 middle and high schoolers reported e-cigarette use last year, representing 13 percent of students statewide. And within AISD, the number of adolescents who said they’ve never vaped dropped from 95 percent in 2017 to 88 percent in 2019.

UT School of Public Health professor and youth smoking expert Steven Kelder says the same tactics that have helped drive down cigarette smoking, like raising the age for buying tobacco and e-cigarette products (which Texas did in September), are promising ways to combat the vaping epidemic, too. Nonetheless, Kelder believes health advocates are in for a long, fierce fight with the vaping industry, which is increasingly run by the original nicotine pushers: cigarette makers.

“Today, it’s Big Tobacco behind the scenes,” says Kelder, noting that Altria, one of the world’s largest cigarette manufacturers, now own a 35 percent stake in Juul. “That’s the playbook we’re up against.”