WASHINGTON, DC – Thirty-one leading public health and medical organizations today urged President Obama to quickly finalize long-overdue rules covering all tobacco products, including electronic cigarettes, cigars and hookah.

In a letter to the President, the groups said the continued lack of federal oversight of these products is putting the health of America’s kids at risk. Underscoring the urgent need for action, a recent government survey showed that youth e-cigarette use tripled from 2013 to 2014 and now exceeds youth cigarette smoking for the first time.

“In the absence of regulation, we have seen irresponsible marketing of unregulated products such as cigars and electronic cigarettes, often using tactics and sweet flavors that clearly appeal to youth. It’s no wonder use of e-cigarettes by youth has skyrocketed,” the letter states. “This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.”

The Food and Drug Administration currently regulates cigarettes, smokeless tobacco and roll-your-own tobacco and can extend its jurisdiction to all other tobacco products under a 2009 law, the Family Smoking Prevention and Tobacco Control Act. Although the agency announced its intention to regulate all tobacco products in April 2011, it did not issue a proposed rule until April 25, 2014, and has yet to issue a final rule or set a firm date to do so.

The letter expresses concern about recent trends that demonstrate the need for quick action to protect kids. These include:

E-cigarette use by youth has exploded. From 2013 to 2014, e-cigarette use rose from 4.5 percent to 13.4 percent among high school students and from 1.1 percent to 3.9 percent among middle school students. The Centers for Disease Control and Prevention estimated there were 2.4 million youth e-cigarette users in 2014.

From 2013 to 2014, e-cigarette use rose from 4.5 percent to 13.4 percent among high school students and from 1.1 percent to 3.9 percent among middle school students. The Centers for Disease Control and Prevention estimated there were 2.4 million youth e-cigarette users in 2014. Cigar use among teens remains a concern. While overall youth cigar use declined from 2013 to 2014, high school boys smoke cigars at about the same rate as cigarettes (10.8 percent for cigars and 10.6 percent for cigarettes). Cigars are the most commonly used tobacco product among African-American high school students, who smoke cigars at nearly twice the rate of cigarettes. Health advocates have called on the FDA to regulate all cigars and reject calls to exempt some cigars.

While overall youth cigar use declined from 2013 to 2014, high school boys smoke cigars at about the same rate as cigarettes (10.8 percent for cigars and 10.6 percent for cigarettes). Cigars are the most commonly used tobacco product among African-American high school students, who smoke cigars at nearly twice the rate of cigarettes. Health advocates have called on the FDA to regulate all cigars and reject calls to exempt some cigars. Hookah use roughly doubled for both middle and high school students, with past-month use among high school students rising from 5.2 percent in 2013 to 9.4 percent in 2014. Hookah tobacco is available in a variety of fruit and candy flavors that can be attractive to youth. According to the CDC, hookah smoking exposes smokers to many toxic substances and has many of the same health risks as cigarette smoking.

Health advocates have called on the FDA not only to finalize the rule, but also to strengthen it by extending current FDA restrictions on cigarette marketing to newly-regulated products and prohibiting the use of flavorings that appeal to kids.

The letter can be read in its entirety here.