The medical profession came out swinging against electronic cigarettes on Monday, urging federal and local officials to ratchet up regulations over the multi-billion-dollar e-cig industry. The American College of Physicians – one of the country’s most influential doctors’ groups – cited the growing use of e-cigs among adolescents and unanswered questions about their health effects while issuing detailed prescriptions in the Annals of Internal Medicine. They called on the government to:

Regulate e-cigs under the same Food and Drug Administration guidelines as traditional tobacco products

Ban all flavored products

Boost local taxes on e-cigs to discourage use among adolescents

Ban television advertising of e-cigs and related products

Prohibit the use e-cigs indoors or in public places

Increase federal funding for e-cig research

The position paper follows a number of studies raising questions about electronic-cigarette use, which is often touted as a safer alternative to traditional tobacco products. Some researchers are concerned about the vapors that users inhale because they can contain formaldehyde. Just last week, a Centers of Disease Control study showed that e-cigarette use among middle-school and high-school students more than tripled between 2013 and 2014. E-cigs are now more popular among teens than the real thing.

The ACP has unusual clout, and some of its previous position papers have become law or the de facto standards of care. “Despite the widespread popularity and availability of [e-cigarettes], little is known about the direct and second-hand long-term effects of their use or their potential as a smoking cessation aid,” the group writes.

Read More:

What do we really know about the safety of e-cigarettes (fivethirtyeight.com/)

American teens smoke e-cigarettes more than real cigarettes (Vocativ)

E-cig ads may cause people to crave real cigarettes (Vocativ)