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Some 20 percent of Wisconsin high school students said last year they were using electronic cigarettes, up from 8 percent in 2014 — an “alarming” increase that led the state Department of Health Services to issue an advisory Friday.

As U.S. Surgeon General Jerome Adams recently described in a report, “nicotine exposure during adolescence can harm the developing brain, which continues to develop until around age 25, and can impact learning, memory, and attention,” the advisory from the state health officer notes.

In November, Food and Drug Administration Commissioner Scott Gottlieb pledged to ban menthol cigarettes and flavored cigars, and tighten rules governing the sale of most flavored versions of e-cigarettes.

About 21 percent of high schoolers said they had vaped recently, Gottlieb said. The proposed restrictions include allowing sales of flavored e-cigarettes only in parts of stores not open to teenagers.

“I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” Gottlieb said at the time in a statement.

In Dane County, nearly 19 percent of high school students said they vaped in the past month, according to a youth assessment released in September. That’s up from 16 percent three years before.

E-cigarettes, or vaping, can expose users and others to harmful substances including heavy metals, volatile organic compounds and tiny particles that can be inhaled deep into the lungs, the state advisory said.

Some e-cigarettes resemble flash drives, while others are about the size of a credit card, the advisory said. E-liquid bottles can resemble eye droppers, and vape pens can come in a variety of colors and look like pens or lip gloss.

E-cigarettes can also be used to deliver other drugs, such as marijuana, the advisory said. In 2016, a third of U.S. middle and high school students who had ever used e-cigarettes reported using them for marijuana.

“The epidemic use of e-cigarettes is a complicated problem which requires a cooperative effort between partners, organizations, and communities,” the advisory said.

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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.