INDIANAPOLIS, Indiana — Hundreds of schools across the country have joined a lawsuit against the makers of JUUL vape products. The nationwide effort is aimed at reducing e-cigarette use among teenagers. While it's been an ongoing suit over the last few years, the latest to join is Indianapolis Public Schools.

Amy Peak is the director of Undergraduate Health Science Programs at Butler University. She points out the prominence of underage e-cigarette use is still a major health issue they are working to combat.

“From a health professional standpoint, the challenge is we haven’t done anything to decrease nicotine addiction. While we have absolutely decreased combustible cigarette smoking, we’ve just replaced those risks with different types of risks," Peak said.

School districts from California to New York have signed onto a lawsuit that could shape the future of e-cigarettes. The districts claim that JUUL Labs. Inc. targeted teens in the marketing of their products, harming the schools that educate those kids in the process.

“We are shifting the risk so maybe the risk isn’t as much lung cancer as it was previously, but we see completely different types of lung disease. We see higher addiction rates and then we see more gateways into other things," Peak said.

Peak says the problem, at this point, reaches far beyond JUUL.

“I think that JUUL was the leader of the pack. It became a verb not a noun. People juuled, they were juuling," Peak said.

The company stopped selling flavored products in 2019. They also pulled all U.S. advertising.

“They have taken some very responsible steps and likely ahead of some legislation that was inevitable," Peak said.

Windi Hornsby is the parent of two students within Indianapolis public schools.

“I think about how easy it was for me to start smoking, I can’t imagine how much easier it is for a kid to, if they can get their hands on it, to become addicted to some fruit-flavored to candy flavor e-cigarette," Hornsby said. “I think that’s just another facet for our school district caring about our children’s safety.”

She worries this lawsuit won’t go far enough to fight teenage e-cigarette use.

"It needs to be targeted as an industry-wide thing which would probably come with legislation and our law makers doing something on that end," Hornsby said.

More than 2 million U.S. youth currently use e-cigarettes, according to the 2021 Annual National Youth Tobacco Survey. Of that group, most teenagers are using flavored e-cigs. About 1 in 4 use them daily.

“So, what you see now are things like puff bars that are all of those really enticing flavors. There is no difference between a puff bar and a JUUL, other than one is not a reusable device," Peak said.

JUUL says it is trying to be responsible. In response to the survey the company acknowledged, “We will only be trusted to provide alternatives to adult smokers if we continue to combat underage use, respect the central role of our regulator and build on our shared commitment to science and evidence.”

“I think there is a misperception that e-cigarettes aren’t as dangerous. You can’t see the tobacco-like you can see it in a cigarette. So, I do wonder if people just think oh this is safer and you do hear about people going to e-cigarettes as a ween to go off of smoking,"Hornsby said.

“Very often, it’s to self medicate for anxiety that’s uncontrolled, sometimes it’s from a depression standpoint. The use of nicotine and other addictive substances and mental health disorders go hand in hand," Peak said.

Peak says we can’t combat this issue, without working on a larger issue: adolescent mental health.

“I’m very concerned that we have a larger number of youth addicted to nicotine than we had previously, we were making good progress and all of that progress is going away," Peak said.

For the first time in history, the FDA authorized three e-cigarette products: the Vuse Solo device and its pods.

The agency says the company that makes the Vuse Solo gave them data that shows it can be helpful to cigarette smokers.

In an email, the FDA said, "the potential benefit to smokers who switch completely or significantly reduce their cigarette use would outweigh the risk to youth."

Gregory Conley is the American Vaping Association president.

“After years of debate, you now have the FDA, which is our chief regulatory arm for things that we ingest - The FDA is saying that this particular product is appropriate for the protection of public health,” Conley said.

He says electronic cigarettes, which have been sold in the U.S. since 2006, are an essential step in the fight to help smokers quit tobacco cigarettes.

Last year, the FDA also took steps to keep vape products out of kids' hands, sending warning letters to 10 companies telling them to pull their flavored e-cigarette and e-liquid products because they appeal to young people.

Hasmeena Kathuria, MD, is an associate professor of medicine at Boston University and the director of the tobacco treatment center.

“Inhaling anything directly into the lungs is not a good idea,” Kathuria said.

She says she’s glad the FDA is acting on its promise to regulate these products. Nonetheless, the U.S. Surgeon General's office says since 2014, E-cigarettes have been the most commonly used tobacco product by American kids, and Kathuria says that's concerning.

“We think all e-cigarettes should not be allowed on the market because of – one, the youth epidemic of nicotine addiction, two, we know that there's FDA approved medications for smoking cessation that have that are regulated, that we know are safe, that we know that, that there are effective,” Kathuria said.

Knowing e-cigarettes aren't leaving the market anytime soon, the FDA will make these authorizations and marketing decisions on a case-by-case basis.

The agency says it hopes to get to a place where every vape product is “appropriate for the protection of the public health.”