July 13 is the deadline for the Food and Drug Administration’s approval process on synthetic nicotine products.

Any marketed product sold in U.S. stores, such as Puff Bars or other vaping products, will become illegal if they do not meet the requirements of the FDA’s health and safety standards.

“Today, young people see vaping as cool. It was the kids who never would have smoked, and if you don’t get your arms around that fast, you’ll have another 30-year problem,” said Matt Myers, president of the Campaign for Tobacco-Free Kids.

In 2020, the FDA outlawed the sale of flavored tobacco products due to the number of kids it was enticing. According to a 2020 study from the Centers for Disease Control and Prevention, as many as 3 million high school students, or 19.6%, vape regularly, and 550,000 or 4.7% of middle schoolers do as well.

The law meant companies such as Juul, which controlled as much as 70% of the U.S. vaping market at the time, could only sell tobacco-flavored and mentholated tobacco products. Myers says the law was written in such a way that it allowed for loopholes. However, as other companies began creating synthetic nicotine that used no tobacco, which is why to this day, dozens of flavored vaping products are sold in convenience stores and gas stations nationwide.

“We’re really at a critical juncture both for e-cigarettes and in regard to youth cigarette use,” said Myers. “If the FDA follows through and removes from the market all of the flavored products that appeal to kids, we can reverse the youth e-cigarette epidemic in a relatively short period of time.”

The FDA does not have a clear list of vaping companies that have applied for approval and has not revealed if any have received it.

Advocates say what happens next weighs on if and how the FDA enforces its policy after July 13.

Video above: Juul executive tells lawmakers electronic cigarettes were never intended for teens

Electronic cigarette maker Juul Labs will pay nearly $440 million to settle a two-year investigation by 33 states into the marketing of its high-nicotine vaping products, which have long been blamed for sparking a national surge in teen vaping.

Connecticut Attorney General William Tong announced the deal Tuesday on behalf of the states plus Puerto Rico, which joined together in 2020 to probe Juul's early promotions and claims about the safety and benefits of its technology as a smoking alternative.

The settlement resolves one of the biggest legal threats facing the beleaguered company, which still faces nine separate lawsuits from other states that are suing the company. Additionally, Juul faces hundreds of personal suits brought on behalf of teenagers and others who say they became addicted to the company's vaping products.

The state investigation found that Juul marketed its e-cigarettes to underage teens with launch parties, product giveaways and ads and social media posts using youthful models, according to a statement.

"Through this settlement, we have secured hundreds of millions of dollars to help reduce nicotine use and forced Juul to accept a series of strict injunctive terms to end youth marketing and crack down on underage sales," Tong said in a press release.

The $438.5 million will be paid out over a period of six to 10 years. Tong said Connecticut's payment of at least $16 million will go toward vaping prevention and education efforts. Juul previously settled lawsuits in Arizona, Louisiana, North Carolina and Washington.

Most of the limits imposed by Tuesday's settlement won't affect Juul's practices, which halted use of parties, giveaways and other promotions after coming under scrutiny several years ago.

Teen use of e-cigarettes skyrocketed after Juul's launch in 2015, leading the U.S. Food and Drug Administration to declare an "epidemic" of underage vaping among teenagers. Health experts said the unprecedented increase risked hooking a generation of young people on nicotine.

Video above: Children's psychologist on kids' vaping, JUUL use

But since 2019 Juul has mostly been in retreat, dropping all U.S. advertising and pulling its fruit and candy flavors from store shelves.

The biggest blow came earlier this summer when the FDA moved to ban all Juul e-cigarettes from the market. Juul challenged that ruling in court and the FDA has since reopened its scientific review of the company's technology.

The FDA review is part of a sweeping effort by regulators to bring scrutiny to the multibillion-dollar vaping industry after years of regulatory delays. The agency has authorized a handful of e-cigarettes for adult smokers looking for a less harmful alternative.

While Juul's early marketing focused on young, urban consumers, the company has since shifted to pitching its product as an alternative nicotine source for older smokers.

"We remain focused on our future as we fulfill our mission to transition adult smokers away from cigarettes - the number one cause of preventable death - while combating underage use," the company said in a statement.

Juul has agreed to refrain from a host of marketing practices as part of the settlement. They include not using cartoons, paying social media influencers, depicting people under 35, advertising on billboards and public transportation and placing ads in any outlets unless 85% of their audience are adults.

The deal also includes restrictions on where Juul products may be placed in stores, age verification on all sales and limits to online and retail sales.

Video above: Juul to pay $40M in teen vaping suit settlement

Juul initially sold its high-nicotine pods in flavors like mango, mint and creme. The products became a scourge in U.S. high schools, with students vaping in bathrooms and hallways between classes.

But recent federal survey data shows that teens have been shifting away from the company. Most teens now prefer disposable e-cigarettes, some of which continue to be sold in sweet, fruity flavors.

Overall, the survey showed a drop of nearly 40% in the teen vaping rate as many kids were forced to learn from home during the pandemic. Still, federal officials cautioned about interpreting the results given they were collected online for the first time, instead of in classrooms.

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.

New research shows U.S. teens who use electronic cigarettes prefer ones made by Juul Labs, and mint is the top flavor for many of them. That suggests a shift after Juul's sweeter flavors were removed from retail stores.

The results are in two studies published online Tuesday in the Journal of the American Medical Association. They include a U.S. government report based on a survey indicating that the U.S. teen vaping epidemic shows no signs of slowing down.

An estimated 28% of high school students and 11% of middle schoolers surveyed earlier this year had vaped within the past month. That amounts to over 5 million young users, versus about 3.6 million last year.

The results follow the Trump administration's call in September to ban virtually all vaping flavors.

Related video above: Juul to pay $40M in teen vaping suit settlement

The U.S. Food and Drug Administration blocked the sale of more than 55,000 flavored e-cigarette products Thursday, its first ban of e-cigarette products since it began requiring makers to apply for premarket review last September.

The FDA issued marketing denial orders for the electronic nicotine delivery system (ENDS) products, saying they pose a public health threat to youth in the U.S. Of the more than 55,000 products impacted by the decision, those not yet being sold may not be introduced into the market, and those already on the market must be removed or risk enforcement.

Advocates complained the action did not cover big name products such as Juul, but the agency said more decisions are coming.

"Ensuring new tobacco products undergo an evaluation by the FDA is a critical part of our aim to reduce tobacco-related disease and death," said Acting FDA Commissioner Dr. Janet Woodcock. "We know that flavored tobacco products are very appealing to young people, therefore assessing the impact of potential or actual youth use is a critical factor in our decision-making about which products may be marketed."

Though e-cigarette products are often marketed as tools to help adults quit smoking cigarettes, health experts have been sounding the alarm for years over an alarming uptick in use among children and teens.

U.S. e-cigarette sales rose by nearly 300% between November 2016 and August 2019, according to the U.S. Centers for Disease Control and Prevention. Nearly 20% of high schoolers and almost 5% of middle schoolers reported using vape products in 2020, according to research published in the journal JAMA Network Open.

Many point to the sweet flavors and flashy packaging of these products as proof that companies know exactly who they are marketing to.

The non-tobacco, flavored e-cigarette products impacted by Thursday's decision -- which include flavors, like Apple Crumble, Dr. Cola and Cinnamon Toast Cereal -- are made by three companies: JD Nova Group LLC, Great American Vapes and Vapor Salon.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the decision is a step in the right direction, but does not go far enough.

"The FDA's action covers just a fraction of the more than 6.5 million tobacco products for which the FDA has received marketing applications, and it does not include any e-cigarette brands with a significant market share or that are most popular with kids, such as Juul, the number one youth brand," Myers told CNN in a statement.

The FDA said it's making its way through those applications, submitted by 500 companies by the September 2020 deadline for deemed new tobacco products to apply for pre-market review.

The agency is tasked with determining whether these products "have a benefit to adult smokers sufficient to overcome the public health threat posed by the well-documented, alarming levels of youth use of such products."

"Flavored ENDS products are extremely popular among youth, with over 80% of e-cigarette users between ages 12 through 17 using one of these products," said Mitch Zeller, director of the FDA's Center for Tobacco Products. "Companies who want to continue to market their flavored ENDS products must have robust and reliable evidence showing that their products' potential benefit for adult smokers outweighs the significant known risk to youth."

In February 2020, the Trump administration enacted a "flavor ban," establishing that the Food and Drug Administration would prioritize enforcement against flavored, cartridge-based vaping products.

Because disposable vapes, some e-liquids, and tobacco and menthol-flavored products were exempted from the policy, health experts expressed concern that it would simply redirect users to those available products.

"In 2020, over one million middle and high school students used menthol e-cigarettes, including 44.5% of youth who used flavored, pre-filled cartridge products like Juul," Myers said.

The FDA's decision is "not a substitute for comprehensive action to eliminate all flavored e-cigarettes, including menthol-flavored products that are popular with and widely used by kids," he added.

The FDA noted the scientific review of menthol e-cigarettes, as opposed to other non-tobacco flavored e-cigarettes, raises "unique considerations."

While menthol products were not included in Thursday's decision, the FDA's evaluation of those applications will consider the same question: Does the benefit to adult users outweigh the risk to youth?