GREENVILLE, N.C. (WNCT) – A new study shows teens in the U.S. who use electronic cigarettes are six times more likely to move on to smoking traditional cigarettes.

The study released in the Journal of Pediatrics surveyed 300 high schoolers. Half of them had used e-cigs. 16 months later, those smoking e-cigs were six times more likely to have moved on to tobacco.

In North Carolina, fewer teens are smoking cigarettes than ever before, yet the number using e-cigs continues to rise.

So WNCT asked local Tobacco Prevention Coordinator Moneka Midgette what’s driving e-cigs to act as a gateway.

“It contains nicotine and nicotine is highly addictive. So when you have an e-cigarette product that has nicotine, the normalization of going to a regular cigarette, it’s the same chemical, the same thing that they’re getting,” Midgette said.

Midgette says some cities in the East, like Greenville, have zoning ordinances to keep tobacco or vaping shops from opening too close to schools, but other rural communities in eastern North Carolina do not. She says they’re pushing for more zoning ordinances like this across the state, along with raising the legal age limit to smoke.

E-cigs have become the most popular form of tobacco use for middle and high school kids, and a local doctor found that’s the case in the East too.

Midgette says to combat this booming trend, she and other local health experts learn more about the dangers and normalization of e-cigs every day.

“It’s an ever-changing battle. And sometimes the tobacco industry is 2, 3 steps ahead of public health. So we’re working really hard to stay one step or right on top of what the tobacco industry is putting out,” Midgette said.

Midgette also says parents need to be aware of a new trend for teens in the area called dabbing, where e-cigs are used to smoke marijuana.

In recent years, scientists have debated whether e-cigarettes help smokers quit, or act as a gateway to tobacco smoking. Due to health concerns, the FDA will ban the sale of all e-cigs to minors starting mid-summer.