Juul use among older teens and young adults soared between 2018 and 2019, according to a new study.

Researchers from the nonprofit health group Truth Initiative found use of Juul vaping devices doubled among young people ages 18 to 20, from 11.9% to 23.9%, Reuters reports. Among 21- to 24-year-olds, Juul use more than tripled, from 5.6% to 18.1%, they report in JAMA Pediatrics.

“Youth tobacco use is at its highest in nearly 20 years primarily driven by e-cigarettes resulting in more than 5 million youth now vaping across America,” Robin Koval, CEO and President of Truth Initiative said in a news release. “As evidenced by these new findings, years of progress in the fight against youth tobacco have been reversed with millions of teens, most of whom were not smokers, now using a high nicotine tobacco product.”