Are electronic cigarettes a bridge to help people quit smoking or a gateway to start smoking young?

Either way, a leading heart health organization says it’s time federal laws prohibit the sale of these devices to minors, and it recommends e-cigarettes be regulated along with traditional combustible cigarettes.

Smoking rates in the U.S. have dropped steadily over the last several decades, but e-cigarette use is on the rise. The battery-powered, pen-sized devices, which release nicotine-laced water vapor instead of smoke, are escaping the regulatory scrutiny that traditional light-a-match cigarettes receive, says the American Heart Association.

“E-cigarette use and acceptance of e-cigarettes has the potential to renormalize smoking behavior,” association officials wrote in a new policy statement in the journal Circulation.

They warn the current holes in regulation could have far-reaching consequences.

“Unregulated e-cigarette use also has the potential to erode gains in smoking cessation and smoke-free laws,” they wrote.

They may have reason to worry. The heart association’s policy statement comes on the heels of a study in the journal Nicotine & Tobacco Research showing the number of youths (grades 6-12) who had used e-cigarettes more than tripled from 2011 to 2013, skyrocketing from 79,000 to more than 263,000.

The study, conducted by researchers from the Centers for Disease Control and Prevention, also showed young people who had used e-cigarettes were 1.7 times as likely to intend to smoke cigarettes in the future compared with those who had never used them. A full 43.9 percent of those young e-cigarette users said they would smoke combustible cigarettes in the future, roughly twice the rate of those who had never used e-cigs.

“E-cigarette use was associated with increased intentions to smoke cigarettes,” the CDC researchers wrote.

That trend may not abate if current marketing practices keep up; according to the heart association paper, youth exposure to e-cigarette ads shot up more than 250 percent from 2011 to 2013.

“Such marketing practices are likely to recruit a new generation of nicotine addicts,” the policy authors wrote.