Use of e-cigarettes by children and non-smokers—either as a step toward smoking (see Section 18.7) or exclusively—is a concern to public health specialists and regulators. During 2017–2018, current e-cigarette use among US high school students increased by 78% (from 11.7% to 20.8%),1 leading the US FDA to label e-cigarette use among youth an ‘epidemic’.2 In 2019, 27.5% of US high school students and 10.5% of middle school students reported current use of e-cigarettes.3 Exposure to nicotine during adolescence may have significant and lasting health consequences,4 including long-term addiction.5 Further, although the long-term health risks are not well understood, limited evidence suggests that e-cigarette use—particularly when e-liquids include sweet flavourings6, 7—may increase users’ risks of cardiovascular and respiratory disease (see Section 18.6). Some adolescents are also using e-cigarettes for vaping cannabis and other substances that pose additional risks (see Section 18.4).8
As with tobacco cigarettes, there are a range of demographic, environmental, behavioural and personal factors that predict the likelihood that a person will start using e-cigarettes. This section summarises research on the relationship between e-cigarette uptake and:
For a discussion of the effectiveness of policies and programs aiming to prevent the uptake of e-cigarettes among children and non-smokers, see Section 18.10.
18.9.1 Demographics
Prevalence of e-cigarette use is generally highest among teenagers and young adults. Research in the US,9 Canada,10 and UK11 has found that e-cigarette use is more common among older adolescents compared with those in their early teen years. Among Australian high school students in 2017, although ever use of e-cigarettes increased with age, recent and frequent use was more common among those aged 12–15 than 16–17 year olds.12 Among Australian adults, use was substantially more common among young adults compared with middle-aged and older adults in 2019, both for Aboriginal and Torres Strait Islander peoples13 and other Australians14—see Section 18.3.
Research in Australia,12 as well as overseas,12, 15-21 has consistently found that e-cigarette use is more common among males than females. Studies in the US have generally found that e-cigarette use is more common among young White people than young Black people.15, 22 In Australia, use of e-cigarettes is less common among Aboriginal and Torres Strait Islander peoples than among other Australians.13, 23
18.9.2 Health and temperament
18.9.2.1 Physical health
Researchers have identified a number of chronic health conditions associated with e-cigarette use among young people. One US study found that compared with young adult never smokers without the conditions, those with a history of arthritis or diabetes, and those who currently had asthma, had increased odds of e-cigarette use.15 Other studies have similarly found that e-cigarette use was more common among young people with asthma.16, 24 Adolescents with asthma may be particularly vulnerable to the health effects of e-cigarette use, with research suggesting that they are more likely to have an increase in respiratory symptoms and exacerbations compared with adolescents with asthma who do not use the products25—see Section 18.6.
A person’s weight may also influence their likelihood of vaping, with studies finding that adolescents who are overweight/obese,15 or perceive themselves to be overweight,26 are more likely to use e-cigarettes. Use is also associated with intentions to lose weight and as a means of appetite control among teenagers.27, 28
18.9.2.2 Mental health
People with mental health conditions are far more likely than those without to smoke tobacco cigarettes (see Section 9A.3). A growing body of research suggests the same is true for e-cigarettes; studies have found that young people with mental illness,29, 30 including depression,15, 24, 31 anxiety,24 ADHD,24 and internalising and externalising problems30 are more likely to use e-cigarettes. Those with exposure to childhood trauma32 and adverse childhood experiences33, 34 also appear to be more vulnerable to e-cigarette use. An Australian study found that in 2016, e-cigarette use was correlated with higher levels of psychological distress among adults.35
18.9.2.3 Temperament
Research on adolescent smoking suggests that it is more likely to occur in the context of a range of risk-taking behaviours (see Section 5.5). Similarly, a growing body of research suggests that e-cigarette use is more common among young people who engage in other risk behaviours. For example, studies have shown that engaging in unsafe sex,36 experiencing injury and violence,36, 37 having been arrested or suspended from school,38 using other substances,24, 36, 37, 39 associating with delinquent peers,40 drink driving,39 texting while driving,39 and driving without a seatbelt15 are associated with increased e-cigarette use among youth. Sensation seeking—a personality trait characterised by the desire to experience novel sensations and the willingness to take risks—is also associated with vaping.41, 42 Curiosity about the products is also often cited as one of the main reasons young people experiment with e-cigarettes.43-45
18.9.3 Tobacco and other substance use
Experimentation with e-cigarettes among non-smoking middle-aged to older adults appears to be relatively rare.46, 47 In Australia in 2019, about one-quarter to one-third of current smokers aged 40–69 reported having ever used e-cigarettes, compared with fewer than five per cent of non-smokers in the same age groups.14 Among young people, although e-cigarette use is also more common among those who also use tobacco products,15, 21, 22, 24, 37, 38, 42, 48-54, 55 vaping has increased among young never smokers over time.56 An analysis of trends from 2011 to 2015 in e-cigarette use among US adolescents found that past month e-cigarette users increasingly encompassed those who were not users of other tobacco products.57 In Australia in 2017, about one-third (34%) of high school students who were current e-cigarette users had not smoked cigarettes prior to using e-cigarettes.12 Among adults, one study reported that in 2016 in the US, 1.4% of never smokers reported using e-cigarettes, and of these users, about 60% were aged 18 to 24.58 Another US study found that the prevalence of current e-cigarette use increased significantly among adult never smokers between 2015 and 2018. 59 Similarly in Australia, lifetime use of e-cigarettes among non-smokers significantly increased between 2016 and 2019, with the highest prevalence of ever use among 18–24 year-olds (20%) and current use among 25–29 year-olds (3%) in 2019. 14
E-cigarette use also appears to share a strong relationship with alcohol consumption among young people.15, 16, 24, 30, 38, 48, 60 A systematic review and meta-analysis found that among adolescents, e-cigarette users had more than six-fold greater odds of reporting alcohol use or binge drinking compared to non-e-cigarette users.61 There is also evidence that e-cigarette use is related to use of other drugs, particularly marijuana.24, 30, 37, 39, 60 Longitudinal research in the US found that regardless of the level of vaping, e-cigarette use was associated with increasing use of alcohol and marijuana over time.62 Conversely, several other US longitudinal studies have found that marijuana use is associated with initiation of e-cigarette use.63, 64 Dual users of alcohol and marijuana also appear to be at greater risk of e-cigarette use.65
18.9.4 Advertising and promotion of e-cigarettes
A growing body of studies have examined the effects of e-cigarette advertising on the appeal of e-cigarettes and tobacco cigarettes among children. As with adults, children exposed to e-cigarette adverts report more positive attitudes toward and greater curiosity about and intention to use the products.66-70 Correlational71-75 and longitudinal76-79 studies have also found an association between e-cigarette marketing exposure and greater use of e-cigarettes.
See Section 18.2 for a detailed discussion of the advertising and promotion of e-cigarettes.
18.9.5 Product features
18.9.5.1 Flavours and packaging
E-cigarette liquids are available in a variety of flavours that appeal to children, such as cotton candy and gummy bear.80 The wide range of fruit, lolly, and other sweet flavours is one of the most commonly cited reasons for using e-cigarettes among young people.43, 81-89 E-cigarette manufacturers have also been criticised for creating child-friendly packaging that resembles juice boxes, lollies, and cookies (sweet biscuits).90 Further, some products have been designed to maximise discrete use,87, 91-94 which likely appeals to young people who may wish to hide e-cigarette use from parents and teachers. Technophilia—or the interest in and adoption of new technologies—is also associated with e-cigarette use among youth.95, 96 See Section 18.2 for a detailed discussion of each of these issues.
18.9.5.2 Nicotine content
The presence of nicotine in e-cigarette liquids can affect the likelihood that a person will become a regular user. Studies in the US have found that adolescents who use e-cigarettes with nicotine use the products more frequently than those who use nicotine-free e-cigarettes.88, 97 One of the most popular e-cigarette brands in the US among adolescents, JUUL, exposes users to high levels of nicotine;98 however several studies have shown that most young people are unaware of JUUL’s high nicotine concentration.99, 100
18.9.6 Social and environmental factors
18.9.6.1 Peer group
A young person’s peer group plays an important role in their likelihood of using tobacco and other substances, including e-cigarettes. Studies have consistently shown that adolescents are more likely to use e-cigarettes if they have friends who use e-cigarettes.44, 45, 63, 101 Twin studies have found that environmental factors, such as having friends who use e-cigarettes, play a much more important role in predicting e-cigarette use than genetic factors.102 Having peers who use tobacco products21, 48, 63 and other substances38 has also been shown to predict e-cigarette use among teenagers.
Adolescents’ attitudes toward and use of e-cigarettes can be influenced by how the products are perceived within their friendship group.101, 103 For example, beliefs that vaping will increase a young person’s social status might increase their risk of initiating e-cigarette use.104 Perceptions that the products are cool, fun, and help a young person ‘fit in’ can promote greater use, while for some adolescents, perceptions among peers that vaping is uncool and unfashionable can help to prevent use.105
18.9.6.2 The home environment
Although peers play a predominant role in a young person’s likelihood of vaping, research shows that parents can also influence their children’s perceptions and use of e-cigarettes. One study in the US found that parents' perceptions of the harms of e-cigarette use predicted both lower intentions and use of e-cigarettes among a sample of high school students, regardless of peer attitudes and norms.103 Another found that teens with weaker parental support and monitoring were more likely to be e-cigarette users.40 A review found that parents may implicitly approve e-cigarette use as a smoking cessation device and through favourable comparisons with tobacco smoking, which can also influence adolescents’ attitudes and products use.105 Having a higher amount of pocket money,21 or living in a household with someone who uses e-cigarettes,42 are also home-based predictors of e-cigarette use among young people.
18.9.6.3 The school environment
Higher levels of engagement with and achievement at school are associated with lower levels of tobacco use (see Section 5.9). Similarly, research has found that e-cigarette users appear to be less likely to participate in music/dance/art,24 academic activities,24 and organised sports 24 or other types of physical activity.106 One review similarly noted that studies have generally found an association between e-cigarette use and lower school performance, being out of school, and attending a disadvantaged school.21 One study in the US of middle school students (grades 6–8) showed that compared with non-users, e-cigarette users performed worse in school, were more likely to feel alienated from school, and were more likely to to associate with delinquent peers.40 Several studies have shown that e-cigarette users are more likely to experience bullying.24, 107
18.9.6.4 Exposure to e-cigarette and tobacco use
Given the rapidly increasing use of e-cigarettes in recent years, particularly in the US, exposure to vaping has become more common.108 Concerns have been raised that such exposure could serve to normalise e-cigarette use among young people and reduce perceptions of harm. Data from a nationally representative survey of US secondary school students showed that youth observation of vaping on school grounds was associated with significantly higher odds of being susceptible to smoking cigarettes and using e-cigarettes, especially among middle-school students.109 Another similarly found that observing e-cigarette use at school was associated with greater odds of e-cigarette use and susceptibility.110 Longitudinal research in Canada has found that teenagers and young adults who reported seeing anyone use e-cigarettes sometimes, very often, or always had more than four times the odds of initiating e-cigarette use compared to those who had not seen anyone vape.111 Seeing e-cigarette use in public at least some days also predicted initiation of e-cigarette use in European study.112 Exposure to secondhand tobacco smoke has also been found to predict use of e-cigarettes among young people.30, 113
18.9.7 Beliefs about health risks and addiction
Adolescents often have a poor understanding of addiction, with research on smoking showing that adolescent smokers often do not perceive themselves as addicted and are optimistic about their ability to quit (see Section 6.14). Similarly, a recent study on e-cigarettes found optimism bias among US teenagers about their ability to quit vaping.114 Further, despite some popular e-cigarettes containing very high levels of nicotine,98 many young people believe that e-cigarettes are less addictive than tobacco cigarettes, and such beliefs predict e-cigarette susceptibility and use.24, 115
E-cigarettes are often marketed as less harmful than tobacco cigarettes (see Section 18.2), and studies have shown that adolescents who believe vaping is less harmful than smoking are at greater risk of e-cigarette use.18, 24, 42, 48, 87, 115 Other studies have found that some adolescents perceive e-cigarettes as posing little to no harm, regardless of their comparative risk with cigarettes, and that these adolescents are also more likely to use e-cigarettes.50, 53, 116 See Section 18.6 for a discussion of the health effects of e-cigarette use, including for adolescents.
Relevant news and research
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References
1. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, et al. Notes from the field: Use of electronic cigarettes and any tobacco product among middle and high school students - United States, 2011-2018. Morbidity and Mortality Weekly Report, 2018; 67(45):1276–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30439875
2. US Food & Drug Administration. Statement from FDA commissioner on launch of ‘the real cost’ youth e-cigarette prevention campaign amid evidence of sharply rising use among kids. 2018. Available from: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620791.htm
3. Wang TW, Gentzke AS, Creamer MR, Cullen KA, Holder-Hayes E, et al. Tobacco product use and associated factors among middle and high school students - United States, 2019. MMWR Surveill Summ, 2019; 68(12):1–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31805035
4. England LJ, Bunnell RE, Pechacek TF, Tong VT, and McAfee TA. Nicotine and the developing human: A neglected element in the electronic cigarette debate. American Journal of Preventive Medicine, 2015; 49(2):286–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25794473
5. Klein JD. Electronic cigarettes are another route to nicotine addiction for youth. JAMA Pediatrics, 2015; 169(11):993–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26349006
6. Leigh NJ, Lawton RI, Hershberger PA, and Goniewicz ML. Flavourings significantly affect inhalation toxicity of aerosol generated from electronic nicotine delivery systems (ends). Tobacco Control, 2016; 25(Suppl 2):ii81–ii7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27633767
7. Tierney PA, Karpinski CD, Brown JE, Luo W, and Pankow JF. Flavour chemicals in electronic cigarette fluids. Tobacco Control, 2016; 25(e1):e10-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25877377
8. Moore G, Hewitt G, Evans J, Littlecott HJ, Holliday J, et al. Electronic-cigarette use among young people in Wales: Evidence from two cross-sectional surveys. BMJ Open, 2015; 5(4):e007072. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25877272
9. Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, et al. E-cigarette use among middle and high school students - United States, 2020. Morbidity and Mortality Weekly Report, 2020; 69(37):1310–2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32941408
10. Health Canada. Canadian student tobacco, alcohol and drugs survey 2018-19. 2019. Available from: https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html
11. Action on Smoking and Health UK. Use of e-cigarettes among young people in Great Britain. 2021. Available from: https://ash.org.uk/information-and-resources/fact-sheets/statistical/use-of-e-cigarettes-among-young-people-in-great-britain-2021/
12. Guerin N and White V. Secondary school students’ use of tobacco, alcohol and other drugs in 2017: Second edition. Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/publications/secondary-school-students-use-of-tobacco-alcohol-and-other-drugs-in-2017.
13. Thurber K, Walker J, Maddox R, Marmor A, Heris C, et al. A review of evidence on the prevalence of and trends in cigarette and e-cigarette use by Aboriginal and Torres Strait Islander youth and adults. The Australian National University: Aboriginal and Torres Strait Islander Health Program; National Centre for Epidemiology and Population Health; Research School of Population Health, 2020. Available from: https://openresearch-repository.anu.edu.au/bitstream/1885/210569/1/Aboriginal%20cigarette%20ecigarette%20prevalence%20trends_2020.pdf.
14. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 2. Tobacco smoking chapter, supplementary data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data.
15. Atuegwu NC, Oncken C, Laubenbacher RC, Perez MF, and Mortensen EM. Factors associated with e-cigarette use in US young adult never smokers of conventional cigarettes: A machine learning approach. International Journal of Environmental Research and Public Health, 2020; 17(19). Available from: https://www.ncbi.nlm.nih.gov/pubmed/33027932
16. Han CH and Chung JH. Factors associated with electronic cigarette use among adolescents asthma in the republic of Korea. The Journal of Asthma, 2020:1–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32718189
17. Hyeon JH, Shelley C, and Lee CM. Prevalence and correlates of prior experimentation with e-cigarettes over conventional cigarettes among adolescents: Findings from the 2015 Korea youth risk behaviour web-based survey. Tob Prev Cessat, 2019; 5:33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32411896
18. Lewek P, Wozniak B, Maludzinska P, Smigielski J, and Kardas P. E-cigarette use and its predictors: Results from an online cross-sectional survey in Poland. Tobacco Induced Diseases, 2019; 17:79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31772557
19. Park S, Lee H, and Min S. Factors associated with electronic cigarette use among current cigarette-smoking adolescents in the republic of Korea. Addictive Behaviors, 2017; 69:22–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28110154
20. Perez A, Bluestein M, Chen B, Perry CL, and Harrell MB. Prospectively estimating the age of initiation of e-cigarettes among US youth: Findings from the population assessment of tobacco and health (PATH) study, 2013-2017. J Biom Biostat, 2020; 11(4). Available from: https://www.ncbi.nlm.nih.gov/pubmed/33552669
21. Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, and Nena E. E-cigarette use among adolescents: An overview of the literature and future perspectives. Front Public Health, 2018; 6:86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29632856
22. US Surgeon General. 2016 surgeon general's report: E-cigarette use among youth and young adults. US 2016. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm.
23. Thomas DP, Lusis N, Van der Sterren AE, and Borland R. Electronic cigarette use and understanding among a national sample of Australian Aboriginal and Torres Strait Islander smokers. Nicotine & Tobacco Research, 2019; 21(10):1434–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30053109
24. Benyo SE, Bruinsma TJ, Drda E, Brady-Olympia J, Hicks SD, et al. Risk factors and medical symptoms associated with electronic vapor product use among adolescents and young adults. Clin Pediatr (Phila), 2021; 60(6-7):279–89. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33896217
25. National Academies of Sciences Engineering and Medicine. Public health consequences of e-cigarettes. The National Academies Press, Washington, DC 2018. Available from: http://nationalacademies.org/hmd/Reports/2018/public-health-consequences-of-e-cigarettes.aspx.
26. Cho BY, Seo DC, Lin HC, Lohrmann DK, Chomistek AK, et al. Adolescent weight and electronic vapor product use: Comparing BMI-based with perceived weight status. American Journal of Preventive Medicine, 2018; 55(4):541–50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30126669
27. Mantey DS, Omega-Njemnobi O, and Kelder SH. E-cigarette use is associated with intentions to lose weight among high school students. Nicotine & Tobacco Research, 2020; 22(5):838–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30452714
28. Morean ME, Bold KW, Kong G, Camenga DR, Simon P, et al. High school students' use of flavored e-cigarette e-liquids for appetite control and weight loss. Addictive Behaviors, 2020; 102:106139. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31704428
29. Wamamili B, Wallace-Bell M, Richardson A, Grace RC, and Coope P. Associations of history of mental illness with smoking and vaping among university students aged 18-24 years in New Zealand: Results of a 2018 national cross-sectional survey. Addictive Behaviors, 2021; 112:106635. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32932103
30. Seo DC, Kwon E, Lee S, and Seo J. Using susceptibility measures to prospectively predict ever use of electronic cigarettes among adolescents. Preventive Medicine, 2020; 130:105896. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31730945
31. Cho BY. Parent's depression as a moderator of the association between offspring's depressive symptoms and use of combustible cigarettes and electronic vapor products. J Behav Health Serv Res, 2019; 46(4):648–55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30868451
32. Shin SH. Preventing e-cigarette use among high-risk adolescents: A trauma-informed prevention approach. Addictive Behaviors, 2021; 115:106795. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33387976
33. Williams L, Clements-Nolle K, Lensch T, and Yang W. Exposure to adverse childhood experiences and early initiation of electronic vapor product use among middle school students in nevada. Addictive Behaviors Reports, 2020; 11:100266. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32467855
34. Shin SH, Conley D, Ksinan Jiskrova G, and Wills TA. Adverse childhood experiences and e-cigarette use during young adulthood. American Journal on Addictions, 2019; 28(4):303–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31069879
35. Chan G, Leung J, Gartner C, Yong HH, Borland R, et al. Correlates of electronic cigarette use in the general population and among smokers in Australia - findings from a nationally representative survey. Addictive Behaviors, 2019; 95:6–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30784874
36. Demissie Z, Everett Jones S, Clayton HB, and King BA. Adolescent risk behaviors and use of electronic vapor products and cigarettes. Pediatrics, 2017; 139(2). Available from: https://www.ncbi.nlm.nih.gov/pubmed/28115539
37. Chang YP and Seo YS. E-cigarette use and concurrent risk behaviors among adolescents. Nurs Outlook, 2021; 69(3):302–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33121761
38. Boccio CM and Jackson DB. Examining potential risk factors for early age of nicotine vaping initiation in a sample of Florida youth. Addictive Behaviors, 2021; 120:106962. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33964584
39. Fatemi NN, Cruz TH, Kesler DO, and Schiff MA. The association between risk behaviors and vaping among youth in new Mexico. J Public Health Manag Pract, 2021; 27(Suppl 3):S164–S7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33785690
40. Kristjansson AL, Mann MJ, Smith ML, and Sigfusdottir ID. Social profile of middle school-aged adolescents who use electronic cigarettes: Implications for primary prevention. Prev Sci, 2018; 19(6):805–12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28725992
41. Case KR, Harrell MB, Perez A, Loukas A, Wilkinson AV, et al. The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents. Addictive Behaviors, 2017; 73:151–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28521240
42. Vallone DM, Bennett M, Xiao H, Pitzer L, and Hair EC. Prevalence and correlates of JUUL use among a national sample of youth and young adults. Tobacco Control, 2019; 28(6):603–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30377241
43. Kong G, Morean ME, Cavallo DA, Camenga DR, and Krishnan-Sarin S. Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine & Tobacco Research, 2015; 17(7):847–54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25481917
44. Leavens ELS, Stevens EM, Brett EI, Hebert ET, Villanti AC, et al. JUUL electronic cigarette use patterns, other tobacco product use, and reasons for use among ever users: Results from a convenience sample. Addictive Behaviors, 2019; 95:178–83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30933713
45. Leavens ELS, Stevens EM, Brett EI, Leffingwell TR, and Wagener TL. JUUL in school: JUUL electronic cigarette use patterns, reasons for use, and social normative perceptions among college student ever users. Addictive Behaviors, 2019; 99:106047. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31442788
46. Hajek P, Etter JF, Benowitz N, Eissenberg T, and McRobbie H. Electronic cigarettes: Review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction, 2014; 109(11):1801–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25078252
47. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Cat. no. PHE 183 Canberra: AIHW, 2014. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3.
48. Kaleta D, Niedzin M, Jankowska A, and Polanska K. Predictors of e-cigarette use susceptibility-a study of young people from a socio-economically disadvantaged rural area in Poland. International Journal of Environmental Research and Public Health, 2019; 16(20). Available from: https://www.ncbi.nlm.nih.gov/pubmed/31623178
49. Krishnan-Sarin S, Jackson A, Morean M, Kong G, Bold KW, et al. E-cigarette devices used by high-school youth. Drug and Alcohol Dependence, 2019; 194:395–400. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30497057
50. Margolis KA, Thakur SK, Nguyen Zarndt A, Kemp CB, and Glover-Kudon R. E-cigarette susceptibility among US middle and high school students: National youth tobacco survey data trend analysis, 2014-2018. Preventive Medicine, 2021; 143:106347. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33271235
51. McCabe SE, Boyd CJ, Evans-Polce RJ, McCabe VV, and Veliz PT. School-level prevalence and predictors of e-cigarette use in 8th, 10th, and 12th grade US youth: Results from a national survey (2015-2016). The Journal of Adolescent Health, 2020; 67(4):531–41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32402800
52. Prom-Wormley EC, Clifford JS, Cooke ME, Cecilione J, Maes HH, et al. The genetic and environmental influences contributing to the association between electronic and conventional cigarette initiation. Nicotine & Tobacco Research, 2021; 23(5):856–60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33017842
53. Tackett AP, Keller-Hamilton B, Hebert ET, Smith CE, Wallace SW, et al. Adolescent susceptibility to e-cigarettes: An update from the 2018 national youth tobacco survey. American Journal of Health Promotion, 2021; 35(4):551–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33167676
54. Vuolo M, Janssen E, Le Nezet O, and Spilka S. Community- and individual-level risk factors of past month e-cigarette use among adolescents in France. Drug and Alcohol Dependence, 2021; 226:108823. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34216860
55. Britton J and Bogdanovica I. Electronic cigarettes: A report commissioned by Public Health England. 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/311887/Ecigarettes_report.pdf.
56. Barrington-Trimis JL, Urman R, Leventhal AM, Gauderman WJ, Cruz TB, et al. E-cigarettes, cigarettes, and the prevalence of adolescent tobacco use. Pediatrics, 2016; 138(2). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27401102
57. Chaffee BW, Couch ET, and Gansky SA. Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS One, 2017; 12(5):e0177073. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28475634
58. Mirbolouk M, Charkhchi P, Orimoloye OA, Uddin SMI, Kianoush S, et al. E-cigarette use without a history of combustible cigarette smoking among US adults: Behavioral risk factor surveillance system, 2016. Annals of Internal Medicine, 2019; 170(1):76–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30304466
59. Owusu D, Huang J, Weaver SR, Pechacek TF, Ashley DL, et al. Patterns and trends of dual use of e-cigarettes and cigarettes among US adults, 2015-2018. Preventive Medicine Reports, 2019; 16:101009. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31763161
60. Han DH, Lee SH, Lee S, and Seo DC. Identifying emerging predictors for adolescent electronic nicotine delivery systems use: A machine learning analysis of the population assessment of tobacco and health study. Preventive Medicine, 2021; 145:106418. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33422574
61. Rothrock AN, Andris H, Swetland SB, Chavez V, Isaak S, et al. Association of e-cigarettes with adolescent alcohol use and binge drinking-drunkenness: A systematic review and meta-analysis. American Journal of Drug and Alcohol Abuse, 2020; 46(6):684–98. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32795246
62. Park E, Livingston JA, Wang W, Kwon M, Eiden RD, et al. Adolescent e-cigarette use trajectories and subsequent alcohol and marijuana use. Addictive Behaviors, 2020; 103:106213. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31862618
63. Case KR, Obinwa UC, Clendennen SL, Perry CL, and Harrell MB. Predictors of JUUL, other electronic nicotine delivery systems, and combustible tobacco initiation among Texas youth. Preventive Medicine, 2020; 138:106097. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32335030
64. Weinberger AH, Zhu J, Lee J, Xu S, and Goodwin RD. Cannabis use and the onset of cigarette and e-cigarette use: A prospective, longitudinal study among youth in the United States. Nicotine & Tobacco Research, 2021; 23(3):609–13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32835370
65. Bluestein M, Kelder S, Perry CL, and Perez A. Exploring associations between the use of alcohol and marijuana with e-cigarette use in a US nationally representative sample of young adults. Int J Health Sci (Qassim), 2019; 13(1):30–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30842716
66. Duke JC, Allen JA, Eggers ME, Nonnemaker J, and Farrelly MC. Exploring differences in youth perceptions of the effectiveness of electronic cigarette television advertisements. Nicotine & Tobacco Research, 2016; 18(5):1382–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26706908
67. Farrelly MC, Duke JC, Crankshaw EC, Eggers ME, Lee YO, et al. A randomized trial of the effect of e-cigarette tv advertisements on intentions to use e-cigarettes. American Journal of Preventive Medicine, 2015; 49(5):686–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26163170
68. Margolis KA, Donaldson EA, Portnoy DB, Robinson J, Neff LJ, et al. E-cigarette openness, curiosity, harm perceptions and advertising exposure among US middle and high school students. Preventive Medicine, 2018; 112:119–25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29673886
69. Stroup AM and Branstetter SA. Effect of e-cigarette advertisement exposure on intention to use e-cigarettes in adolescents. Addictive Behaviors, 2018; 82:1–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29471130
70. Vogel EA, Ramo DE, Rubinstein ML, Delucchi KL, Darrow SM, et al. Effects of social media on adolescents' willingness and intention to use e-cigarettes: An experimental investigation. Nicotine & Tobacco Research, 2021; 23(4):694–701. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31912147
71. Singh T, Agaku IT, Arrazola RA, Marynak KL, Neff LJ, et al. Exposure to advertisements and electronic cigarette use among US middle and high school students. Pediatrics, 2016; 137(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27244815
72. Mantey DS, Cooper MR, Clendennen SL, Pasch KE, and Perry CL. E-cigarette marketing exposure is associated with e-cigarette use among US youth. The Journal of Adolescent Health, 2016; 58(6):686–90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27080732
73. Best C, Haseen F, van der Sluijs W, Ozakinci G, Currie D, et al. Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: A cross-sectional study. BMC Public Health, 2016; 16(1):310. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27075888
74. Pu J and Zhang X. Exposure to advertising and perception, interest, and use of e-cigarettes among adolescents: Findings from the US national youth tobacco survey. Perspect Public Health, 2017; 137(6):322–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28379069
75. Collins L, Glasser AM, Abudayyeh H, Pearson JL, and Villanti AC. E-cigarette marketing and communication: How e-cigarette companies market e-cigarettes and the public engages with e-cigarette information. Nicotine & Tobacco Research, 2019; 21(1):14–24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29315420
76. Camenga D, Gutierrez KM, Kong G, Cavallo D, Simon P, et al. E-cigarette advertising exposure in e-cigarette naive adolescents and subsequent e-cigarette use: A longitudinal cohort study. Addictive Behaviors, 2018; 81:78–83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29432916
77. Chen-Sankey JC, Unger JB, Bansal-Travers M, Niederdeppe J, Bernat E, et al. E-cigarette marketing exposure and subsequent experimentation among youth and young adults. Pediatrics, 2019; 144(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/31659003
78. Kreitzberg DS, Pasch KE, Marti CN, Loukas A, and Perry CL. Bidirectional associations between young adults' reported exposure to e-cigarette marketing and e-cigarette use. Addiction, 2019; 114(10):1834–41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31183884
79. Pike JR, Tan N, Miller S, Cappelli C, Xie B, et al. The effect of e-cigarette commercials on youth smoking: A prospective study. American Journal of Health Behavior, 2019; 43(6):1103–18. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31662169
80. St Claire S, Fayokun R, Commar A, Schotte K, and Prasad VM. The World Health Organization's world no tobacco day 2020 campaign exposes tobacco and related industry tactics to manipulate children and young people and hook a new generation of users. The Journal of Adolescent Health, 2020; 67(3):334–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32682598
81. Measham F, O’Brien K, and Turnbull G. “Skittles & red bull is my favourite flavour”: E-cigarettes, smoking, vaping and the changing landscape of nicotine consumption amongst British teenagers – implications for the normalisation debate. Drugs: Education, Prevention and Policy, 2016; 23(3):224–37. Available from: http://dx.doi.org/10.1080/09687637.2016.1178708
82. Harrell MB, Weaver SR, Loukas A, Creamer M, Marti CN, et al. Flavored e-cigarette use: Characterizing youth, young adult, and adult users. Preventive Medicine Reports, 2017; 5:33–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27896041
83. Pepper JK, Ribisl KM, and Brewer NT. Adolescents' interest in trying flavoured e-cigarettes. Tobacco Control, 2016; 25(Suppl 2):ii62–ii6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27633762
84. Meernik C, Baker HM, Kowitt SD, Ranney LM, and Goldstein AO. Impact of non-menthol flavours in e-cigarettes on perceptions and use: An updated systematic review. BMJ Open, 2019; 9(10):e031598. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31619431
85. Leventhal AM, Goldenson NI, Cho J, Kirkpatrick MG, McConnell RS, et al. Flavored e-cigarette use and progression of vaping in adolescents. Pediatrics, 2019; 144(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/31659004
86. Leventhal AM, Goldenson NI, Barrington-Trimis JL, Pang RD, and Kirkpatrick MG. Effects of non-tobacco flavors and nicotine on e-cigarette product appeal among young adult never, former, and current smokers. Drug and Alcohol Dependence, 2019; 203:99–106. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31434028
87. Han G and Son H. What influences adolescents to continuously use e-cigarettes? Public Health Nurs, 2020; 37(4):504–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32372518
88. Audrain-McGovern J, Rodriguez D, Pianin S, and Alexander E. Initial e-cigarette flavoring and nicotine exposure and e-cigarette uptake among adolescents. Drug and Alcohol Dependence, 2019; 202:149–55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31351341
89. Abadi MH, Lipperman-Kreda S, Shamblen SR, Thompson K, Grube JW, et al. The impact of flavored ends use among adolescents on daily use occasions and number of puffs, and next day intentions and willingness to vape. Addictive Behaviors, 2021; 114:106773. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33338905
90. U.S. Food and Drug Administration. FDA warns company for selling e-liquids that resemble kid-friendly foods as part of the agency’s ongoing youth tobacco prevention plan. FDA, 2018. Available from: https://www.fda.gov/news-events/press-announcements/fda-warns-company-selling-e-liquids-resemble-kid-friendly-foods-part-agencys-ongoing-youth-tobacco
91. Fadus MC, Smith TT, and Squeglia LM. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug and Alcohol Dependence, 2019; 201:85–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31200279
92. Ramamurthi D, Chau C, and Jackler RK. JUUL and other stealth vaporisers: Hiding the habit from parents and teachers. Tobacco Control, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30219794
93. Schillo BA, Cuccia AF, Patel M, Simard B, Donovan EM, et al. JUUL in school: Teacher and administrator awareness and policies of e-cigarettes and JUUL in US middle and high schools. Health Promotion Practice, 2020; 21(1):20–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31530185
94. Dormanesh A and Allem JP. New products that facilitate stealth vaping: The case of sleav. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34031224
95. Barrientos-Gutierrez I, Lozano P, Arillo-Santillan E, Morello P, Mejia R, et al. "Technophilia": A new risk factor for electronic cigarette use among early adolescents? Addictive Behaviors, 2019; 91:193–200. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30224154
96. Thrasher JF, Abad-Vivero EN, Barrientos-Gutierrez I, Perez-Hernandez R, Reynales-Shigematsu LM, et al. Prevalence and correlates of e-cigarette perceptions and trial among early adolescents in Mexico. The Journal of Adolescent Health, 2016; 58(3):358–65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26903433
97. Vogel EA, Ramo DE, and Rubinstein ML. Prevalence and correlates of adolescents' e-cigarette use frequency and dependence. Drug and Alcohol Dependence, 2018; 188:109–12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29763848
98. Goniewicz ML, Boykan R, Messina CR, Eliscu A, and Tolentino J. High exposure to nicotine among adolescents who use Juul and other vape pod systems ('pods'). Tobacco Control, 2019; 28(6):676–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30194085
99. Willett JG, Bennett M, Hair EC, Xiao H, Greenberg MS, et al. Recognition, use and perceptions of JUUL among youth and young adults. Tobacco Control, 2019; 28(1):115–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29669749
100. Morean ME, Bold KW, Kong G, Gueorguieva R, Camenga DR, et al. Adolescents' awareness of the nicotine strength and e-cigarette status of JUUL e-cigarettes. Drug and Alcohol Dependence, 2019; 204:107512. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31487572
101. Durkin K, Williford DN, Turiano NA, Blank MD, Enlow PT, et al. Associations between peer use, costs and benefits, self-efficacy, and adolescent e-cigarette use. J Pediatr Psychol, 2021; 46(1):112–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33120416
102. Bares C and Lopez Quintero C. Shared environmental influences on electronic cigarette use among adolescent and young adult females. Nicotine & Tobacco Research, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33539519
103. Trucco EM, Cristello JV, and Sutherland MT. Do parents still matter? The impact of parents and peers on adolescent electronic cigarette use. The Journal of Adolescent Health, 2021; 68(4):780–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33431246
104. Trucco EM, Fallah-Sohy N, Hartmann SA, and Cristello JV. Electronic cigarette use among youth: Understanding unique risks in a vulnerable population. Curr Addict Rep, 2020; 7(4):497–508. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33409119
105. Smith H, Lucherini M, Amos A, and Hill S. The emerging norms of e-cigarette use among adolescents: A meta-ethnography of qualitative evidence. Int J Drug Policy, 2021; 94:103227. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33780877
106. Miller C, Smith DM, and Goniewicz ML. Physical activity among adolescent tobacco and electronic cigarette users: Cross-sectional findings from the population assessment of tobacco and health study. Preventive Medicine Reports, 2019; 15:100897. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31193540
107. Azagba S, Mensah NA, Shan L, and Latham K. Bullying victimization and e-cigarette use among middle and high school students. J Sch Health, 2020; 90(7):545–53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32406087
108. Dai H. Exposure to secondhand aerosol from electronic cigarettes among US youth from 2015 to 2018. JAMA Pediatrics, 2020; 174(3):298–300. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31985771
109. Dai H. Youth observation of e-cigarette use in or around school, 2019. American Journal of Preventive Medicine, 2021; 60(2):241–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33353794
110. Mantey DS, Omega-Njemnobi O, Ruiz FA, Vaughn TL, Kelder SH, et al. Association between observing peers vaping on campus and e-cigarette use and susceptibility in middle and high school students. Drug and Alcohol Dependence, 2021; 219:108476. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33360854
111. Jayakumar N, O'Connor S, Diemert L, and Schwartz R. Predictors of e-cigarette initiation: Findings from the youth and young adult panel study. Tob Use Insights, 2020; 13:1179173X20977486. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33447117
112. McDermott MS, East KA, Hitchman SC, McNeill A, Tountas Y, et al. Social norms for e-cigarettes and smoking: Associations with initiation of e-cigarette use, intentions to quit smoking and quit attempts: Findings from the eurest-plus ITC Europe surveys. European Journal of Public Health, 2020; 30(Suppl_3):iii46–iii54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32918818
113. Zhang X and Pu J. E-cigarette use among US adolescents: Secondhand smoke at home matters. International Journal of Public Health, 2016; 61(2):209–13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26781545
114. Strombotne K, Sindelar J, and Buckell J. Who, me? Optimism bias about US teenagers' ability to quit vaping. Addiction, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33891783
115. Ebrahimi Kalan M, McKelvey K, Ibrahimou B, Trucco EM, and Ben Taleb Z. The road to vaping: E-cigarette susceptibility and curiosity among US adolescents susceptible and nonsusceptible to cigarette smoking. Health Education & Behavior, 2020; 47(5):696–705. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32696676
116. Rohde JA, Noar SM, Horvitz C, Lazard AJ, Cornacchione Ross J, et al. The role of knowledge and risk beliefs in adolescent e-cigarette use: A pilot study. International Journal of Environmental Research and Public Health, 2018; 15(4). Available from: https://www.ncbi.nlm.nih.gov/pubmed/29690606