Know the Facts

Youth tobacco product use increased during 2017-2018.

In 2018, about 4.9 million middle and high school students used a tobacco product in the last 30 days, up from 3.6 million in 2017. This increase was driven by a startling increase in e-cigarette use—a 78% increase among high school students and nearly 50% increase among middle school students. Since 2014, e-cigarettes have been the most commonly used tobacco product among youth.

What is an e-cigarette?

E-cigarettes are battery-powered devices that can deliver nicotine and flavorings to the user in the form of an aerosol. E-cigarettes come in many shapes and sizes. Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items that are easy to conceal.

JUUL, an e-cigarette shaped like a USB flash drive, is now the most commonly sold e-cigarette in the United States. JUUL uses liquid nicotine refills called “pods,” which contain at least as much nicotine as a pack of cigarettes.

What is in the aerosol?

E-cigarette aerosol is not harmless water vapor. In addition to nicotine, the aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs. Some of the flavorings used in e-cigarettes may also have health risks when inhaled.

Youth use of any tobacco product, including e-cigarettes, is unsafe.

Scientists are still learning about the long-term health effects of e-cigarettes, but we know enough to take action to protect kids from known risks of these products. Most e-cigarettes contain nicotine – the same addictive drug in regular cigarettes, cigars, and other tobacco products. Nicotine exposure during adolescence can harm the developing brain, and impact learning, memory, and attention. Using nicotine during adolescence can also increase risk for future addiction to other drugs.

All JUUL e-cigarettes contain a high level of nicotine.

These products also use nicotine salts, which allow particularly high levels of nicotine to be inhaled more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes. This is of particular concern for young people, because it could make it easier for them to initiate the use of nicotine through these products. But despite these risks, approximately two-thirds of JUUL users aged 15–24 do not know that JUUL always contains nicotine.

Other health risks for youth and young adults.

Young people who use e-cigarettes may be more likely to go on to use regular cigarettes. E-cigarettes also can be used to deliver other drugs, including marijuana; in 2016, approximately one-third of U.S. middle and high school students who have ever used an e-cigarette reported using marijuana in the device.

Also, defective e-cigarette batteries have caused fires and explosions, a few of which have resulted in serious injuries. Children have also been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. Nationally, approximately 50% of calls to poison control centers for e-cigarettes are for kids 5 years of age or younger.

Flavors and marketing make e-cigarettes appealing to youth.

Many e-cigarettes come in fruit, candy, and other kid-friendly flavors, such as mango and crème. A majority of youth e-cigarette users report using flavored varieties, most youth e-cigarette users first start using e-cigarettes with a flavored variety, and flavors are a primary reason youth report using e-cigarettes.

E-cigarettes are also advertised using the same themes and tactics that have been shown to increase youth initiation of other tobacco products, including cigarettes. In 2016, about 8 in 10 middle school and high school students—more than 20 million youth—said they had seen e-cigarette advertising.

Refer to the Frequently Asked Questions section for additional information on youth and e-cigarettes.