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The E-Cigarette Phenomenon: What it is, Why it is Happening, and What You Should Know About it

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Electronic Cigarettes and Vape Devices

Abstract

In 2018, the FDA Commissioner described the “disturbing and accelerating trajectory” of youth e-cigarette use as an “almost ubiquitous” trend among youth, and the FDA Commissioner and the U.S. Surgeon General called youth e-cigarette use an “epidemic.” While there is some hope that e-cigarette use is declining modestly, more than one fifth of high school students and about one in ten middle school students are using e-cigarettes every day. This increase in use frequency may be associated with greater nicotine dependence among young users, highlighting the threat of hooking a new generation on nicotine and other tobacco products, including combustible cigarettes. E-cigarettes are associated with a number of significant health consequences, including cardiovascular and respiratory impacts, nicotine harms and addiction, toxic effects of flavors, and psychological, social, and educational effects. Adolescents and young adults are especially attracted to using e-cigarettes because of their youth-friendly flavors; the new salt-based nicotine formulation which makes the products easier to use, less harsh, and allows users to more easily take in higher levels of nicotine more quickly which effectively makes them more addictive; the appealing designs and concealability of the e-cigarette devices; the aggressive marketing that targets youth; misperceptions about the products’ harmfulness; and their ability to easily access and afford e-cigarettes. Previous successful efforts to reduce adolescent, young adult, and adult tobacco use are being eroded through the adolescent e-cigarette epidemic. Clearly there is a great deal of work to do to once again bring tobacco use levels to single digits. Proven tobacco control measures should be adopted to reduce and prevent e-cigarette use, including effective education campaigns; rigorous regulations at the federal, state, and local levels; and measures taken to ensure that these programs and laws will not become obsolete with the introduction of new and enticing tobacco products in the future.

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References

  1. Hsu G, Sun JY, Zhu SH. Evolution of electronic cigarette brands from 2013-2014 to 2016-2017: analysis of brand websites. J Med Internet Res. 2018;20(3):e80.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Food and Drug Administration. Nicotine: the addictive chemical in tobacco products (updated 8/28/20). Available: https://www.fda.gov/tobacco-products/health-information/nicotine-addictive-chemical-tobacco-products (accessed Jan 28, 2020).

  3. Zettler PJ, Hemmerich N, Berman ML. Closing the regulatory gap for synthetic nicotine products. Boston College law review. Boston College. Law School. 2018;59(6):1933.

    Google Scholar 

  4. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation. 2014;129(19):1972–86.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Centers for Disease Control and Prevention. About Electronic Cigarettes (E-Cigarettes), updated September 9, 2020. Available: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html (accessed Nov 9, 2020).

  6. Centers for Disease Control and Prevention. E-Cigarette, or Vaping, Products Visual Dictionary. Available: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/ecigarette-or-vaping-products-visual-dictionary-508.pdf (accessed Nov 12, 2020).

  7. Campaign for Tobacco-Free Kids. Electronic cigarettes: an overview of key issues, September 18, 2020. Available: https://www.tobaccofreekids.org/us-resources/fact-sheet/electronic-cigarettes-an-overview-of-key-issues (accessed Nov 10, 2020).

  8. Zaleski O, Kary T, Bloomberg News. Altria Invests $12.8 Billion in E-Cigarette Maker Juul, December 20, 2018. Available: https://www.bloomberg.com/news/articles/2018-12-20/altria-invests-12-8-billion-in-e-cigarette-maker-juul-labs#:~:text=The%20%2412.8%20billion%20deal%2C%20which,cigarettes%20on%20American%20retail%20shelves (accessed Nov 9, 2020).

  9. RJ Reynolds Vapor Company. RJ Reynolds Vapor, available: https://www.rjrvapor.com/ (accessed Nov 9, 2020).

  10. ITG Brands. ITG Brands Tobacco Products website. Available: https://www.itgbrands.com/brands/ (accessed Nov. 9, 2020).

  11. Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629–37.

    Article  PubMed  Google Scholar 

  12. McNeill A, Brose L, Calder R, Hitchman S, Hajek P, McRobbie H. E-cigarettes: an evidence update. Public Health England. 2015;3.

    Google Scholar 

  13. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. Available: https://doi.org/10.17226/24952 (accessed Nov. 9, 2020) 2018 xxiii, 750 pages].

  14. Helen GS, Liakoni E, Nardone N, Addo N, Jacob P, Benowitz NL. Comparison of systemic exposure to toxic and/or carcinogenic volatile organic compounds (VOC) during vaping, smoking, and abstention. Cancer Prev Res. 2020;13(2):153–62.

    Article  Google Scholar 

  15. Goniewicz ML, Smith DM, Edwards KC, Blount BC, Caldwell KL, Feng J, et al. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. JAMA Netw Open. 2018;1(8):e185937.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: a review of reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;163(8):608–21.

    Article  PubMed  Google Scholar 

  17. Gaiha SM, Halpern-Felsher B. Public health considerations for adolescent initiation of electronic cigarettes. Pediatrics. 2020;145(Suppl 2):S175–S80.

    Article  PubMed  Google Scholar 

  18. Pierce JP, Benmarhnia T, Chen R, White M, Abrams DB, Ambrose BK, et al. Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: the PATH study 2013-16. PLoS One. 2020;15(9):e0237938.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Centers for Disease Control and Prevention. QuickStats: cigarette smoking status among current adult e-cigarette users, by age group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:1177. https://doi.org/10.15585/mmwr.mm6542a7 (accessed Nov. 9, 2020).

  20. Alzahrani T, Pena I, Temesgen N, Glantz SA. Association between electronic cigarette use and myocardial infarction. Am J Prev Med. 2018;55(4):455–61.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SI, Benjamin EJ, et al. Association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers. Am J Med. 2019;132(8):949–54. e2.

    Article  CAS  PubMed  Google Scholar 

  22. Glantz SA, Bareham DW. E-cigarettes: use, effects on smoking, risks, and policy implications. Annu Rev Public Health. 2018;39:215–35.

    Article  PubMed  PubMed Central  Google Scholar 

  23. U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. Available: https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/index.html

  24. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control. 2014;23(suppl 2):ii11-ii7.

    Article  Google Scholar 

  25. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133–9.

    Article  PubMed  Google Scholar 

  26. Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS One. 2013;8(3):e57987.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Schmidt S. Vaper, beware: the unique toxicological profile of electronic cigarettes. Environ Health Perspect. 2020;128(5):52001.

    Article  CAS  PubMed  Google Scholar 

  28. Allen JG, Flanigan SS, LeBlanc M, Vallarino J, MacNaughton P, Stewart JH, et al. Flavoring chemicals in e-cigarettes: diacetyl, 2, 3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environ Health Perspect. 2016;124(6):733–9.

    Article  CAS  PubMed  Google Scholar 

  29. Leigh NJ, Lawton RI, Hershberger PA, Goniewicz ML. Flavourings significantly affect inhalation toxicity of aerosol generated from electronic nicotine delivery systems (ENDS). Tob Control. 2016;25(Suppl 2):ii81–i7.

    Article  PubMed  Google Scholar 

  30. Tierney PA, Karpinski CD, Brown JE, Luo W, Pankow JF. Flavour chemicals in electronic cigarette fluids. Tob Control. 2016;25(e1):e10–e5.

    Article  PubMed  Google Scholar 

  31. Clapp PW, Pawlak EA, Lackey JT, Keating JE, Reeber SL, Glish GL, et al. Flavored e-cigarette liquids and cinnamaldehyde impair respiratory innate immune cell function. Am J Physiol-Lung Cell Mol Physiol. 2017.

    Google Scholar 

  32. Behar R, Davis B, Wang Y, Bahl V, Lin S, Talbot P. Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Toxicol In Vitro. 2014;28(2):198–208.

    Article  CAS  PubMed  Google Scholar 

  33. Benowitz NL, St. Helen G, Nardone N, Addo N, Zhang J, Harvanko AM, et al. Twenty-four-hour cardiovascular effects of electronic cigarettes compared with cigarette smoking in dual users. J Am Heart Assoc. 2020:e017317.

    Google Scholar 

  34. Bhatnagar A. E-cigarettes and cardiovascular disease risk: evaluation of evidence, policy implications, and recommendations. Curr Cardiovasc Risk Rep. 2016;10(7):24.

    Article  Google Scholar 

  35. Xie W, Kathuria H, Galiatsatos P, Blaha MJ, Hamburg NM, Robertson RM, et al. Association of electronic cigarette use with incident respiratory conditions among US adults from 2013 to 2018. JAMA Netw Open. 2020;3(11):e2020816.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Gotts JE, Jordt S-E, McConnell R, Tarran R. What are the respiratory effects of e-cigarettes? BMJ. 2019;366:l5275.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Wills TA, Pagano I, Williams RJ, Tam EK. E-cigarette use and respiratory disorder in an adult sample. Drug Alcohol Depend. 2019;194:363–70.

    Article  PubMed  Google Scholar 

  38. Berry KM, Fetterman JL, Benjamin EJ, Bhatnagar A, Barrington-Trimis JL, Leventhal AM, et al. Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Netw Open. 2019;2(2):e187794.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr. 2017;171(8):788–97.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chaffee BW, Watkins SL, Glantz SA. Electronic cigarette use and progression from experimentation to established smoking. Pediatrics. 2018;141(4).

    Google Scholar 

  41. Dai H, Catley D, Richter KP, Goggin K, Ellerbeck EF. Electronic cigarettes and future marijuana use: a longitudinal study. Pediatrics. 2018;141(5):e20173787.

    Article  PubMed  Google Scholar 

  42. Gaiha SM, Halpern-Felsher B. Escalating safety concerns are not changing adolescent E-cigarette use patterns: the possible role of adolescent mental health. J Adolesc Health. 2020;66(1):3–5.

    Article  PubMed  Google Scholar 

  43. Grant JE, Lust K, Fridberg DJ, King AC, Chamberlain SR. E-cigarette use (vaping) is associated with illicit drug use, mental health problems, and impulsivity in university students. Ann Clin Psychiat. 2019;31(1):27.

    Article  Google Scholar 

  44. Leventhal AM, Strong DR, Sussman S, Kirkpatrick MG, Unger JB, Barrington-Trimis JL, et al. Psychiatric comorbidity in adolescent electronic and conventional cigarette use. J Psychiatr Res. 2016;73:71–8.

    Article  PubMed  Google Scholar 

  45. Leventhal AM, Bae D, Kechter A, Barrington-Trimis JL. Psychiatric comorbidity in adolescent use and poly-use of combustible, vaporized, and edible cannabis products. J Psychiatr Res. 2020;124:91–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SI, Dzaye O, et al. Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016–2017. JAMA Netw Open. 2019;2(12):e1916800.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Vallone DM, Cuccia AF, Briggs J, Xiao H, Schillo BA, Hair EC. Electronic cigarette and JUUL use among adolescents and young adults. JAMA Pediatr. 2020;174(3):277–86.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gentzke AS, Creamer M, Cullen KA, Ambrose BK, Willis G, Jamal A, et al. Vital signs: tobacco product use among middle and high school students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep. 2019;68(6):157–64.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Cullen KA, Gentzke AS, Sawdey MD, Chang JT, Anic GM, Wang TW, et al. JAMA. 2019:2019.

    Google Scholar 

  50. Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette use among middle and high school students - United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1310–2.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Centers for Disease Control and Prevention. National Youth Tobacco Survey (NYTS) (last reviewed December 21, 2020). Available: https://www.cdc.gov/tobacco/data_statistics/surveys/nyts/ (accessed Jan. 27, 2020).

  52. Cornelius ME, Wang TW, Jamal A LC, Neff LJ. Tobacco product use among adults — United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69:1736–42. November 20, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6946a4.htm.

  53. Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., On New Steps to Address Epidemic of Youth E-cigarette Use. Available: https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-new-steps-address-epidemic-youth-e-cigarette-use#:~:text=I%20use%20the%20word%20epidemic,It’s%20simply%20not%20tolerable (accessed January 28, 2021).

  54. Office of the Surgeon General. Surgeon General’s Advisory on E-cigarette Use Among Youth, December 18, 2018. Available: https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf (accessed Nov. 9, 2020).

  55. Wang TW, Gentzke AS, Creamer MR, et al. Tobacco product use and associated factors among middle and high school students—United States, 2019. MMWR Surveill Summ. 2019;68(12). Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903396/.

  56. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116–28.

    Article  PubMed  PubMed Central  Google Scholar 

  57. El Dib R, Suzumura EA, Akl EA, Gomaa H, Agarwal A, Chang Y, et al. Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis. BMJ Open. 2017;7(2).

    Google Scholar 

  58. Wang RJ, Bhadriraju S, Glantz SA. E-cigarette use and adult cigarette smoking cessation: a meta-analysis. Am J Public Health. 2021;111(2):230–46.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Benson R, Hu M, Chen AT, Nag S, Zhu S-H, Conway M. Investigating the attitudes of adolescents and young adults towards JUUL: computational study using Twitter data. JMIR Public Health Surveill. 2020;6(3):e19975.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hamberger ES, Halpern-Felsher B. Vaping in adolescents: epidemiology and respiratory harm. Curr Opin Pediatr. 2020;32(3):378–83.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Chaffee BW, Couch ET, Urata J, Cash D, Werts M, Halpern-Felsher B. Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions. Tob Induc Dis. 2020;18:71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. U.S. Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. Available: https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf (accessed Nov. 9, 2020).

  63. Villanti AC, Johnson AL, Ambrose BK, Cummings KM, Stanton CA, Rose SW, et al. Flavored tobacco product use in youth and adults: findings from the first wave of the PATH study (2013-2014). Am J Prev Med. 2017;53(2):139–51.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Nguyen N, McKelvey K, Halpern-Felsher B. Popular flavors used in alternative tobacco products among young adults. J Adolesc Health. 2019;65(2):306–8.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Kowitt SD, Meernik C, Baker HM, Osman A, Huang LL, Goldstein AO. Perceptions and experiences with flavored Non-menthol tobacco products: a systematic review of qualitative studies. Int J Environ Res Public Health. 2017;14(4).

    Google Scholar 

  66. Pepper JK, Ribisl KM, Brewer NT. Adolescents’ interest in trying flavoured e-cigarettes. Tob Control. 2016;25(Suppl 2):ii62–i6.

    Article  CAS  PubMed  Google Scholar 

  67. Kong G, Morean ME, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine Tob Res. 2015;17(7):847–54.

    Article  PubMed  Google Scholar 

  68. McKelvey K, Baiocchi M, Halpern-Felsher B. Adolescents’ and young adults’ use and perceptions of pod-based electronic cigarettes. JAMA Netw Open. 2018;1(6):e183535.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Ambrose BK, Day HR, Rostron B, Conway KP, Borek N, Hyland A, et al. Flavored tobacco product use among US youth aged 12-17 years, 2013-2014. JAMA. 2015;314(17):1871–3.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Family Smoking Prevention and Tobacco Control Act, Pub. L. No. 111–31, 123 Stat. 1776 (2009).

    Google Scholar 

  71. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products; Final Rule. 81 FR 28973 (10 May 2016). Available: https://www.federalregister.gov/documents/2016/05/10/2016-10685/deeming-tobacco-products-to-be-subject-to-the-federal-food-drug-and-cosmetic-act-as-amended-by-the (accessed Nov. 10, 2020).

  72. TAB B 2014–850 Deeming Final Rule Redline Changes, p.167 et seq. Available: https://beta.regulations.gov/document/FDA-2014-N-0189-83193 (accessed Nov. 10, 2020).

  73. Campaign for Tobacco-Free Kids. Flavored Tobacco Products Attract Kids, updated September 16, 2020. Available: https://www.tobaccofreekids.org/assets/factsheets/0383.pdf (accessed Nov. 10, 2020).

  74. Zhu SH, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23(Suppl 3):iii3–9.

    Article  PubMed  Google Scholar 

  75. King BA. Flavors are a major driver of the youth e-cigarette epidemic. Am J Public Health. 2020;110(6):773–4.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Schneller LM, Bansal-Travers M, Goniewicz ML, et al. Use of flavored e-cigarettes and the type of e-cigarette devices used among adults and youth in the US—Results from wave 3 of the Population Assessment of Tobacco and Health Study (2015–2016) Int. J Environ Res Public Health. 2019;16:2991. https://doi.org/10.3390/ijerph16162991.

    Article  Google Scholar 

  77. Morean ME, Butler ER, Bold KW, Kong G, Camenga DR, Cavallo DA, et al. Preferring more e-cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults. PLoS One. 2018;13(1):e0189015.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  78. Harrell MB, Loukas A, Jackson CD, Marti CN, Perry CL. Flavored tobacco product use among youth and young adults: what if flavors didn't exist? Tob Regul Sci. 2017;3(2):168–73.

    Article  PubMed  PubMed Central  Google Scholar 

  79. McKelvey K, Baiocchi M, Ramamurthi D, McLaughlin S, Halpern-Felsher B. Youth say ads for flavored e-liquids are for them. Addict Behav. 2019;91:164–70.

    Article  PubMed  Google Scholar 

  80. Chen JC, Das B, Mead EL, Borzekowski DL. Flavored e-cigarette use and cigarette smoking susceptibility among youth. Tob Regul Sci. 2017;3(1):68–80.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Food and Drug Administration. Enforcement Priorities for Electronic Nicotine Delivery Systems (ENDS) and other deemed products on the market without premarket authorization (revised): guidance for industry. Available: https://www.fda.gov/media/133880/download (accessed Nov. 10, 2020).

  82. Cwalina SN, Leventhal AM, Barrington-Trimis JL. E-cigarette flavour enhancers: flavoured pod attachments compatible with JUUL and other pod-based devices. Tob Control. 2020;

    Google Scholar 

  83. Hemmerich N. Flavoured pod attachments score big as FDA fails to enforce premarket review. Tob Control. 2020.

    Google Scholar 

  84. Delnevo C, Giovenco DP, Hrywna M. Rapid proliferation of illegal pod-mod disposable e-cigarettes. Tob Control. 2020.

    Google Scholar 

  85. Williams R. The rise of disposable JUUL-type e-cigarette devices. Tob Control. 2019.

    Google Scholar 

  86. Ali FRM, Diaz MC, Vallone D, Tynan MA, Cordova J, Seaman EL, et al. E-cigarette unit sales, by product and flavor type - United States, 2014-2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1313–8.

    Article  PubMed  PubMed Central  Google Scholar 

  87. U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.

    Google Scholar 

  88. U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.

    Google Scholar 

  89. Chatham-Stephens K, Law R, Taylor E, Melstrom P, Bunnell R, Wang B, et al. Calls to poison centers for exposures to electronic cigarettes—United States, September 2010–February 2014. MMWR Morb Mortal Wkly Rep. 2014;63(13):292.

    PubMed  PubMed Central  Google Scholar 

  90. Leslie FM. Unique, long-term effects of nicotine on adolescent brain. Pharmacol Biochem Behav. 2020:173010.

    Google Scholar 

  91. Counotte DS, Smit AB, Pattij T, Spijker S. Development of the motivational system during adolescence, and its sensitivity to disruption by nicotine. Dev Cogn Neurosci. 2011;1(4):430–43.

    Article  PubMed  PubMed Central  Google Scholar 

  92. U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.

    Google Scholar 

  93. Goniewicz ML, Gupta R, Lee YH, Reinhardt S, Kim S, Kim B, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the US, Korea, and Poland. Int J Drug Policy. 2015;26(6):583–8.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Jackler RK, Ramamurthi D. Nicotine arms race: JUUL and the high-nicotine product market. Tob Control. 2019;28(6):623–8.

    Article  PubMed  Google Scholar 

  95. Goniewicz ML, Boykan R, Messina CR, Eliscu A, Tolentino J. High exposure to nicotine among adolescents who use Juul and other vape pod systems (‘pods’). Tob Control. 2019;28(6):676–7.

    Article  PubMed  Google Scholar 

  96. Al-Hamdani M, Hopkins DB, Hardardottir A, Davidson M. Perceptions and experiences of vaping among youth and young adult e-cigarette users: considering age, gender, and tobacco use. J Adolesc Health. 2020.

    Google Scholar 

  97. Shamout M, Tanz L, Herzig C, Oakley LP, Peak CM, Heinzerling A, et al. Notes from the field: characteristics of e-cigarette, or vaping, products confiscated in public high schools in California and North Carolina—March and May 2019. Morb Mortal Wkly Rep. 2020;69(42):1552.

    Article  Google Scholar 

  98. Vogel EA, Cho J, McConnell RS, Barrington-Trimis JL, Leventhal AM. Prevalence of electronic cigarette dependence among youth and its association with future use. JAMA Netw Open. 2020;3(2):e1921513.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Patel M, Czaplicki L, Perks SN, Cuccia AF, Liu M, Hair EC, et al. Parents’ awareness and perceptions of JUUL and other e-cigarettes. Am J Prev Med. 2019;57(5):695–9.

    Article  PubMed  Google Scholar 

  100. Ramamurthi D, Chau C, Jackler RK. JUUL and other stealth vaporisers: hiding the habit from parents and teachers. Tob Control. 2019;28(6):610–6.

    Article  Google Scholar 

  101. McKelvey K, Halpern-Felsher B. How and why California young adults are using different brands of Pod-Type electronic cigarettes in 2019: implications for researchers and regulators J Adolesc Health. 2020.

    Google Scholar 

  102. Pierce D. This might be the first great e-cig. Wired April 21, 2015. https://www.wired.com/2015/04/pax-juul-ecig 11, 2020).

  103. Mark Hurst. Juul and the corruption of design thinking, October 24, 2019. Available: https://creativegood.com/blog/19/juul-corruption-design-thinking.html (accessed Nov. 12, 2020).

  104. Marynak K, Gentzke A, Wang TW, Neff L, King BA. Exposure to electronic cigarette advertising among middle and high school students—United States, 2014–2016. Morb Mortal Wkly Rep. 2018;67(10):294.

    Article  Google Scholar 

  105. Liu J, Ramamurthi D, Halpern-Felsher B. Inside the adolescent voice: a qualitative analysis of the appeal of different tobacco products. Tob Induc Dis. 2021;19:15.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Liu J, McLaughlin S, Lazaro A, Halpern-Felsher B. What does it meme? A qualitative analysis of adolescents’ perceptions of tobacco and marijuana messaging. Public Health Rep. 2020;135(5):578–86.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Jackler RK, Chau C, Getachew BD, et al. JUUL advertising over its first three years on the market (January 31, 2019). Available: http://tobacco.stanford.edu/tobacco_main/publications/JUUL_Marketing_Stanford.pdf (accessed Nov 11, 2020).

  108. Public Health Law Center. Juul & the Guinea Pig Generation Revisited: Juul’s Spawning of the Youth Vaping Epidemic (July 2020). Available: https://www.publichealthlawcenter.org/sites/default/files/resources/JUUL-and-the-Guinea-Pig-Generation-Revisited.pdf (accessed Nov 11, 2020).

  109. Terry Turner. How JUUL Created a Teen Vaping Epidemic, Drugwatch (March 10, 2020, modified September 21, 2020). Available: https://www.drugwatch.com/featured/juul-created-teen-vaping-epidemic/ (accessed Nov 11, 2020).

  110. Pokhrel P, Fagan P, Herzog TA, Laestadius L, Buente W, Kawamoto CT, et al. Social media e-cigarette exposure and e-cigarette expectancies and use among young adults. Addict Behav. 2018;78:51–8.

    Article  PubMed  Google Scholar 

  111. U.S. House Committee on Oversight and Reform. New Documents Show JUUL Deliberately Targeted Children to Become the Nation’s Largest Seller of E-Cigarettes. Press release, July 25, 2019. Available: https://oversight.house.gov/news/press-releases/new-documents-show-juul-deliberately-targeted-children-to-become-the-nation-s. (accessed Nov 12, 2020).

  112. Campaign for Tobacco-Free Kids, Bach L. Electronic Cigarettes and Youth, updated September 16, 2020. Available: https://www.tobaccofreekids.org/assets/factsheets/0382.pdf (accessed Nov 9, 2020).

  113. Truth Initiative. Vaporized: youth and young adult exposure to e-cigarette marketing (November 2015). Available: https://truthinitiative.org/sites/default/files/media/files/2019/03/Vaporized-Youth-Exposure-To-E-Cigarette-Marketing.pdf (accessed Nov 12, 2020).

  114. D'Angelo H, Rose SW, Golden SD, Queen T, Ribisl KM. E-cigarette availability, price promotions and marketing at the point-of sale in the contiguous United States (2014–2015): National estimates and multilevel correlates. Prev Med Rep. 2020;19:101152.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Wagoner KG, Song EY, King JL, Egan KL, Debinski B, Wolfson M, et al. Availability and placement of electronic nicotine delivery systems at the point-of-sale. Nicotine Tob Res. 2018;20(8):1020–4.

    Article  PubMed  Google Scholar 

  116. Collins L, Glasser AM, Abudayyeh H, Pearson JL, Villanti AC. E-cigarette marketing and communication: how e-cigarette companies market e-cigarettes and the public engages with e-cigarette information. Nicotine Tob Res. 2019;21(1):14–24.

    Article  PubMed  Google Scholar 

  117. Papaleontiou L, Agaku IT, Filippidis FT. Effects of exposure to tobacco and electronic cigarette advertisements on tobacco use: an analysis of the 2015 National Youth Tobacco Survey. J Adolesc Health. 2020;66(1):64–71.

    Article  PubMed  Google Scholar 

  118. Vogel EA, Ramo DE, Rubinstein ML, Delucchi KL, Darrow S, Costello C, et al. Effects of social media on adolescents’ willingness and intention to use e-cigarettes: an experimental investigation. Nicotine Tob Res. 2020.

    Google Scholar 

  119. Pokhrel P, Fagan P, Kehl L, Herzog TA. Receptivity to e-cigarette marketing, harm perceptions, and e-cigarette use. Am J Health Behav. 2015;39(1):121–31.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Wood GG, Waselewski ME, Bryant AC, Sonneville KR, Chang T. Youth perceptions of Juul in the United States. JAMA Pediatr. 2020;174(8):800–2.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Roditis M, Delucchi K, Cash D, Halpern-Felsher B. Adolescents’ perceptions of health risks, social risks, and benefits differ across tobacco products. J Adolesc Health. 2016;58(5):558–66.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Keamy-Minor E, McQuoid J, Ling PM. Young adult perceptions of JUUL and other pod electronic cigarette devices in California: a qualitative study. BMJ Open. 2019;9(4):e026306.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Kong G, Bold KW, Morean ME, Bhatti H, Camenga DR, Jackson A, et al. Appeal of JUUL among adolescents. Drug Alcohol Depend. 2019;205:107691.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  124. Willett JG, Bennett M, Hair EC, Xiao H, Greenberg MS, Harvey E, et al. Recognition, use and perceptions of JUUL among youth and young adults. Tob Control. 2019;28(1):115–6.

    PubMed  Google Scholar 

  125. Roditis M, Lee J, Halpern-Felsher BL. Adolescent (mis) perceptions about nicotine addiction: results from a mixed-methods study. Health Educ Behav. 2016;43(2):156–64.

    Article  PubMed  Google Scholar 

  126. Further Consolidated Appropriations Act. Sec. 603, Minimum Age of Sale of Tobacco Products, amending section 906(d) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 387f(d) (December 16, 2019). Available: https://www.fda.gov/tobacco-products/ctp-newsroom/newly-signed-legislation-raises-federal-minimum-age-sale-tobacco-products-21 (accessed Nov. 10, 2020).

  127. Campaign for Tobacco-Free Kids. Youth access and exposure to e-cigarettes at the point of sale, updated August 18, 2020. Available: https://www.tobaccofreekids.org/assets/factsheets/0412.pdf (accessed Nov 10, 2020).

  128. Sapru S, Vardhan M, Li Q, Guo Y, Li X, Saxena D. E-cigarettes use in the United States: reasons for use, perceptions, and effects on health. BMC Public Health. 2020;20(1):1–10.

    Article  Google Scholar 

  129. Levinson AH, Lee JGL, Jason LA, DiFranza JR. Asking for identification and retail tobacco sales to minors. Pediatrics. 2020;145(5).

    Google Scholar 

  130. Williams RS, Derrick J, Liebman AK, LaFleur K, Ribisl KM. Content analysis of age verification, purchase and delivery methods of internet e-cigarette vendors, 2013 and 2014. Tob Control. 2018;27(3):287–93.

    Article  PubMed  Google Scholar 

  131. Soneji S, Gerling M, Yang J, Sargent J. Online electronic cigarette marketing-violation of self-regulated standards by tobacco companies. JAMA Pediatr. 2016;170(5):511–2.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Gaiha SM, Lempert LK, Halpern-Felsher B. Underage youth and young adult e-cigarette use and access before and during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020;3(12):e2027572. https://doi.org/10.1001/jamanetworkopen.2020.27572.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Pesko MF, Huang J, Johnston LD, Chaloupka FJ. E-cigarette price sensitivity among middle-and high-school students: evidence from monitoring the future. Addiction. 2018;113(5):896–906.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Holford TR, Meza R, Warner KE, Meernik C, Jeon J, Moolgavkar SH, et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012. JAMA. 2014;311(2):164–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. Campaign for Tobacco-Free Kids. CDC report raises concerns e-cigarettes could be hindering efforts to reduce tobacco use in U.S.; Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids, November 19, 2020. Available: https://www.tobaccofreekids.org/press-releases/2020_11_19_cdc-e-cigarettes.

  136. Truth Initiative. CDC report shows rise in e-cigarette use does not result in decreases in adult smoking; Statement of Robin Koval, CEO and President of Truth Initiative, November 20, 2020. Available: https://truthinitiative.org/press/press-release/cdc-report-shows-rise-e-cigarette-use-does-not-result-decreases-adult-smoking.

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Acknowledgments

The research reported in this article was supported by the Taube Research Faculty Scholar Endowment to Bonnie Halpern-Felsher. Additional support was from grant U54 HL147127 from the National Heart, Lung, and Blood Institute (NHLBI) and the Food and Drug Administration Center for Tobacco Products. The content is solely the responsibility of the authors.

Conflict of Interest

Dr. Bonnie Halpern-Felsher is a paid expert scientist in some e-cigarette litigation and an unpaid scientific advisor and expert regarding some tobacco-related policies. Lauren Kass Lempert has nothing to disclose.

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  1. Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA

    Lauren Kass Lempert & Bonnie Halpern-Felsher

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Correspondence to Bonnie Halpern-Felsher .

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  1. Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Susan Chu Walley

  2. Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Karen Wilson

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Lempert, L.K., Halpern-Felsher, B. (2021). The E-Cigarette Phenomenon: What it is, Why it is Happening, and What You Should Know About it. In: Walley, S.C., Wilson, K. (eds) Electronic Cigarettes and Vape Devices . Springer, Cham. https://doi.org/10.1007/978-3-030-78672-4_2

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