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The Toll of Tobacco in Washington

High school students who smoke

5.0% (18,300)

Male high school students who smoke cigars (female use much lower)

3.6%

High school students who use e-cigarettes

21.2%

Kids (under 18) who become new daily smokers each year

1,600

Adults in Washington who smoke

11.5% (684,400)

Proportion of cancer deaths in Washington attributable to smoking

27.4%

Deaths in Washington from Smoking

Adults who die each year from their own smoking

8,300

Kids now under 18 and alive in Washington who will ultimately die prematurely from smoking

104,000

Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined - and thousands more die from other tobacco-related causes - such as fires caused by smoking (more than 1,000 deaths/year nationwide) and smokeless tobacco use.

Smoking-Caused Monetary Costs in Washington

Annual health care costs in Washington directly caused by smoking

$2.81 billion

Medicaid costs caused by smoking in Washington

$788.5 million

Residents' state & federal tax burden from smoking-caused government expenditures

$742 per household

Smoking-caused productivity losses in Washington

$2.2 billion

Amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use, or cigar and pipe smoking. Tobacco use also imposes additional costs such as workplace productivity losses and damage to property.

Tobacco Industry Influence in Washington

Annual tobacco industry marketing expenditures nationwide

$8.4 billion

Estimated portion spent for Washington marketing each year

$80.3 million

Published research studies have found that kids are twice as sensitive to tobacco advertising as adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure. One-third of underage experimentation with smoking is attributable to tobacco company advertising.
View sources of information.
More detailed fact sheets on tobacco's toll in each state are available by emailing factsheets@tobaccofreekids.org
Last updated Jan. 21, 2022

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The Toll of Tobacco in Washington High school students who smoke 5.0% (18,300) Male high school students who smoke cigars (female use much lower) 3.6% High school students who use e-cigarettes 21.2% Kids (under 18) who become new daily smokers each year 1,600 Adults in Washington who smoke 11.5% (684,400)

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Centers for Disease Control and Prevention

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On September 9, 2020, this report was posted online as an MMWR Early Release.

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The use of any tobacco product by youths is unsafe, including electronic cigarettes (e-cigarettes) (1). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs ( 1). E-cigarette use has increased considerably among U.S. youths since 2011 ( 1, 2). Multiple factors have contributed to this increase, including youth-appealing flavors and product innovations ( 1- 3). Amid the widespread use of e-cigarettes and popularity of certain products among youths, on February 6, 2020, the Food and Drug Administration (FDA) implemented a policy prioritizing enforcement against the manufacture, distribution, and sale of certain unauthorized flavored prefilled pod or cartridge-based e-cigarettes (excluding tobacco or menthol).*

CDC and FDA analyzed nationally representative data from the 2020 National Youth Tobacco Survey (NYTS), † a cross-sectional, school-based, self-administered survey of U.S. middle school (grades 6-8) and high school (grades 9-12) students conducted during January 16-March 16, 2020. § The NYTS study protocol was approved by the CDC institutional review board. Current (past 30-day) e-cigarette use was assessed, overall and by device ¶ and flavor** type. Weighted prevalence estimates and population totals †† were calculated. Analyses were conducted using SAS-callable SUDAAN (version 11.0.3; RTI International).

In 2020, 19.6% of high school students (3.02 million) and 4.7% of middle school students (550,000) reported current e-cigarette use. Among current e-cigarette users, 38.9% of high school students and 20.0% of middle school students reported using e-cigarettes on 20 or more of the past 30 days; 22.5% of high school users and 9.4% of middle school users reported daily use. Among all current e-cigarette users, 82.9% used flavored e-cigarettes, including 84.7% of high school users (2.53 million) and 73.9% of middle school users (400,000).

Among high school current e-cigarette users, the most commonly used device type was prefilled pods or cartridges (48.5%; 1.45 million), followed by disposables (26.5%; 790,000), and tanks (14.8%; 440,000). Among middle school current e-cigarette users, the most commonly used device type was prefilled pods or cartridges (41.3%; 220,000), followed by tanks (21.5%; 110,000), and disposables (15.2%; 80,000).

Among high school students who currently used any type of flavored e-cigarettes, the most commonly used flavor types were fruit (73.1%; 1.83 million); mint (55.8%; 1.39 million); menthol (37.0%; 920,000); and candy, desserts, or other sweets (36.4%; 910,000). Among middle school students who currently used any type of flavored e-cigarettes, the most commonly used flavor types were fruit (75.6%; 290,000); candy, desserts, or other sweets (47.2%; 180,000); mint (46.5%; 180,000); and menthol (23.5%; 90,000).

Among current users of flavored prefilled pods or cartridges, the most commonly used flavor types were fruit (66.0%; 920,000); mint (57.5%; 800,000); menthol (44.5%; 620,000); and candy, desserts, or other sweets (35.6%; 490,000) ( Figure). Among current users of flavored disposable e-cigarettes, the most commonly used flavor types were fruit (82.7%; 650,000), mint (51.9%; 410,000); candy, desserts, or other sweets (41.7%; 330,000); and menthol (23.3%; 180,000).

In 2020, approximately one in five high school students and one in 20 middle school students currently used e-cigarettes. By comparison, in 2019, 27.5% of high school students (4.11 million) and 10.5% of middle school students (1.24 million) reported current e-cigarette use ( 2). Although these data reflect a decline in current e-cigarette use since 2019, 3.6 million U.S. youths still currently used e-cigarettes in 2020, and among current users, more than eight in 10 reported using flavored e-cigarettes.

Consistent with 2019, prefilled pods or cartridges were the most commonly used device type in 2020; however, during 2019-2020, disposable e-cigarette use increased approximately 1,000% (from 2.4% to 26.5%) among high school current e-cigarette users and approximately 400% (from 3.0% to 15.2%) among middle school current e-cigarette users. Although use of fruit flavored e-cigarettes was common among users in 2020, findings also suggest prominent menthol e-cigarette use, including among nearly one half of flavored prefilled pod or cartridge users and one quarter of flavored disposable product users.

Comprehensive implementation of evidence-based strategies at the national, state, and local levels, in coordination with FDA regulation, can prevent and reduce youth tobacco product use ( 1, 4, 5). Strategies to address factors driving youth e-cigarette use are particularly critical. In addition to FDA's enforcement policy that prohibits the sale of prefilled pod or cartridge-based e-cigarettes in any flavor other than tobacco or menthol, several states and communities have restricted all flavored e-cigarette sales, including menthol. §§

Corresponding author: Linda J. Neff, len2@cdc.gov, 404-639-3286.

¹Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; ² Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland.

References

1. US Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdfpdf icon CrossRefexternal icon PubMedexternal icon

2. Cullen KA, Gentzke AS, Sawdey MD, et al. E-cigarette use among youth in the United States, 2019. JAMA 2019;322:2095-103. CrossRefexternal icon PubMedexternal icon

3. Leventhal AM, Miech R, Barrington-Trimis J, Johnston LD, O'Malley PM, Patrick ME. Flavors of e-cigarettes used by youths in the United States. JAMA 2019;322:2132-4. CrossRefexternal icon PubMedexternal icon

4. Office of the Surgeon General. Surgeon General's advisory on e-cigarette use among youth. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2018. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdfpdf icon external icon

5. US Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. https://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm

FIGURE. Percentage of flavor types used by current (past 30-day) flavored e-cigarette users among U.S. middle and high school students,* by device type†,§ - National Youth Tobacco Survey, United States, 2020

* Flavor type use among current (past 30-day) users of flavored e-cigarettes was determined by answers to the question "What flavors were the e-cigarettes that you have used in the past 30 days? (Select one or more)." Response options were "menthol," "mint," "clove or spice," "fruit," "chocolate," "alcoholic drinks (such as wine, cognac, margarita, or other cocktails)," "candy, desserts, or other sweets," and "some other flavor not listed here" (write-in responses were not assessed). Data for "clove or spice" are not shown because of statistically unreliable estimates due to unweighted denominator <50 or relative standard error >30% across all device types.

† Device type use among current e-cigarette users was determined by answers to the question "Which of the following best describes the type of e-cigarette you have used in the past 30 days? If you have used more than one type, please think about the one you use most often." Response options were "a disposable e-cigarette," "an e-cigarette that uses pre-filled pods or cartridges (e.g., JUUL)," "an e-cigarette with a tank that you refill with liquids," "a mod system (an e-cigarette that can be customized by the user with their own combination of batteries or other parts)," and "I don't know the type."

§ The following data were statistically unreliable and not shown due to unweighted denominator <50 or relative standard error >30%: use of chocolate flavor types among current flavored e-cigarette users of disposable e-cigarettes, mod systems, or those who reported "I don't know the type" for device type; alcoholic drink flavor types among current flavored e-cigarette users of mod systems or those who reported "I don't know the type" for device type; and "some other flavor" among current flavored e-cigarette users who reported "I don't know the type" for device type.

Suggested citation for this article: 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;69:1310-1312. DOI: http://dx.doi.org/10.15585/mmwr.mm6937e1external icon .

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e-cigarette use among middle and high school students

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use of electronic cigarettes among youth in the u.s.

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e-cigarette users among students by device type

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E-cigarette Use Among Middle and High School Students ...

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On September 9, 2020, this report was posted online as an MMWR Early Release. Altmetric: Citations: Views: Views equals page views plus PDF downloads The use of any tobacco product by youths is unsafe, including electronic cigarettes (e-cigarettes) (1).

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The FDA Postpones A Long-Awaited Decision On Juul’s Vaping Products

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More than 500 companies submitted applications for 6.5 million vaping products to the FDA. The agency ruled on some of them but did not yet make a decision on products made by Juul.

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As an educator, you can play an active role in fighting the teen vaping epidemic. FDA research suggests that when teachers talk about the health consequences of e-cigarettes and schools enforce anti-vaping policies, students may be less likely to vape. Use these resources to start an honest conversation with your class and help to change social norms at your school.

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As an educator, you can play an active role in fighting the teen vaping epidemic. FDA research suggests that when teachers talk about the health consequences of e-cigarettes and schools enforce anti-vaping policies, students may be less likely to vape. Use these resources to start an honest conversation with your class and help to change social norms at your school.

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Texas Department of State Health Services

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The American Cancer Society medical and editorial content team

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The long-term health effects of e-cigarettes are still unclear.

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Know the Risks: E-Cigarettes and Young People | U.S. Surgeon General's Report

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No matter how it's delivered, nicotine is harmful for youth and young adults. E-cigarettes typically contain nicotine as well as other chemicals that are known to damage health. For example, users risk exposing their respiratory systems to potentially harmful chemicals in e-cigarettes. Read about these and other risks young people face if they use e-cigarettes.

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Know the Risks: E-cigarettes & Young People | U.S. Surgeon General's Report

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Facts on e-cigarettes, addiction, and how nicotine can harm the developing brain from the U.S. Surgeon General. Risks of use along with resources and actions to help prevent harm to youth and young adults.

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Photo by Getty Images

[Originally published: September 13, 2018. Updated: December 18, 2019.]

Several months ago, the Centers for Disease Control and Prevention (CDC) advised people to avoid e-cigarettes while federal and state officials investigate an ongoing nationwide outbreak of severe lung injuries associated with the use of e-cigarette, or vaping, products.

Even though the agency announced that vitamin E acetate (an ingredient added to some THC products) appears associated with this vaping-related illness, officials stressed that their findings remain inconclusive, and more than one chemical could be contributing to lung damage. With no single cause yet identified, the agency continues to double down on its cautionary advice.

"E-cigarette use is never safe for youth, young adults, or pregnant women," said CDC's Dana Meaney-Delman, MD, who is leading the agency's response to the outbreak, which emerged this past summer. The CDC further warns against using any vaping products that contain THC; buying devices from "informal sources, including friends and family" and modifying or adding substances to e-cigarettes. For adults using the devices to quit smoking, the advice is to "weigh all risks and benefits and consider using FDA-approved nicotine replacement therapies."

Since that time, federal and state officials have reported thousands of cases and dozens of deaths related to a newly identified lung disease that the CDC has named EVALI (the acronym stands for e-cigarette or vaping product use-associated lung injury).

Patients affected by the disease have symptoms ranging from cough, chest pain, and shortness of breath to fatigue, vomiting, diarrhea, weight loss, and fever.

As part of their investigations, Food and Drug Administration (FDA) and state health officials have analyzed samples of vaping products that patients treated for EVALI have provided in order to find a possible culprit of the disease. Most of the products have contained THC (the high-inducing compound in marijuana), according to the FDA. Federal and state lab tests have also found vitamin E acetate and other oil compounds in vaping products.

Even if or when a potential cause is identified, Mitch Zeller, director of FDA's Center for Tobacco Products, cautioned that it will be only "one piece of the puzzle...and it makes all of our ongoing work that much more critical."

In the meantime, a study found that people who use only e-cigarettes increase their risk of developing lung disease by about 30% compared with nonusers. At the same time, the risk of being diagnosed with lung disease-which includes chronic bronchitis, emphysema, asthma, or chronic obstructive pulmonary disease (COPD)-was highest among adults who smoke cigarettes and vape, according to the researchers, who tracked study participants over three years.

Last year, the U.S. Surgeon General's office began the work of awareness when the nation's doctor, Jerome Adams, MD, issued a warning that vaping among youth has reached epidemic levels.

The numbers are shocking. More than 5 million middle and high school students currently use e-cigarettes, according to the 2019 National Youth Tobacco Study (NYTS), up from more than 3.6 million last year.

Another study this year found that the rates of youth who say they vaped with nicotine in the past month more than doubled in two years. About 11 percent of high school seniors reported this habit in 2017, compared to 25 percent, or one in four seniors, in 2019. Among eighth-graders, the numbers jumped from 3.5 percent to 9 percent. The worrying part? Young people think vaping is mostly harmless.

To understand vaping, it's best to start on broad terms. To vape is to inhale vapor created from a liquid heated up inside a device. From there, things quickly get complicated. The devices have many names-vape pens, pod mods, tanks, electronic nicotine delivery devices (ENDS), e-hookahs and e-cigarettes. The liquid they contain also has many monikers-it might be called e-juice, e-liquid, cartridges, pods, or oil. Most vape liquids contain a combination of propylene glycol or glycerol-also called glycerin-as a base, and nicotine, THC, or flavoring chemicals to produce common or outlandish flavors, from mint to "unicorn puke." The devices rely on batteries to power heating elements made of various materials that aerosolize the liquid.

What's more, the San Francisco-based company that sells Juuls offers vape liquid made from nicotine salts found in loose-leaf tobacco instead of the traditional free-base nicotine found in most e-cigarette liquid. This may allow the user to experience a higher-and more addictive-concentration of nicotine, according to an article in The New England Journal of Medicine.

Responding to a public outrage of the popularity of Juul's flavored vaping pods among youth, the company in November announced it would stop selling its mint-flavored pods, which made up about 70 percent of its sales, according to news reports. Before this, Juul had already halted sales of its other flavored pods, including crème brulee, mango, and cucumber, to retailers and online.

Juul also faces a lawsuit filed by a former senior executive employee who alleges that the company did not recall or warn consumers about 1 million potentially contaminated pods it released for sale.

Problems even before EVALI outbreak

Since e-cigarettes arrived in the U.S. in 2007, they have been investigated by addiction researchers as possible cessation devices for adults trying to quit combustible, or regular, cigarettes. The FDA lists 93 harmful or potentially harmful chemicals found in regular cigarettes, and the National Cancer Institute (NCI) describes cigarettes as having more than 7,000 chemicals in them. Because e-cigarettes contain fewer chemicals the industry has presented them as a healthier alternative to regular cigarettes. But vape liquids can still contain nicotine, a highly addictive drug.

And on one point, Yale health researchers who study the health effects of vaping and e-cigarettes agree: Vape devices have not been proven to help adult smokers quit smoking. Moreover, vaping increases the risk a teen will smoke regular cigarettes later.

"The addiction to nicotine and later conversion to (or dual use with) regular cigarettes are the greatest concerns," says Roy S. Herbst, MD, Yale Medicine's chief of medical oncology at Yale Cancer Center. He points to two heavyweight organizations, the American Society of Clinical Oncology (ASCO) and the American Association for Cancer Research (AACR), that have issued statements that vaping could be harmful to youth. (Dr. Herbst chairs the AACR Tobacco & Cancer Subcommittee that led the development of the statement.)

The popularity of Juul is worrying to addiction researchers. Juuls arrived late to the e-cigarette market in 2015, about eight years after vaping devices first began appearing here. But the company, called Juul Labs, quickly surged ahead of competitors. Sleek and slim, with an appearance that mirrors a flash drive, Juul remains the vaping tool of choice among high school students, according to this year's NYTS data.

Teens even morphed the brand into a verb-juuling-according to widespread news coverage chronicling its rise. "When we ask teens about their vaping or e-cig habits, they don't even consider juuling to be part of that," says Suchitra Krishnan-Sarin, PhD, co-leader of the Yale Tobacco Center for Regulatory Science, one of nine centers in the country currently funded by the National Institutes of Health (NIH) and the FDA to foster tobacco regulatory research.

Juul and other vape manufacturers, including Vuse, MarkTen XL, blu, and Logic, came under scrutiny by the FDA for marketing and sales practices that seemed aimed at teens and young adults, according to an announcement the FDA released in September 2018. At the time, the agency asked the companies to submit plans on how they planned to address widespread youth access and use of their products.

"We cannot allow a whole new generation to become addicted to nicotine," former FDA Commissioner Scott Gottlieb, MD, said in the release.

While it's possible to buy liquid without nicotine for some e-cigarettes, it's not possible to do so with popular pod mod devices. According to Juul's website-in a description that has since been taken down-a single Juulpod contains 40 mg of nicotine, which is similar to "the nicotine yield of a pack of cigarettes." (The company also sells Juulpods with approximately 23 mg of nicotine.) But researchers explain that it's difficult to describe a single pod as a "serving." A person might consume one pod in a week, while another may take only one day.

A stubborn trend

When potentially risky behaviors experience an uptick in popularity, health researchers are never far behind-gathering data. A Yale study last year found that, among students at three Connecticut public schools, those who used e-cigarettes were more likely to smoke regular cigarettes in the future.

Krishnan-Sarin points to progress that has been made-finally-in recent years to reduce regular cigarette smoking rates among young adults. In her opinion, the significant decline is due to the success of large-scale public health campaigns and a general awareness among youth that cigarettes are harmful to health.

She is concerned that most teens who vape with nicotine don't know the drug can be damaging to their development. "We have a lot of evidence showing that the adolescent brain is extremely sensitive to the effects of nicotine," she says, adding that the brain doesn't stop growing until around age 25. "Studies have shown us that nicotine can interfere with memory and attention processing."

In his imaging studies of adults who use e-cigarettes, Stephen Baldassarri, MD, an internist at Yale Medicine, has begun to gather information on the factors that influence nicotine delivery from e-cigarettes and whether vaping promotes cessation from conventional cigarette smoking. Teens cannot participate in such studies, but "we all agree that e-cigs are not a good thing for youth and nonsmokers," Dr. Baldassarri says.

How to talk to your kids

Probably the worst thing a parent could do for their child would be to buy an e-cigarette under the misconception that this might prevent them from smoking regular cigarettes, Krishnan-Sarin says. She encourages parents to talk openly and freely about vaping-with the caveat that they provide accurate information. "I think the problem is that parents lose credibility if they say something to try and convince their child, who then finds out that it isn't true," she says.

"Parents should base their information on accurate facts and also encourage their children to read about and understand the science on this issue instead of relying on what their friends and peers tell them."

Dr. Baldassarri suggests explaining the addictive nature of vaping, which would mess with the one thing teens crave the most: independence. "In some ways, when you get addicted to a drug, it's like losing your freedom of choice," he says. "The risk of losing that freedom might be a persuasive message for kids."

Deepa Camenga, MD, a pediatrician who is board-certified in addiction medicine, says it's never too early to begin talking about e-cigarettes in age-appropriate language. "When you are out and about with your children and see an advertisement, for example, take the opportunity to talk about it," she says. As they grow older, parents can expand on their thoughts and expectations. "It's also important to give teens and young adults the space to ask questions," she says.

Patrick O'Connor, MD, Yale Medicine's chief of general internal medicine, who has dedicated his career to researching opioid and alcohol drug abuse, points to similarities between epidemic cigarette use in the 1940s and 50s, and e-cigarette use now.

Even as evidence accumulated on the link between lung cancer and cigarette use, doctors didn't always take time to talk to patients about those risks, he says. "I think it's a major responsibility of physicians, family medicine doctors, pediatricians, and adolescent medicine practitioners. One of the big deficits in medical education has been to prepare medical students to address these issues with their patients, ask them about their use of these substances, and advise them on the risks," Dr. O'Connor says. "This is as true for e-cigarette use and vaping as it is for alcohol and other drug use."

What may be the most important message of all is that e-cigarettes and vaping come with many health unknowns, Dr. O'Connor adds. "You see plumes of what looks like steam coming out of people's mouths on the street when they are vaping, and I think they assume it's mostly safe, mostly water. But these liquids used in vaping are filled with all kinds of stuff [like nicotine, marijuana, flavoring agents, chemicals], and we don't always know what else is in there," he says.

Surgeon General Adams echoed these concerns in his news conference following the release of his advisory: "Studies show that youth, like my son, have no clue what's in these products most of the time."

Months after the release of the advisory, Yale researchers found that byproducts, called acetals, form when flavoring agents mix with solvents in the liquid. It is not yet known if this has negative effects on the body, but Sven-Eric Jordt, PhD, one of the study's authors, says he hopes that the FDA will begin to study the short- and long-term effects of inhaled acetals.

But parents shouldn't wait for government regulations and monitoring to catch up with this disturbing trend, says Richard Martinello, MD, an infectious disease specialist who has treated EVALI patients.

"Kids are smart. They do make good decisions and while it may not seem like it at times, they do listen," Dr. Martinello says. "It's critical that they hear from parents and other loved ones about the dangers of vaping. They may not hear this from their friends."

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Originally published: September 13, 2018. Updated: December 18, 2019.] Several months ago, the Centers for Disease Control and Prevention (CDC) advised people to avoid e-cigarettes while federal and state officials investigate an ongoing nationwide outbreak of severe lung injuries associated with the use of e-cigarette, or vaping, products.

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There is a vaping epidemic in this country, especially among teens. Every day, over 3,500 youths start vaping. In 2018 alone, the number of high school students who vape nearly doubled.

This is an emergency situation.

Join the fight! The American Heart Association is a relentless force against vaping. We're doing the important research, advocacy, and education to turn the tide on this dangerous epidemic. Your help is desperately needed. You can make a huge difference! Let's protect our children's health!

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Join the fight! The American Heart Association is a relentless force against vaping. We're doing the important research, advocacy, and education to turn the tide on this dangerous epidemic.

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Centers for Disease Control and Prevention

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The use of e-cigarettes is unsafe for kids, teens, and young adults.

Most e-cigarettes contain nicotine. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s.1

E-cigarettes can contain other harmful substances besides nicotine.

Young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Find Data on E-cigarette Use Among Youth

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or "mods," do not look like other tobacco products.

E-cigarettes are known by many different names. They are sometimes called "e-cigs," "e-hookahs," "mods," "vape pens," "vapes," "tank systems," and "electronic nicotine delivery systems (ENDS)."

Using an e-cigarette is sometimes called "vaping."

Some e-cigarettes look like regular cigarettes, cigars, or pipes.
Some look like USB flash drives, pens, and other everyday items.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.

The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called "e-juice," "e-liquid," "vape juice," or "vape liquid."

Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

E-cigarette devices can be used to deliver marijuana and other drugs.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

JUUL is a brand of e-cigarette that is shaped like a USB flash drive. Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.

All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2

JUUL is one of a few e-cigarettes that 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.

News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.

Approximately two-thirds of JUUL users aged 15 - 24 do not know that JUUL always contains nicotine.

Although JUUL is currently the top-selling e-cigarette brand in the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.

Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at CDC's Infographic [PDF - 1.2MB]

Most e-cigarettes (vapes) contain nicotine-the addictive drug in regular cigarettes, cigars, and other tobacco products.

A CDC study found that 99% of the e-cigarettes sold in assessed venues in the United States contained nicotine.1

Some vape product labels do not disclose that they contain nicotine, and some vape liquids marketed as containing 0% nicotine have been found to contain nicotine.

Nicotine can harm the developing adolescent brain.2 The brain keeps developing until about age 25.

Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.2

Each time a new memory is created or a new skill is learned, stronger connections - or synapses - are built between brain cells. Young people's brains build synapses faster than adult brains. Nicotine changes the way these synapses are formed.

Using nicotine in adolescence may also increase risk for future addiction to other drugs.2

When a person is dependent on (or addicted to) nicotine and stops using it, their body and brain have to get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal.

Nicotine withdrawal symptoms include irritability, restlessness, feeling anxious or depressed, trouble sleeping, problems concentrating, and craving nicotine.3 People may keep using tobacco products to help relieve these symptoms.4

Youth may turn to vaping to try to deal with stress or anxiety, creating a cycle of nicotine dependence. But nicotine addiction can be a source of stress.

What may start as social experimentation can become an addiction.

The most common reason U.S. middle and high school students give for trying an e-cigarette is "a friend used them." 5

The most common reason youth give for continuing to use e-cigarettes is "I am feeling anxious, stressed, or depressed." 5

Youth e-cigarette and cigarette use have been associated with mental health symptoms such as depression.9, 10

Yes. As long as a person stays quit, withdrawal symptoms will fade over time as the brain gets used to not having nicotine.

Scientists are still learning about the effects of quitting vaping on mental health. Quitting smoking cigarettes is associated with lower levels of anxiety, depression, and stress, as well as improved positive mood and quality of life.9

Scientists are still learning about the long-term health effects of e-cigarettes.

Some of the ingredients in e-cigarette aerosol could also be harmful to the lungs in the long-term. For example, some e-cigarette flavorings may be safe to eat but not to inhale because the gut can process more substances than the lungs.1

Defective e-cigarette batteries have caused some fires and explosions, a few of which have resulted in serious injuries.

Children and adults have 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.

E-cigarette aerosol is NOT harmless "water vapor."

The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances, including:

Nicotine

Ultrafine particles that can be inhaled deep into the lungs

Flavorings such as diacetyl, a chemical linked to a serious lung disease

Volatile organic compounds

Cancer-causing chemicals

Heavy metals such as nickel, tin, and lead1

The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.

It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.3

E-cigarettes come in various flavors, including fruit, candy, mint, and menthol.

A study from 2013-2014 showed that most youth who use e-cigarettes first start with a flavored variety, and flavors are the primary reason youth report using e-cigarettes.⁶

In 2023, most youth who reported using e-cigarettes used flavored varieties (89.4%). Among middle and high school students who currently used any type of flavored e-cigarette in 2023, the most commonly used flavors were fruit (63.4%), candy, desserts, or other sweets (35%), mint (27.8%), and menthol (20.1%).¹¹

On January 2, 2020, the U.S. Food and Drug Administration (FDA) finalized an enforcement policy that prohibits the sale of prefilled cartridge e-cigarettes in any flavor other than tobacco or menthol, unless authorized by FDA. FDA has since taken additional steps to prohibit certain companies from selling youth-appealing, flavored disposable e-cigarettes and flavored e-liquids without authorization.⁷

Several states and communities have restricted the sale of flavored tobacco products, including menthol-flavored products.⁸

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 2021, approximately 76% of students reported exposure to tobacco product marketing through traditional sources and approximately 74% of students who used social media had seen e-cigarette-related posts or content.¹²

Widespread advertising for e-cigarettes, including via media for which advertising for conventional tobacco products is prohibited (e.g., TV), and the lower costs of some e-cigarettes relative to regular cigarettes has contributed to use among youth.¹

Many youth also report using e-cigarettes because they are curious about these products.¹

Many young people who use e-cigarettes also smoke cigarettes.1 There is some evidence that young people who use e-cigarettes may be more likely to smoke cigarettes in the future.

Specifically, a 2018 National Academy of Medicine report found that there was some evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future.4

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.

But e-cigarette use among young people is still unsafe, even if they do not progress to future cigarette smoking.

E-cigarettes expose users to fewer harmful chemicals than burned cigarettes.1

But burned cigarettes are very dangerous, killing half of all people who smoke long-term.

The use of any tobacco product, including e-cigarettes, is unsafe for young people.

Yes. In August 2016, the regulatory authority of the FDA was extended to cover e-cigarettes through the agency's "deeming rule."

Through authority granted by the Family Smoking Prevention and Tobacco Control Act (FSPTCA), FDA has authority to develop regulations that address the manufacturing, marketing, and sale of e-cigarettes.

There are some strategies that the FDA does not have authority to implement, such as including e-cigarettes in smoke-free policies or increasing the minimum legal sales age for these products, unless directed to do so by Congress. However, the FSPTCA does not prevent states and communities from including e-cigarettes in smoke-free policies or from regulating the sale and distribution of e-cigarettes. These types of strategies can include further raising the minimum legal sales age, licensing retailers, implementing price policies, and restricting or prohibiting the sale of tobacco products.

Yes. In 2018, the FDA expanded its successful youth tobacco prevention campaign, "The Real Cost," to reach the more than 10 million youth aged 12-17 who have used e-cigarettes or are open to trying them. The campaign educates youth about the potential risks of using e-cigarettes.

The "Real Cost" reaches teens where they spend most of their time: in school and online. The campaign is also placing e-cigarette prevention materials in high schools across the nation, both in school bathrooms and on educational digital platforms accessed by students during the school day.

Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as "heat-not-burn" technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.

HTPs are available in at least 40 countries and several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of people who currently smoke surveyed) had ever used HTPs. In 2023, 1.0% of U.S. middle and high school students, combined, reported having used heated tobacco products in the past 30 days.¹¹

Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows they contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.

It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Set a good example by being tobacco-free and ensure that your kid is not exposed to the secondhand emissions from any tobacco products, including e-cigarettes.

If you use tobacco, it's never too late to quit. For free help, visit smokefree.gov or call 1-800-QUIT-NOW.

Talk to your child or teen about why e-cigarettes are harmful for them. It's never too late.

Get the Talk With Your Teen About E-cigarettes [PDF - 5.2MB] tip sheet for parents. Start the conversation early with children about why e-cigarettes are harmful for them.

Let your child know that you want them to stay away from all tobacco products, including e-cigarettes, because they are not safe for them. Seek help and get involved.

Set up an appointment with your child's health care provider so that they can hear from a medical professional about the health risks of tobacco products, including e-cigarettes.

Speak with your child's teacher and school administrator about enforcement of tobacco-free school grounds policies and tobacco prevention curriculum.

Encourage your child to learn the facts and get tips for quitting tobacco products at Teen.smokefree.gov.

Fact Sheet for Educators:

Conversation Card for Educators:

1. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta: 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 [accessed 2022 April 4].

2. Truth Initiative Mental Health x Vaping Headline Survey Internal Data - August 2021.

3. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1-29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1.

4. 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: US 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.

5. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students - National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023; 72(44);1173-1182.

6. Cooper M, Park-Lee E, Ren C, Cornelius M, Jamal A, Cullen KA. Notes from the Field: E-cigarette Use Among Middle and High School Students - United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1283-1285. DOI: http://dx.doi.org/10.15585/mmwr.mm7140a3

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Quick Facts on the Risks of E-cigarettes for Young People

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Learn quick facts on the risks of e-cigarettes for kids, teens, and young adults, including how they work, why nicotine is unsafe, what is in e-cigarette aerosol, and resources for parents to prevent their child from using e-cigarettes or help them stop.

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What Is Vaping?

Vaping is the inhaling of a vapor created by an electronic cigarette ( e-cigarette) or other vaping device.

How Does Vaping Work?

E-cigarettes (or "vape pens") heat a liquid until it becomes a vapor, which is inhaled. The liquid (e-liquid or "vape juice") can contain nicotine or marijuana distillate or oil. E-cigarettes can be refillable or pre-filled with cartridges containing the e-liquid. The pre-filled e-cigarettes (called "Puff Bars") are designed for one-time use. After taking a certain number of "puffs," the user throws the device away.

What Are the Health Effects of Vaping?

The health risks of vaping include:

addiction: E-cigarettes contain nicotine, a drug that's highly addictive. You don't have to vape every day to get addicted.

anxiety and depression: Nicotine makes anxiety and depression worse. It also affects memory, concentration, self-control, and attention, especially in developing brains.

becoming a smoker: People who vape are more likely to start smoking regular (tobacco) cigarettes and may be more likely to develop other addictions in the future.

impotence: There is some evidence that vaping can cause sexual dysfunction in men.

sleep problems

exposure to cancer-causing chemicals

chronic bronchitis

lung damage that can be life-threatening

Other health effects are possible that we don't yet know about. Vaping hasn't been around that long, so its health risks aren't all known.

Why Should I Quit?

Wanting to be the best, healthiest version of yourself is an important reason to quit vaping. Others include:

Addiction: Addiction in the growing brain may set up pathways for later addiction to other substances.

Brain risks: Nicotine affects your brain development. This can make it harder to learn and concentrate. Some of the brain changes are permanent and can affect your mood and ability to control your impulses as an adult.

Use of other tobacco products: Studies show that vaping makes it more likely that someone will try other tobacco products, like regular cigarettes, cigars, hookahs, and smokeless tobacco.

Toxins (poisons): The vapor made from e-cigarettes is not made of water. The vapor contains harmful chemicals and very fine particles that are inhaled into the lungs and exhaled into the environment.

Sports: You want to do your best in sports, and vaping may lead to lung inflammation (irritation).

Money: Vaping is expensive! The cost of the cartridges over time starts to add up. Instead, you could spend that money on other things you need or enjoy.

To go against tobacco company advertising: Many e-cigarettes are made by the same companies that produce regular cigarettes. Their marketing targets young people by making fun flavors for e-cigarettes and showing young, healthy people vaping. They're trying to make you their next lifetime customer.

How Can I Quit?

Decide why you want to quit and write it down or put it in your phone. Look at the reason(s) when you feel the urge to vape.

Pick a day to stop vaping. Put it on the calendar and tell supportive friends and family that you're quitting on that day.

Get rid of all vaping supplies.

Download tools (such as apps and texting programs) to your phone that can help with cravings and give encouragement while you try to stop vaping. You can try:

Understand withdrawal. Nicotine addiction leads to very strong cravings for nicotine. It can also lead to:

feeling tired, cranky, angry, or depressed

trouble concentrating

trouble sleeping

hunger

restlessness

The signs of withdrawal are strongest in the first few days after stopping. They get better over the following days and weeks.

Get ready for feelings, people, and places that make you want to vape. If possible, avoid places and people that trigger the urge to vape. If you feel the urge to vape, try these things instead:

Chew sugar-free gum or drink water.

Text, call, or hang out with a friend who will support you.

Listen to your favorite playlist.

Go for a walk or jog.

Try yoga or meditation.

Take 10 deep breaths.

Keep your hands busy with a hobby, like drawing or making jewelry.

Go somewhere where smoking/vaping isn't allowed.

When Should I Call the Doctor?

Call your doctor right away if you vape and have:

coughing, shortness of breath, or chest pain

nausea, vomiting, or diarrhea

tiredness, fever, or weight loss

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Vaping: What You Need to Know (for Teens) - Nemours KidsHealth

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E-cigarettes (or “vape pens”) heat a liquid until it becomes a vapor that’s inhaled. Vape juice can contain nicotine or marijuana distillate or oil. Here are the facts on vaping and its many health risks.

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