# data[].attributes.body
I think teens think that using e cigs look cool so they decide to use them. Yes, I feel like the e cigs are marketed to teens. Teens also feel like there is nothing harmful in them.

# data[].attributes.body
I think that more people use e cigs are used because people thinks it makes them look cool. Ecigs are more targeted to youth or teens https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
Teens think it’s cool  so they vape . Yes I fell lik they come for teens . Reaching says 90% of people with substances abuse problems smoke be for they are 18.

# data[].attributes.body
Teens think that it’s cool to smoke or vape.I feel the real target is teens because they are more likely to smoke Because they have all the flavors and they look cool.

# data[].attributes.attachment_link.readable_text
Many teens have questions about drugs. On Drug Facts Chat Day, NIDA scientists get to listen in and answer these questions from students all across the country. Here's one from "zippy do da " fromKingswood Middle School in New Hampshire:
"Why do teens who smoke think they are so cool?"
There could be many reasons why teens who smoke think they're cool: maybe their friends smoke, maybe their parents told them not to smoke, maybe they think it gives them an edgy look, or a temporary high. But the truth is, as far as your health goes, smoking is so not cool.

And who defines cool anyway? What's cool to one person may not be cool to another. Just as beauty is in the eye of the beholder, coolness is an individual decision. Not everyone thinks that doing something illegal or unhealthy, just because your friends are doing it, is cool. Lots of teens would say it's cooler to hold a pen, paintbrush, or drum stick between your fingers, instead of a cigarette.

When our parents were younger, many of them thought "the Fonz" from the hit TV show "Happy Days" was the epitome of cool. Pretty dorky now.
Smoking among teens is lower than ever
Today it seems like a lot of teen smokers are figuring out that smoking is not very cool at all. According to a 2007 survey from the Centers for Disease Control and Prevention, 50 percent of all high school smokers are actively trying to quit. And, according to the recent NIDA-funded Monitoring the Future study of 8th, 10th and 12th graders, smoking among American teens is at an all time low.

Coolness is a funny thing. Some things are cool one year (or one minute!), and not the next. Other things are cool no matter how much time has passed. What's cool is also influenced by your gender, age, where you live, and, most of all, by who you are.

Check out how one high school student examined the cool factor as a science fair project; it even won her a cool prize. But don't take our word for it-you decide.

# data[].attributes.attachment_link.title
Real Teens Ask: Why Do Teens Who Smoke Think They Are So Cool?

# data[].attributes.attachment_link.description
Many teens have questions about drugs. On Drug Facts Chat Day, NIDA scientists get to listen in and answer these questions from students all across the country. Here's one from "zippy do da" from Kingswood Middle School in New Hampshire: "Why do teens who smoke think they are so cool?"

# data[].attributes.headline
YES I FEEL LIKE TEENS are being targeted 

# data[].attributes.subject
YES I FEEL LIKE TEENS are being targeted 

# data[].attributes.headline
Dallas q.1 they think that it’s is cool to smoke e cigs

# data[].attributes.subject
Dallas q.1 they think that it’s is cool to smoke e cigs

# data[].attributes.body
Some teens just think it’s cool.

# data[].attributes.body
I think some teens think tobacco use is okay or will make them look cool. E cigarettes look mostly marketed towards kids and teens because of the flavors. https://www.tobaccofreekids.org/assets/factsheets/0008.pdf

# data[].attributes.body
Teens Think that it’s cool to smoke with friends

# data[].attributes.body
They see it as not harmful and cool. They market teens bc we will be the ones to buy it. https://www.nbcnews.com/health/kids-health/e-cigarette-ads-target-millions-kids-cdc-says-n490601

# data[].attributes.body
I think that teens turn to e-cigs because they see it advertised and said as “safer” so they believe it , I feel like they market teens because they add these flavors that teens and kids would like , they make them colorful like candy

# data[].attributes.body
Most teens view tobacco as harmful but e cigarettes as not that bad. They think that e cigerattes are not that bad because they think that it does not have any bad chemicals in it. 2. Yes they are marketed to teens because they will make the product more appealing to teens. 3. https://www.healthychildren.org/English/ages-stages/teen/substance-abuse/Pages/Teens-and-Tobacco-Use.aspx

# data[].attributes.body
Most teens view e-cigarettes are safer then regular cigarettes because they think that e-cigarettes have less nicotine and tobacco. Yes, I think e-cigarettes are marketed towards teens because adults aren’t going to really care about different flavors.

# data[].attributes.attachment_link.readable_text
E-cigarette makers are pouring tens of millions of dollars into advertising their wares - and teenagers are getting the message loud and clear, federal health officials reported Tuesday.

As advertising skyrockets, so do the number of teens seeing it. They're vaping by the millions now, the Centers for Disease Control and Prevention reports. The CDC says that trend threatens to derail decades of progress in helping prevent kids from taking up smoking.

"The same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes," said CDC director Dr. Tom Frieden.
Inside the Vaper's Den: E-Cigarette Salvation and New Dangers
"What's happening is widespread marketing of e-cigarettes that kids are seeing," Frieden told reporters in a telephone briefing.

"It shouldn't be a surprise that youth use of e-cigarettes has skyrocketed when kids are being inundated with marketing for these products."

"Kids should not be using e-cigarettes and yet 2/3 of kids in this country are seeing e-cigarette ads."

CDC researchers used a 2014 survey of 22,000 children and teens to find that 68.9 percent of middle and high school students - more than 18 million kids - see e-cigarette ads. More than half see them advertised in stores, 40 percent online and 36 percent on TV or in movies.

"During 2011 to 2014, current e-cigarette use among high school students soared from 1.5 percent to 13.4 percent, and among middle school students from 0.6 percent to 3.9 percent," the CDC said in a statement. "At the same time, spending on e-cigarette ads rose from $6.4 million to $115 million."

Advocates said the industry must be stopped from advertising to children.

"The irresponsible and indiscriminate marketing by the e-cigarette industry, coupled with a complete lack of government oversight, is putting the health of our nation's kids at risk," said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

"It shouldn't be a surprise that youth use of e-cigarettes has skyrocketed when kids are being inundated with marketing for these products."

Frieden said the tactics are effective, and include online "viral" marketing that cannot even be measured.

"E-cigarette ads use many of the same themes - independence, rebellion, and sex - used to sell cigarettes and other conventional tobacco products," the CDC report said.

There's also a widespread belief that e-cigarettes are safe, or at least safer than conventional tobacco products. But several studies have suggested this may not be the case.

"E-cigarettes typically deliver nicotine derived from tobacco, which is highly addictive, might harm brain development, and could lead to sustained tobacco product use among youths," the CDC said.

Late last year a team at the Harvard School of Public Health found many e-cigarette flavors deliver harmful chemicals, including diacetyl, the chemical blamed for causing "popcorn lung" in workers at microwave popcorn packaging plants. Other teams found formaldehyde, which is known to cause cancer.

The U.S. Food and Drug Administration in 2014 proposed asserting its authority over new tobacco products including e-cigarettes, cigars, pipe tobacco and nicotine gels. The White House is reviewing final proposed regulations for it to do that.

Supporters and some researchers say e-cigarettes may help people quit smoking what they call combustible cigarettes, but the research is limited.

Public health experts have been clamoring for FDA to extend its authority as e-cigarettes have exploded in popularity. Former FDA commissioner Dr. Margaret Hamburg called the industry the "wild, wild West."

The American Cancer Society's Cancer Action Network and the American Lung Association both urged the White House to speed authority for FDA to regulate e-cigarettes.

"Once the FDA has authority, the American Lung Association urges it to act swiftly to crack down and end marketing practices aimed at youth," the group said in a statement.

"It is also incumbent on states to enact and enforce laws to stop retailers from selling these products to children."

CDC says studies have shown that tobacco ads work. "Tobacco product advertising can entice youth to start using tobacco," the report says.

And limits on that advertising, as well as taxes, restrictions on retail sales, ads promoting tobacco abstinence and other measures have been shown to work.

But states are not using money they were awarded from tobacco companies to fight tobacco use, the CDC said.

"However, in 2015, states appropriated only 1.9 percent ($490.4 million) of combined revenues of $25.6 billion from settlement payments and tobacco taxes for all states on comprehensive tobacco control programs, representing less than 15 percent of the CDC-recommended level of funding ($3.3 billion) for all states combined," it said.

"Only two states (Alaska and North Dakota) currently fund tobacco control programs at CDC-recommended levels."

# data[].attributes.attachment_link.title
'Widespread Marketing' of E-Cigarettes Targets Teens, CDC Says

# data[].attributes.attachment_link.description
E-cigarette makers are pouring tens of millions of dollars into advertising their wares - and teenagers are getting the message loud and clear, federal health officials reported Tuesday. As advertising skyrockets, so do the number of teens seeing it. They're vaping by the millions now, the Centers for Disease Control and Prevention reports.

# data[].attributes.body
Most teens view E-cigarettes as ok because ads make them seem like they are not that bad for you. Yes i think teens are targeted because in advertising they show young people using E-cigarettes and they make tons of flavors like candy and fruit.
https://www.medicalnewstoday.com/articles/10566.php

# data[].attributes.body
They see them as cool. They are marked at teens because of the flavored.

# data[].attributes.body
Most kids view them as an alternative for smoking actual cigarettes and they think it fun and safe. Yes they are marketed towards teens. https://www.sciencenews.org/article/kid-friendly-e-cigarette-ads-appear-work

# data[].attributes.body
They think it is safer than cigarettes, I think it is marketed to kids because of the flavors,https://cbsloc.al/2KtC4Si

# data[].attributes.body
Most teens view E-cigs as a safer thing to do. Yes I feel they are marketed towards teens. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
1) Most teens see e-cigs as a cool safe alternative to traditional cigarettes because it uses vapor not smoke. 2) e-cigs are absolutely marketed to teens. With flavors and colors and e-cigs that look like flash drives it has teens written all over it. 4) https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
1) Most teens see e-cigs as a cool safe alternative to traditional cigarettes because it uses vapor not smoke. 2) e-cigs are absolutely marketed to teens. With flavors and colors and e-cigs that look like flash drives it has teens written all over it. 4) https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
1. I feel that teens think it’s safe because it isn’t as bad as a cigarette
2. Yes, because they are making flavors that kids would like like cotton candy
3.https://www.health.harvard.edu/blog/electronic-cigarettes-good-news-bad-news-2016072510010

# data[].attributes.body
1.) I say most teens view tobacco and e-cigarettes as harmless, or for fun.
2.) I do, because we will live longer and have scents that make them “good.”  It also is shown to be “cool” as well as shows celebrities.
3.)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221880/

# data[].attributes.body
1.) I say most teens view tobacco and e-cigarettes as harmless, or for fun.
2.) I do, because we will live longer and have scents that make them “good.”  It also is shown to be “cool” as well as shows celebrities.
3.)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221880/

# data[].attributes.body
Teens see the e-cigs as an easier and safer way to smoke without using cigarettes. They also think that the vapor will harm their body and lungs less. Yes these companies do purposely Ray and market these products to us teens because they think we are an easier target and that they will get easy money off of us.https://www.nbcnews.com/health/kids-health/e-cigarette-ads-target-millions-kids-cdc-says-n490601

# data[].attributes.body
I think most teens think that they are safe because they don’t think it will hurt them.I do think they are marketed to teens because of the flavors. http://fortune.com/2018/04/26/teens-and-vaping/

# data[].attributes.body
Teens think its safer than normal cigarettes. They are marked to teens more because they can use them longer. .
https://medlineplus.gov/smokingandyouth.html

# data[].attributes.body
Most teens view E-Cigarettes as a healthy alternative to tobacco products they also find it a cooler way to smoke because it’s not a regular cigarette. E-cigarettes are marketed to teens because they make different flavors to make it seem like it is okay. They target us because if we start smoking now then they will make more money off of us. https://www.tobaccofreekids.org/assets/factsheets/0382.pdf

# data[].attributes.body
That e-cigs are less harmful because it has less nicotine in them. They think that it is much cooler to use e-cigs. Yes i feel as if e-cigs are marketed to teens. Some teens do it because they see it on tv, movies, and ads.https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
Most teens view tobacco and E-cigs as looking more mature and older than some of there fellow peers. Tobacco products are marketed towards teens because they are the future of the tobacco industry making profit for it.https://www.tobaccofreekids.org/assets/factsheets/0008.pdf

# data[].attributes.body
I think teenagers think that smoking e-cigarettes is more safe and healthier than regular cigarettes. I think stuff like this is more targeted to kids because they let you have different flavors and they make you think its more safer.
https://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-e-cigarettes

# data[].attributes.body
Most teens view E-Cigs as a safer alternative to normal cigarettes when it can be just as bad or even worse. I do believe they are marketed to teens. https://www.businessinsider.com/vaping-e-cigs-health-effects-heart-attack-toxic-metals-2018-2

# data[].attributes.body
I think most teens view it as safe, and not dangerous at all. Yes I do think they try and sell them to teens so they can make more money off of them

# data[].attributes.body
They see them as fun. Yes because they make them in kind of childish flavors.

# data[].attributes.attachment_link.readable_text
For years, e-cigarettes have been promoted not only as a less harmful alternative to traditional cigarettes, but also as an option for current smokers to quit or reduce their use of tobacco. New research indicates, however, that e-cigarettes may have the opposite effect, especially in younger individuals who have never smoked.

In a March study published in PLOS ONE,(journals.plos.org) researchers from the Norris Cotton Cancer Center at Dartmouth College concluded that although e-cigarettes may be of some benefit in adults who are trying to quit smoking combustible cigarettes, they may act as a gateway product in other people. In particular, the study findings suggest that e-cigarette use may be associated with teenagers and young adults starting to smoke traditional cigarettes and, eventually, becoming daily smokers.

Study Model and Results

In the study, the authors constructed a population-level risk model using 2014 U.S. census data, previously published study results on e-cigarette use and its association with smoking cessation or initiation, and national health or tobacco use surveys on e-cigarette use. Unlike previous studies, the model considered multiple population subgroups, including current smokers and individuals who had never smoked cigarettes. For current smokers, the authors reviewed information on adults ages 25 to 69; for never-smokers, the authors analyzed data on adolescents and young adults ages 12 to 29.

The model attempted to measure the benefits or harms of e-cigarette use through three estimated outcomes:

the number of current combustible cigarette smokers who would quit smoking through the use of e-cigarettes and remain abstinent for seven or more years;

the number of adolescents and young adults who never smoked but began smoking after using e-cigarettes and eventually became long-term daily smokers later in life; and

the total number of years of life gained or lost by these groups through e-cigarette use.

Data drawn from the information sources cited above indicated that in 2014, 3,490,000 current adult cigarette smokers who had attempted to quit smoking in the past year had also currently used e-cigarettes. Additionally, 3,640,000 never-cigarette smoking adolescents and young adults had ever used e-cigarettes. The authors validated the model against one-year intermediate outcomes from 2013 data sources.

Based on the available information, the study model estimated that using e-cigarettes in 2014 would help an additional 2,070 current adult smokers quit in 2015 and remain abstinent from smoking for at least seven years compared with those who did not currently use e-cigarettes. The model also estimated that about 168,000 never-cigarette smoking adolescents and young adults who used e-cigarettes in 2014 would start smoking combustible cigarettes during the following year and would become daily smokers by age 35-39, compared with those who never used e-cigarettes.

Although current adult cigarette smokers may experience a relative benefit from using e-cigarettes to quit smoking compared with current smokers who never used e-cigarettes, the net effect remains in the red. Specifically, the model estimated that the 2,070 additional long-term quitters would gain -3,000 years of life -- still an overall negative loss of life.

Finally, the model estimated that the adolescents and young adults who transitioned from using e-cigarettes to becoming daily cigarette smokers would lose about 1.5 million years of life. This estimate was based on a 95 percent relative harm reduction of e-cigarette use compared with smoking traditional cigarettes, a figure the authors called "optimistic" given the current lack of evidence on the harms of e-cigarettes. Additional analysis showed that the total number of years of life lost increased as the relative harm reduction of e-cigarette use dropped, reaching 1.6 million years when the relative harm reduction was decreased to about 50 percent.

"Based on the most up-to-date published evidence, our model estimated that e-cigarette use in 2014 represents a population-level harm of about 1.6 million years of life lost over the lifetime of all adolescent and young adult never-cigarette smokers and adult current cigarette smokers in the 2014 U.S. population," the authors wrote. "Our model also estimated even greater population-level harm if e-cigarette use confers long-term health risks."

Although the study authors suggested that e-cigarettes could provide some benefits if they were more effective in helping people quit smoking, they cautioned that e-cigarettes also carry their own health risks. Previous research(pubs.acs.org) has shown, for example, that e-cigarettes contain a number of harmful and potentially harmful ingredients, including heavy metals and chemicals such as diacetyl, which has been linked to lung disease.

Study results have also shown that e-cigarette use can negatively affect the immune system(www.ncbi.nlm.nih.gov) and significantly impair respiratory(www.atsjournals.org) and cardiovascular(jaha.ahajournals.org) function.

The authors noted several limitations to their study, including

uncertainty regarding whether e-cigarette use directly causes cigarette smoking in adolescents and young adults;

inability to identify the types of e-cigarettes, each of which may deliver different levels of nicotine, used by adults who are current smokers;

no consideration of the possibility that e-cigarette use in current smokers may cause a decline in the number of traditional cigarettes smoked per day; and

no consideration of potential harms or benefits resulting from e-cigarette use among former smokers at the population level because of a lack of evidence regarding whether e-cigarette use among former cigarette smokers led to higher or lower rates of relapse.

Despite these limitations, the authors concluded that their study "suggests that e-cigarettes pose more harm than they confer benefit at the population level."

"If e-cigarettes are to confer a net population-level benefit in the future, the effectiveness of e-cigarettes as a smoking cessation tool will need to be much higher than it currently is," the authors stated.

Implications and Related Studies

Jennifer Frost, M.D., medical director for the AAFP's Health of the Public and Science Division, told AAFP News that the study highlights the potential negative health impact of e-cigarettes. She encouraged family physicians to ask patients about their use of e-cigarettes as well as traditional cigarettes.

"Family physicians should remember e-cigarettes when asking their patients whether or not they smoke," Frost said. 'This may mean not only asking, 'Do you smoke?' but also asking, 'Do you vape or use electronic cigarettes?'" Frost added that although many people promote e-cigarettes as less harmful than traditional cigarettes, it's important to recognize that the true harms of these products still are not known.

Several other recently published studies have documented similar associations between e-cigarette use and tobacco smoking.

In January, the National Academies of Sciences, Engineering and Medicine published a comprehensive report(www.nap.edu) on the health effects of e-cigarettes, and found "substantial evidence" to show that e-cigarette use by adolescents and young adults increases the risk of ever using traditional cigarettes.

A March Annals of Internal Medicine study(annals.org) of more than 1,300 recently hospitalized smokers who planned to discontinue smoking found that using e-cigarettes intermittently and concurrently with other tobacco cessation treatments "did not seem to aid quitting and may have hampered" the efforts of some individuals to quit.

Related AAFP News Coverage
FDA Proposes Reducing Nicotine in Combustible Cigarettes
(3/21/2018)

Comprehensive E-cigarettes Study Offers Mixed Findings
Use May Lead Youth to Start Smoking Tobacco, Adults to Quit
(1/26/2018)

More From AAFP
American Family Physician: Electronic Cigarettes: Cautions and Concerns
(9/1/2014)
Policy on Electronic Cigarettes
Tobacco: Preventing and Treating Nicotine Dependence and Tobacco Use (Position Paper)

Tobacco and Nicotine Prevention and Control

Additional Resources
CDC: E-Cigarettes and Young People: A Public Health Concern(www.cdc.gov)

CDC: Smoking & Tobacco Use: Electronic Cigarettes(www.cdc.gov)

# data[].attributes.attachment_link.title
Study Suggests E-cigarettes Cause More Harm Than Good

# data[].attributes.attachment_link.description
For years, e-cigarettes have been promoted not only as a less harmful alternative to traditional cigarettes, but also as an option for current smokers to quit or reduce their use of tobacco. New research indicates, however, that e-cigarettes may have the opposite effect, especially in younger individuals who have never smoked.

# data[].attributes.body
1.) Most teens find these and not being dangerous. The think e-cigs are a safer alternative
2.)yes, I do feel that they are marketed to teens. No adult is going to want a candy flavored e-cigs, but kids will.
3.)https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/stopping-tobacco-use-after-cancer-diagnosis/health-risks-e-cigarettes-smokeless-tobacco-and-waterpipes