E-cigarettes & Youth Risk

E-cigarette use among teens has skyrocketed in recent years. In 2018, 1 in 5 high schoolers and 1 in 20 middle schoolers in the United States regularly used e-cigarettes.1 The same year, the U.S. Surgeon General officially declared a vape epidemic.

  • In 2011, 1.5% of high schoolers and 0.6% of middle schoolers regularly used e-cigarettes. 2
  • By 2018, that increased to 20.8% of high schoolers and 4.9% of middle schoolers. 2
  • 17.3% of South Dakota high schoolers regularly used e-cigarettes in 2015. 3

It’s likely these numbers will continue to rise as more national and state data is released and e-cigarette manufacturers develop sneakier tactics for targeting youth.

E-cigarettes are now the most commonly used tobacco product among youth in the United States. Many of the kids who are using e-cigarettes now will become tomorrow’s cigarette smokers because most tobacco use starts during adolescence.

Parents, educators, and healthcare professionals need to know the facts and work together to inform teens on the dangers of e-cigarettes to help prevent a lifetime of nicotine addiction and associated health risks.

What are e-cigarettes?

E-cigarettes are battery-operated devices that heat a solution (or e-liquid) and convert it into an aerosol (not a vapor), which is then inhaled and delivers nicotine and other chemicals to the user. This process is often called “vaping” or “juuling.”

E-cigarette and vape devices go by many names:

  • electronic nicotine delivery systems (ENDS)
  • e-cigs
  • e-hookahs
  • mods
  • vape pens
  • vapes
  • JUULs 4

Various e-cigarette devices from left to right: vape pens by brand blu PLUS+, Crown Seven, Kanger E-vod, and JUUL shown with flavored JUUL Pod, Suorin Air Open Pod, Joyetech e-Vic-VT Vape MOD.


What’s a JUUL?

JUUL is currently the top-selling e-cigarette brand in the United States. Their product is shaped like a USB or flash drive. Other brands, such as Suorin, resemble a small iPod or other high-tech handheld devices. 5 There are hundreds of different brands and thousands of flavors of e-liquid.

E-cigarette manufacturers have purposely made their devices small and discrete, making it easy for teens to hide them in a sleeve, pocket, purse, or bookbag at school.


Why are e-cigarettes so appealing?

Cool Packaging

E-liquid companies market their products to look like candy or other kid-friendly food items. 6

At first glance, it’s hard to tell which is candy and which isn’t. Well, that’s no accident. Confusion works in the tobacco and vape companies’ best interest. They WANT kids to think products like chew tobacco, vape, mods, JUUL pods, and flavored cigars are as fun and harmless as candy bars. It’s a trick, not a treat. Nicotine in any form is poison and ADDICTIVE!

Fun flavors

Many of the flavorings used in e-liquids have been approved by the Food and Drug Administration for oral consumption, but not for inhalation. 7 The research regarding the safety of these compounds when inhaled is not yet available.

  • 85% of e-cigarette users ages 12-17 use flavored e-liquids. 8
  • E-liquids don’t have the aftertaste or smell of commercial tobacco smoke and come in appealing candy or fruit flavors.
  • There are thousands of unique flavors.
  • Most e-liquids contain highly concentrated nicotine that can cause irreversible damage in developing brains.
Lots of nicotine content

Teens may be unaware of the high levels of nicotine in e-cigarette products. Nicotine in any form causes irreversible harm in developing brains.

  • 1 JUUL Pod = 20 cigarettes worth of nicotine. That’s an entire pack of cigarettes. Yikes! 9
  • Even when manufacturers claim an e-liquid is “nicotine free,” when tested many solutions contain nicotine after all. 10
  • Some manufacturers have included nicotine salts in their e-liquids which increases the rate and amount of nicotine delivered. Yikes again. 11
  • Younger siblings or pets could mistakenly ingest these products. Even a small taste of an e-liquid can cause accidental nicotine poisoning.
  • The chemicals in e-liquids can be absorbed through the skin – kids or pets don’t have to ingest it – just touching it can be very dangerous. Scary stuff. 12
No smoke, just aerosol

It’s a common belief that the cloud produced by “vaping” is harmless water vapor. While vapor is simply a substance in gas form, e-cigarettes produce an aerosol. And, aerosols can contain:

  • Nicotine
  • Toxins
  • Metals
  • Cancer-causing chemicals 13

How does nicotine affect developing brains?

Studies on the long-term health consequences of e-cigarettes are still underway, so teens often underestimate or are unaware of the risks associated with e-cigarettes. But we do know that most e-cigarettes contain nicotine and nicotine in any form is extremely hazardous for teens’ developing brains.

FACT: In people under 25, nicotine in any form… smoke, vape, chew, will shrink young brains. So using nicotine is like self-inflicting brain damage!

Increased risk of addiction

The brain keeps developing until about age 25. Teens are uniquely at risk for long-term, irreversible effects of exposing their developing brains to nicotine.

  • Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.
  • Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells.
  • Because addiction is a form of learning, adolescents can get addicted more easily than adults. 14
Increased risk of substance use

Most tobacco use starts during adolescence.

  • Teens who use e-cigarettes are 4 times more likely to start smoking, which can lead to a lifetime of nicotine addiction. 15
  • Some evidence suggests nicotine may prime teens for alcohol use and other substance use, such a marijuana.
  • Certain e-cigarette products can be used to deliver other drugs like marijuana. 16

What can we do?

Talk with your kids

It’s important to have an open dialogue with your children about the dangers of nicotine and e-cigarette use.

The U.S. Surgeon General offers a tip sheet for starting the conversation.

Provide resources to quit

Help stop nicotine addiction in its tracks.

The SD QuitLine helps users age 13 and older quit e-cigarettes.

Encourage teens to enroll in our coaching program or request a Kickstart Kit.

Work together

Schools, educators, community leaders, and healthcare professionals play important roles in providing the facts and guiding teens away from e-cigarette use.

National websites like Smokefree Teen, the Truth Initiative, and the U.S. Surgeon General’s Know the Risks: E-cigarettes and Young People offer information and tools for combatting the e-cigarette epidemic.


What does the Surgeon General say?

E-cigarettes were initially developed and marketed as a substitute for combustible cigarettes. While they may be less harmful than regular cigarettes when used solely as a form of cessation, they are not an FDA-approved quit aid and most contain nicotine – a highly addictive drug.

Also alarming is the fact that e-cigarette companies are using the same advertising tactics the tobacco industry has used for decades to persuade a new generation of young people to use their products. Companies use celebrities, sexual content, and claims of independence to glamorize these addictive products and make them appealing to young people.

The Surgeon General Report highlights the rapidly changing patterns of e-cigarette use among youth and young adults, assesses what we know about the health effects of using these products, and describes strategies that tobacco companies use to recruit our nation’s youth and young adults to try and continue using e-cigarettes. The report also outlines interventions that can be adopted to minimize the harm these products cause to our nation’s youth.

If you want to quit, or help someone quit – the QuitLine can help you kick your nicotine habit for good. Enroll now.


What’s the FDA regulation?

In 2016, the FDA created a rule for e-cigarettes and e-liquids. This means that e-cigarettes fall under government regulation as tobacco products because they contain nicotine that comes from tobacco. Under this rule:

  • It is illegal to sell e-cigarettes, hookah tobacco, or cigars in person or online to anyone under age 18.
  • Buyers have to show their photo ID to purchase these products.
  • These products cannot be sold in vending machines (unless in an adult-only facility).
  • It is illegal to hand out free samples.
  • The FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of e-cigarettes. This includes components and parts of e-cigarettes but excludes accessories.

The FDA Commissioner released a statement about enforcement and has outlined a plan to prevent e-cigarette use among youth and specifically called out JUUL, in August, 2018. An additional statement was released in November 2018 with plans to limit access to flavored tobacco products.