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Electronic cigarettes (e-cigarettes) deliver an inhaled aerosol to the user that typically contains nicotine, flavorings, and other additives. 1 e-Cigarettes come in many shapes and sizes but generally contain a battery, a heating element, and an e-liquid reservoir. 1 e-Cigarettes could help adult smokers if used as a complete substitute for conventional cigarettes. 1,2 However, research on the effectiveness of e-cigarettes for smoking cessation is inconclusive, 2 and e-cigarettes are not currently approved by the US Food and Drug Administration as a cessation aid. 1,2 Moreover, e-cigarette aerosol can contain harmful constituents, 1,2 and use of these products among young people is a public health concern. 1 Most e-cigarettes deliver nicotine, which is addictive and can harm the developing adolescent brain. 1 National self-reported surveys traditionally provide annual estimates of tobacco product use. In 2016, 3.2% of US adults and 11.3% of US high school students were current users of e-cigarettes. 3 However, e-cigarettes are an evolving product class, and retail sales data available at more frequent intervals (eg, weekly) can complement annual surveys and identify emerging trends. 1 This study assessed e-cigarette sales in the United States during 2013-2017.

BACKGROUND: Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2014. We examined the association between e-cigarette advertisement exposure and current e-cigarette use among US middle school and high school students.

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IntroductionTobacco use mostly begins in adolescence and young adulthood. Earlier age of initiation of cigarette smoking is associated with greater nicotine dependence and sustained tobacco use. However, data are limited on the age of initiation of non-cigarette tobacco products, and the association between using these products and nicotine dependence and progression to established use.MethodsCombined 2014–2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6–12 yielded 19 580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco and hookah. Analyses assessed age of reported first use of each product among ever-users, overall and by sex and race/ethnicity. Current daily use, past 30-day use, feelings of craving tobacco and time to first tobacco use after waking were assessed by age of first use.ResultsAmong ever-users, weighted median age for first use was 12.6 years for cigarettes, 13.8 years for cigars, 13.4 years for smokeless tobacco, 14.1 years for hookah and 14.1 years for e-cigarettes. First trying these tobacco products at age ≤13 years was associated with greater current use of the respective product and nicotine dependence compared with initiating use at age >13 years.ConclusionsFirst tobacco use at age ≤13 years is associated with current daily and past 30-day use of non-cigarette tobacco products, and with the development of nicotine dependence among youth ever-users. Proven tobacco prevention interventions that reach early adolescents are important to reduce overall youth tobacco use.