Introduction E-cigarettes are currently the most commonly used tobacco product among U.S. youth. However, unlike conventional cigarettes, e-cigarettes are not subject to marketing restrictions. This study investigates the association between exposure to e-cigarette marketing and susceptibility and use of e-cigarettes in youth. Methods Data were obtained from the 2014 National Youth Tobacco Survey. Participants were 22,007 U.S. middle and high school students. Multivariate logistic regression models assessed the relationship between e-cigarette marketing (internet, print, retail, TV/movies) and current and ever use as well as susceptibility to use e-cigarettes among never e-cigarette users. Results Exposure to each type of e-cigarette marketing was significantly associated with increased likelihood of ever and current use of e-cigarettes among middle and high school students. Exposure was also associated with susceptibility to use of e-cigarettes among current non-users. In multivariate models, as the number of channels of e-cigarette marketing exposure increased, the likelihood of use and susceptibility also increased. Conclusions Findings highlight the significant associations between e-cigarette marketing and e-cigarette use among youth, and the need for longitudinal research on these relationships.

Findings extend existing research by showing that ENDS use by young adults is a specific risk factor for later cigarette initiation and not an extension of a constellation of existing tobacco use behaviors.

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Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, ≥2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2).NYTS is a cross-sectional, voluntary, school-based, selfadministered, pencil-and-paper questionnaire survey of U.S. middle and high school students. A three-stage cluster sampling procedure is used to generate a nationally representative sample of U.S. students attending public and private schools in grades 6-12. Briefly, primary sampling units are selected at the first stage, schools are selected at the second stage, and students are selected from intact classrooms at each grade level at the third stage. This report used data from seven NYTS waves