1

E-Cigarettes and Youth 

Toolkit for Partners: 

How You Can Help End the Epidemic

www.CDC.gov/e-cigarettes

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention
2

Dear Colleagues:

E-cigarette use among youth has become an epidemic in the United States. According to the National Youth 

Tobacco Survey, current (past 30 day) use of e-cigarettes increased 78% among high school students and nearly 

50% among middle school students during 2017–2018. In 2018, more than 3.6 million youth in the United States 

were current e-cigarette users. 

The Surgeon General has called for aggressive steps to protect our children from the risks of e-cigarettes. In 

December 2018, the U.S. Surgeon General issued an Advisory on E-Cigarette Use Among Youth. It noted that 

nicotine exposure during adolescence can harm the developing adolescent brain, impacting learning, memory, 

and attention. Youth who use e-cigarettes also may be more likely to smoke regular cigarettes in the future and 

be at increased risk for addiction to other drugs.

In his advisory, the Surgeon General issued a critical call to action: 

“We must take action now to protect the health of our nation’s young people. To achieve success, we must 

work together, aligning and coordinating efforts across both old and new partners at the national, state, 

and local levels. Everyone can play an important role in protecting our nation’s young people from the 

risks of e-cigarettes.” 

-U.S. Surgeon General VADM Jerome M. Adams, MD, MPH

CDC is pleased to offer this digital toolkit, which provides information and resources to take action. Inside this 

toolkit, you’ll find evidence-based messaging on the risks of e-cigarette use among young people. The toolkit 

includes free media and communications resources with ideas for using them to reach parents, educators, and 

health care providers—key groups whom we must engage to help end this epidemic. 

Sincerely,

Corinne Graffunder, DrPH, MPH 

Director

Office on Smoking and Health

Centers for Disease Control and Prevention

www.CDC.gov/e-cigarettes
3 www.CDC.gov/e-cigarettes

WHAT IS IN THIS TOOLKIT

PAGE

4

6

10

15

20

KNOW THE FACTS: This section provides a topline 

review of the different types of e-cigarettes, their harmful 

health effects among youth, and ways in which they are 

marketed.

TAKE ACTION TO PROTECT YOUTH: This section 

provides actions that key adult influencer groups can take to 

help end the epidemic of youth e-cigarette use, including:

• Public Health Professionals

• Parents

• Educators

• Health Care Providers

FREE MEDIA AND COMMUNICATIONS 

MATERIALS: This section includes a variety of materials 

to educate key youth influencers, including: 

• Fact Sheets

• Sample Health Advisories

• Sample Newsletter Article/Blog Post 

• Digital and Social Media Materials 

• Free Materials for use in Print, Radio and Television

FREQUENTLY ASKED QUESTIONS: This section 

provides in-depth information on questions that the 

general public, the media, or decision-makers might ask.

KEY RESOURCES: This section provides links to 

evidence-based websites, resources, and reports that have 

served as references for the information in this toolkit.

Information and links to non-federal organizations are provided solely as 

a service. Information and links do not constitute an endorsement of any 

organization by CDC or the Federal Government, and none should be inferred. 

CDC is not responsible for the content found at non-federal links or at links 

from other federal agencies.

Centers for Disease Control and Prevention 

Office on Smoking and Health

www.CDC.gov/tobacco

August 19, 2019
4

KNOW THE FACTS

Youth tobacco product use increased during 

2017-2018.

In 2018, about 4.9 million middle and high school 

students used a tobacco product in the last 30 days, up 

from 3.6 million in 2017. This increase was driven by a 

startling increase in e-cigarette use—a 78% increase 

among high school students and nearly 50% increase 

among middle school students. Since 2014, e-cigarettes 

have been the most commonly used tobacco product 

among youth.

What is an e-cigarette? 

E-cigarettes are battery-powered devices that can 

deliver nicotine and flavorings to the user in the form of 

an aerosol. E-cigarettes come in many shapes and sizes. 

Some e-cigarettes look like regular cigarettes, cigars, or 

pipes. Some look like USB flash drives, pens, and other 

everyday items that are easy to conceal.

JUUL, an e-cigarette shaped like a USB flash drive, is 

now the most commonly sold e-cigarette in the United 

States. JUUL uses liquid nicotine refills called “pods,” 

which contain at least as much nicotine as a pack 

of cigarettes.

What is in the aerosol? 

E-cigarette aerosol is not harmless water vapor. In 

addition to nicotine, the aerosol that users inhale and 

exhale from e-cigarettes can expose both themselves 

and bystanders to other harmful substances, including 

heavy metals, volatile organic compounds, and 

ultrafine particles that can be inhaled deeply into the 

lungs. Some of the flavorings used in e-cigarettes may 

also have health risks when inhaled.

Youth use of any tobacco product, including 

e-cigarettes, is unsafe. 

Scientists are still learning about the long-term 

health effects of e-cigarettes, but we know enough to 

take action to protect kids from known risks of these 

products. Most e-cigarettes contain nicotine – the 

same addictive drug in regular cigarettes, cigars, and 

other tobacco products. Nicotine exposure during 

adolescence can harm the developing brain, and 

impact learning, memory, and attention. Using nicotine 

during adolescence can also increase risk for future 

addiction to other drugs. 

www.CDC.gov/e-cigarettes
5

KNOW THE FACTS

All JUUL e-cigarettes contain a high level of nicotine.

These products also 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. This is of particular 

concern for young people, because it could make it 

easier for them to initiate the use of nicotine through 

these products. But despite these risks, approximately 

two-thirds of JUUL users aged 15–24 do not know that 

JUUL always contains nicotine.

Other health risks for youth and young adults. 

Young people who use e-cigarettes may be more likely 

to go on to use regular cigarettes. 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. 

Also, defective e-cigarette batteries have caused 

fires and explosions, a few of which have resulted in 

serious injuries. Children have also 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. 

Flavors and marketing make e-cigarettes appealing 

to youth. 

Many e-cigarettes come in fruit, candy, and other kidfriendly flavors, such as mango and crème. A majority 

of youth e-cigarette users report using flavored 

varieties, most youth e-cigarette users first start using 

e-cigarettes with a flavored variety, and flavors are a 

primary reason youth report using e-cigarettes. 

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 2016, about 8 in 10 middle school and 

high school students—more than 20 million youth—

said they had seen e-cigarette advertising.

Refer to the Frequently Asked Questions section for 

additional information on youth and e-cigarettes.

www.CDC.gov/e-cigarettes
6

TAKE ACTION TO PROTECT YOUTH

The U.S. Surgeon General has declared that youth e-cigarette use is an epidemic in the United States. Fortunately we 

know what works to prevent youth tobacco product use, and we can apply these proven strategies to protect youth 

from e-cigarettes. 

Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes. To 

achieve success, we must work together, aligning and coordinating efforts across both old and new partners at the 

national, state, and local levels. Public health professionals, parents, educators, and health care providers can all 

take action. This toolkit provides activities each of these groups can consider, along with supporting media and 

communications materials. 

WHAT PUBLIC HEALTH PROFESSIONALS CAN DO:

• Use the materials in this toolkit to educate key youth influencers such as parents, educators and health care 

providers about the harms of e-cigarette use by youth.

• Encourage state and local health officials to issue a health advisory on e-cigarettes and youth. For examples, 

consider the Surgeon General’s Advisory on E-cigarette Use Among Youth, the Minnesota Department of 

Health Advisory or the Wisconsin Department of Health Services Public Health Advisory. 

• Implement evidence-based public education campaigns. CDC’s Media Campaign Resource Center has materials 

you can use, including the following free ads and public service announcements (PSAs):

» One Brain radio PSA

» It’s Not Like You Can Buy A New Brain (Vending Machine) print ad

» It’s a Factradio PSA

» Any Volunteers? video PSA

» E-Cigarettes Risky for Youth digital and social media images

» E-Cigarettes, Nicotine, and Brain Development social media image

» Protecting Young People from E-cigarettes digital and social media images 

(please filter by Media Type “Digital Display” or “Social Media Materials” to find all relevant materials)

• Link to CDC’s web page at www.CDC.gov/e-cigarettes or include syndicated CDC content on your site. 

Syndicated content is available at CDC’s Public Health Media Library by searching for “e-cigarettes” under the 

type “microsites”.

• Issue press releases, Opinion Editorials or letters to the editor to draw attention to the issue of youth e-cigarette 

use and to highlight steps that states and communities can take to address the problem.

• Issue a letter to school administrators that promotes effective prevention strategies, such as the inclusion of 

e-cigarettes in school tobacco-free policies. Consider these examples from state health departments: 

» Letter from North Carolina Division of Public Health and State Education Partners

» Letter from Minnesota Department of Health to School Administrators

www.CDC.gov/e-cigarettes
7

TAKE ACTION TO PROTECT YOUTH

www.CDC.gov/e-cigarettes

• Support the sustained implementation of proven population-based strategies, that complement tobacco product 

regulation by the U.S. Food and Drug Administration (FDA). Effective strategies that states and localities are 

undertaking include:

» Incorporating e-cigarettes into smoke-free indoor air policies.

» Restricting youth access to tobacco products in retail settings.

» Licensing tobacco retailers.

» Setting pricing policies.

» Establishing packaging requirements.

» Increasing the minimum age of sale of tobacco products to 21 years.

» Restricting the sale of flavored tobacco products.

» Curbing tobacco advertising and marketing that are appealing to young people.

» Implementing evidence-based public education initiatives.

ENCOURAGE PARENTS TO: 

• Set a positive example by being tobacco-free. Make their homes and cars tobacco-free. If they use tobacco 

products, they can visit Smokefree.gov or call 1-800-QUIT-NOW for free help to quit.

• Read the E-Cigarettes and Youth: What Parents Need to Know fact sheet to educate themselves about 

e-cigarettes and the risks to youth. 

• Use the Talk with Your Teen about E-Cigarettes: Parent Tip Sheet to start a conversation with their child about 

tobacco products, including e-cigarettes. 

• Talk to school administrators to make sure their child’s school has a tobacco-free policy and teaches an evidence-based 

tobacco prevention curriculum that is not funded by the tobacco industry and includes information on e-cigarettes. 

• Ask their child’s health care provider to speak with their child about the health risks of using tobacco products, 

including e-cigarettes. 

• Learn more about the risks of youth e-cigarette use at the CDC Office on Smoking and Health e-cigarette web pages at 

www.CDC.gov/e-cigarettes.

The Truth Initiative recently surveyed educators and parents about youth and e-cigarettes and found: 

• Many teachers and school administrators lacked knowledge about the harms and addictiveness of 

e -cigarettes, including JUUL.

• Only 1 in 4 parents recalled receiving e-cigarette communication from their schools.
www.CDC.gov/e-cigarettes 8

TAKE ACTION TO PROTECT YOUTH

ENCOURAGE EDUCATORS TO: 

• Read the E-Cigarettes and Youth: What Educators and 

Coaches Need to Know fact sheet to learn about the risks of 

e-cigarettes to youth. 

• Develop, implement, and enforce tobacco-free school policies 

that include e-cigarettes. The Public Health Law Center has 

information and resources on tobacco-free schools. 

• Promote cessation support for students who use tobacco 

products, including free resources such as the Truth 

Initiative® E-cigarette Quit Program (Text QUIT to 

202-804-9884), and the National Cancer Institute’s 

SmokefreeTeen website.

• Educate parents, using the E-Cigarettes and Youth: What 

Parents Need to Know fact sheet. Other ideas include: 

» Use content from the CDC feature article Keep Kids 

E-Cigarette Free in parent communications 

(e.g., newsletters or blog postings). 

» Show the Any Volunteers? video PSA at parent meetings. 

» Link to CDC’s web page at www.CDC.gov/e-cigarettes or include syndicated CDC content on your site. 

Syndicated content is available at CDC’s Public Health Media Library by searching for “e-cigarettes” under 

the type “microsites”. CDC also has infographics on youth and e-cigarettes that can be embedded on a 

website or shared on social media.

• Educate students using evidence-based tobacco prevention materials that are free from tobacco industry 

influence. For instance:

» CDC Know the Risks: A Youth Guide to E-cigarettes presentation, a PowerPoint deck with talking points

» FDA e-cigarette prevention posters, available for download from the FDA Exchange Lab

» FDA lesson plan and activity The Real Cost of Vaping: Understanding the Dangers of Teen E-Cigarette Use, 

developed in collaboration with Scholastic

» The Stanford Medical School Tobacco Prevention Toolkit module on e-cigs, vapes, and pods 

» The University of Texas Health Science Center at Houston Catch My Breath Youth E-Cigarette and JUUL 

Prevention Program

• Learn more about the risks of youth e-cigarette use at the CDC Office on Smoking and Health e-cigarette 

web pages at www.CDC.gov/e-cigarettes.
9 www.CDC.gov/e-cigarettes

TAKE ACTION TO PROTECT YOUTH

ENCOURAGE HEALTH CARE PROVIDERS TO:

• Read the E-Cigarettes and Youth: What Health Care Providers Need to Know fact sheet to learn about 

e-cigarettes and the risks to youth. 

• Screen for all tobacco product use, including e-cigarettes, among youth and young adults.

• Use the Health Care Provider Conversation Card to educate patients to prevent initiation.

• For their young patients who use tobacco products, including e-cigarettes, promote free resources that support 

quitting, such as the Truth Initiative® E-cigarette Quit Program (Text QUIT to 202-804-9884), and the National 

Cancer Institute’s SmokefreeTeen website.

• Learn more about the risks of youth e-cigarette use at the CDC Office on Smoking and Health e-cigarette 

web pages at www.CDC.gov/e-cigarettes.
10

FREE MEDIA AND COMMUNICATIONS MATERIALS

FACT SHEETS FOR PARENTS, EDUCATORS, AND HEALTH CARE PROVIDERS 

These fact sheets can be used to educate key youth influencers. Distribute them at community events, meetings, 

conferences, etc.

www.CDC.gov/e-cigarettes

E-cigarettes and Youth:

What Educators and 

Coaches Need to Know

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention

WHAT ARE E-CIGARETTES?

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings, and other 

ingredients to the user. Using e-cigarettes is sometimes called “vaping.” E-cigarettes do not create harmless 

“water vapor” – they create an aerosol that can contain harmful chemicals. 

HOW MANY YOUTH ARE USING E-CIGARETTES?

• E-cigarettes have been the most commonly used tobacco product among U.S. youth since 2014. 

• In 2018, CDC and FDA data showed that more than 3.6 million U.S. youth, including 1 in 5 high school students and 

1 in 20 middle school students, were past-month e-cigarette users.

• During 2017 and 2018, e-cigarette use skyrocketed among youth, leading the U.S. Surgeon General to call the use 

of these products among youth an epidemic in the United States. 

WHAT ARE THE RISKS FOR YOUTH?

• Most e-cigarettes contain nicotine, which is highly addictive. 

Nicotine exposure during adolescence can:

» Harm brain development, which continues until about age 25.

» Impact learning, memory, and attention. 

» Increase risk for future addiction to other drugs. 

• Young people who use e-cigarettes may be more likely to go on to use regular cigarettes. 

• Many e-cigarettes come in kid-friendly flavors – including mango, fruit, and crème – which make e-cigarettes 

more appealing to young people.

• E-cigarette aerosol is not harmless. It can contain harmful substances, including:

» Nicotine

» Cancer-causing chemicals

» Volatile organic compounds

» Ultrafine particles

» Flavorings that have been linked to lung disease

» Heavy metals such as nickel, tin, and lead

www.CDC.gov/e-cigarettes

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention

E-cigarettes and Youth:

What Health Care 

Providers Need to Know

WHAT ARE E-CIGARETTES?

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings, and other 

ingredients to the user. Using e-cigarettes is sometimes called “vaping.” E-cigarettes do not create harmless 

“water vapor” – they create an aerosol that can contain harmful chemicals. 

HOW MANY YOUTH ARE USING E-CIGARETTES?

• E-cigarettes have been the most commonly used tobacco product among U.S. youth since 2014. 

• In 2018, CDC and FDA data showed that more than 3.6 million U.S. youth, including 1 in 5 high school students and 

1 in 20 middle school students, were past-month e-cigarette users.

• During 2017 and 2018, e-cigarette use skyrocketed among youth, leading the U.S. Surgeon General to call the use 

of these products among youth an epidemic in the United States. 

WHAT ARE THE RISKS FOR YOUTH?

• Most e-cigarettes contain nicotine, which is highly addictive. 

Nicotine exposure during adolescence can:

» Harm brain development, which continues until about age 25.

» Impact learning, memory, and attention. 

» Increase risk for future addiction to other drugs. 

• Young people who use e-cigarettes may be more likely to go on to use regular cigarettes. 

• Many e-cigarettes come in kid-friendly flavors – including mango, fruit, and crème – which make e-cigarettes 

more appealing to young people.

• E-cigarette aerosol is not harmless. It can contain harmful substances, including:

» Nicotine

» Cancer-causing chemicals

» Volatile organic compounds

» Ultrafine particles

» Flavorings that have been linked to lung disease

» Heavy metals such as nickel, tin, and lead

www.CDC.gov/e-cigarettes

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention

E-cigarettes and Youth:

What Parents 

Need to Know

WHAT ARE E-CIGARETTES?

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings, and other 

ingredients to the user. Using e-cigarettes is sometimes called “vaping.” E-cigarettes do not create harmless 

“water vapor” – they create an aerosol that can contain harmful chemicals. 

HOW MANY YOUTH ARE USING E-CIGARETTES?

• E-cigarettes have been the most commonly used tobacco product among U.S. youth since 2014. 

• In 2018, CDC and FDA data showed that more than 3.6 million U.S. youth, including 1 in 5 high school students and 

1 in 20 middle school students, were past-month e-cigarette users.

• During 2017 and 2018, e-cigarette use skyrocketed among youth, leading the U.S. Surgeon General to call the use 

of these products among youth an epidemic in the United States. 

WHAT ARE THE RISKS FOR YOUTH?

• Most e-cigarettes contain nicotine, which is highly addictive. 

Nicotine exposure during adolescence can:

» Harm brain development, which continues until about age 25.

» Impact learning, memory, and attention. 

» Increase risk for future addiction to other drugs. 

• Young people who use e-cigarettes may be more likely to go on to use regular cigarettes. 

• Many e-cigarettes come in kid-friendly flavors – including mango, fruit, and crème – which make e-cigarettes 

more appealing to young people.

• E-cigarette aerosol is not harmless. It can contain harmful substances, including:

» Nicotine

» Cancer-causing chemicals

» Volatile organic compounds

» Ultrafine particles

» Flavorings that have been linked to lung disease

» Heavy metals such as nickel, tin, and lead

www.CDC.gov/e-cigarettes

Click image to download fact sheet.

SAMPLE HEALTH ADVISORY 

Encourage state and local health officials to issue a health advisory on e-cigarettes and youth. For examples, look at 

the Surgeon General’s Advisory on E-cigarette Use Among Youth, this Minnesota Department of Health Advisory

or this Wisconsin Department of Health Services Public Health Advisory. 
11

FREE MEDIA AND COMMUNICATIONS MATERIALS

SAMPLE NEWSLETTER ARTICLE/BLOG POST 

Use the CDC feature article Keep Kids E-Cigarette Free in your various communications channels to share 

information and resources with key stakeholders (e.g., blog post, print or electronic newsletter, listserv). 

DIGITAL AND SOCIAL MEDIA MATERIALS

CDC has free resources you can use in your digital and social media 

efforts. Some of these materials are available for order through the 

Media Campaign Resource Center:

• Protecting Young People from E-cigarettes digital and social media 

images (please filter by Media Type “Digital Display” or “Social 

Media Materials” to find all relevant materials)

• E-Cigarettes Risky for Youth digital and social media images

• E-Cigarettes, Nicotine, and Brain Developmentsocial media image

Other graphics, with code to embed on a website, are available on the 

CDC Youth Tobacco Product Use Infographics page. Here is an example 

of the type of data and facts found in these infographics to build 

awareness among target audiences:

www.CDC.gov/e-cigarettes

TEACHERS AND PARENTS: 

That USB Stick Might Be an E-cigarette

Some e-cigarettes don’t look like 

tobacco products, so some kids use 

them unnoticed in schools, including 

in classrooms and bathrooms.

JUUL delivers a high dose of 

nicotine. Nicotine is highly 

addictive and can harm 

adolescent brain development.

An increasingly 

popular e-cigarette, 

called JUUL, is 

shaped like a USB 

flash drive.

E-cigarettes are the 

most commonly used 

tobacco product among 

U.S. middle and high 

school students.

TEACHERS AND PARENTS: 

That USB Stick Might Be an E-cigarette

Some e-cigarettes don’t look like 

tobacco products, so some kids use 

them unnoticed in schools, including 

in classrooms and bathrooms.

JUUL delivers a high dose of 

nicotine. Nicotine is highly 

addictive and can harm 

adolescent brain development.

LEARN MORE about the risks of e-cigarettes for 

f

TOBACCO PRODUCT 

USE IN ANY FORM, 

INCLUDING 

E-CIGARETTES, IS 

UNSAFE FOR YOUTH.

An increasingly 

popular e-cigarette, 

called JUUL, is 

shaped like a USB 

flash drive.

E-cigarettes are the 

most commonly used 

tobacco product among 

U.S. middle and high 

school students.

TEACHERS AND PARENTS: 

That USB Stick Might Be an E-cigarette

Some e-cigarettes don’t look like 

tobacco products, so some kids use 

them unnoticed in schools, including 

in classrooms and bathrooms.

JUUL delivers a high dose of 

nicotine. Nicotine is highly 

addictive and can harm 

adolescent brain development.

TOBACCO PRODUCT 

USE IN ANY FORM, 

INCLUDING 

E-CIGARETTES, IS 

UNSAFE FOR YOUTH.

An increasingly 

popular e-cigarette, 

called JUUL, is 

shaped like a USB 

flash drive.

E-cigarettes are the 

most commonly used 

tobacco product among 

U.S. middle and high 

school students.
12

CDC TobaccoFree social media channels 

frequently feature new graphics and 

information about e-cigarettes and youth. 

Please like and follow us at CDC Tobacco 

FREE MEDIA AND COMMUNICATIONS MATERIALS

www.CDC.gov/e-cigarettes 12

Free on Facebook and Twitter. Stay 

Connected offers a one-stop shop to link 

to all of CDC’s tobacco control social media 

channels. The images on this page are 

examples of the type of graphics that have 

been shared on these channels.
13

FREE MEDIA AND COMMUNICATIONS MATERIALS

www.CDC.gov/e-cigarettes

FREE MATERIALS FOR USE 

IN PRINT, RADIO AND 

TELEVISION 

These materials are available for order 

at no cost through the CDC Media 

Campaign Resource Center. You can 

work with media outlets to place them 

for free as PSAs, or if you have the 

resources, they can be used in 

paid placements.

• One Brain radio PSA

• It’s Not Like You Can Buy A New 

Brain (Vending Machine) print ad

• It’s a Factradio PSA

• Any Volunteers? video PSA

D4 D5 D6 D7

E4 E5 E6 E7

C4 C5 C6 C7

U.S. Department of 

Health and Human Services

Centers for Disease

Control and Prevention

The human brain is the last organ to fully develop, at around age 25. Nicotine in 

e-cigarettes can harm brain development and lead to addiction in youth and young adults. 

Let's protect our kids.

Learn how at www.cdc.gov/e-cigarettes

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention
14

See this letter sent by CDC to Public Service Directors to promote the One Brain radio PSA for an idea of how you 

could approach your local media outlets regarding PSA placement.

FREE MEDIA AND COMMUNICATIONS MATERIALS

Dear Public Service Director,

According to the Centers for Disease Control and Prevention (CDC), last year, more than 3.6 

million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, 

used electronic cigarettes, also known as “e-cigarettes.” Between 2017 and 2018, e-cigarette 

use increased 78% among high school students and nearly 50% among middle school 

students. This rapid increase led the U.S. Surgeon General to call the use of these products by 

youth an epidemic in the United States. In adolescents, exposure to nicotine can harm brain 

development, which continues until about age 25.

CDC’s Office on Smoking and Health has produced the enclosed radio public service 

announcement (PSA) as part of an initiative to raise awareness about the increase in youth 

e-cigarette use. The goal is to alert influential adults – including parents, educators, coaches, 

and healthcare providers – about the risks of e-cigarette use among youth.

This is an urgent public health issue for your station and its listeners because nicotine exposure 

during adolescence can impact learning, memory, and attention, and e-cigarette use among 

U.S. youth is skyrocketing. Youth who use e-cigarettes also may be more likely to progress to 

regular cigarettes and be at increased risk for future addiction to nicotine and other drugs.

Please help us raise awareness of the dangers of youth e-cigarette use by running this PSA 

frequently. For more information about e-cigarettes and risks among youth, please visit: 

www.CDC.gov/e-cigarettes.

Thank you for your time and support.

Sincerely,

Brian King, PhD, MPH

Deputy Director for Research Translation

Office on Smoking and Health

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

www.CDC.gov/e-cigarettes
15 www.CDC.gov/e-cigarettes

FREQUENTLY ASKED QUESTIONS

WHAT IS AN E-CIGARETTE?

• E-cigarettes are devices that heat a liquid into an 

aerosol that the user inhales. E-cigarettes come 

in many shapes and sizes. Most have a battery, a 

heating element, and a place to hold a liquid.

• E-cigarettes produce an aerosol by heating a liquid 

that usually contains nicotine—the addictive drug 

in regular cigarettes, cigars, and other tobacco 

products—flavorings, and other chemicals that 

help to make the aerosol. Users inhale this aerosol 

into their lungs. Bystanders can also breathe in this 

aerosol when the user exhales into the air.

• E-cigarettes are known by many different names. 

They are sometimes called “e-cigs,” “JUUL,” 

“e-hookahs,” “mods,” “vape pens,” “vapes,” “tank 

systems,” and “electronic nicotine delivery 

systems (ENDS).”

• Some e-cigarettes are made to look like regular 

cigarettes, cigars, or pipes. Some resemble pens, 

USB sticks, and other everyday items. 

• E-cigarettes can be used to deliver marijuana and 

other drugs.

 WHO IS USING E-CIGARETTES?

• In the United States, youth are more likely than 

adults to use e-cigarettes.

• In 2018, more than 3.6 million U.S. middle and high 

school students used e-cigarettes in the past 30 

days, including 4.9% of middle school students and 

20.8% of high school students. 

• In 2017, 2.8% of U.S. adults were current 

e-cigarette users. 

• Factors that have contributed to the increase in 

e-cigarette use among youth include the availability 

of these products in a variety of kid-friendly 

flavors, widespread advertising for these products, 

including via media for which advertising for 

conventional tobacco products is prohibited (e.g., 

TV), and the lower costs of some of these products 

relative to regular cigarettes. 

• Many youth also report using e-cigarettes because 

they are curious about these new products, and 

because they believe these products to be less 

harmful than regular cigarettes.

• Most e-cigarettes contain nicotine—the addictive 

drug in regular cigarettes, cigars, and other tobacco 

products. Nicotine can harm the developing 

adolescent brain. 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. 

• 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, and 

increases the likelihood that they will go on to 

smoke regular cigarettes.
16

FREQUENTLY ASKED QUESTIONS

• The brain is the last organ in the human body to 

develop fully. Brain development continues to 

about the early to mid-20s. 

• E-cigarettes typically contain nicotine. Nicotine 

disrupts the development of brain circuits that 

control attention and learning, and young people 

who use e-cigarettes and other tobacco products 

are at risk for deficits in these areas. 

• Adolescence is a critical period for brain 

development, and brain development continues 

into young adulthood. Young people who use 

e-cigarettes and other tobacco products are 

uniquely at risk for long-term, long-lasting effects 

of exposing their developing brains to nicotine. 

In addition to learning and cognitive deficits, and 

susceptibility to addiction, these risks include 

mood disorders and permanent lowering of 

impulse control. 

• The nicotine in e-cigarettes and other tobacco 

products can also affect the development of the 

brain’s reward system, priming the adolescent brain 

for addiction to other drugs such as cocaine and 

methamphetamine. 

 WHAT ARE THE OTHER RISKS OF 

• Scientists are still learning about the long-term 

health effects of e-cigarettes. However, we know 

that e-cigarette aerosol can contain harmful 

ingredients. For example, some flavorings used in 

e-cigarettes may have been approved as additives 

to food but are not safe to inhale.

• 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.

WHAT IS IN E-CIGARETTE AEROSOL?

• While e-cigarettes are less harmful than 

combustible cigarettes, 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

» Flavoring such as diacetyl, a chemical linked to 

a serious lung disease

» Volatile organic compounds

» Cancer-causing chemicals

» Heavy metals such as nickel, tin, and lead

• 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.

www.CDC.gov/e-cigarettes
17

• Many young people who use e-cigarettes also 

smoke cigarettes. There is a growing body of 

scientific evidence that young people who use 

e-cigarettes may be more likely to smoke cigarettes 

in the future than young people who do not use 

e-cigarettes. 

• A 2018 National Academies report found that 

among young people, there was some evidence that 

e-cigarette use increases the frequency and amount 

of cigarette smoking in the future. 

• But any e-cigarette use among young people is 

unsafe, even if they do not progress to future 

cigarette smoking.

• Most e-cigarettes contain nicotine, and all JUUL 

brand e-cigarettes contain nicotine. A recent 

CDC study found that 99% of the e-cigarettes sold 

in assessed venues in the United States 

contained nicotine. 

• Some e-cigarette labels do not disclose that they 

contain nicotine, and some e-cigarettes marketed 

as containing 0% nicotine have been found to 

contain nicotine. 

• Some of the new products, including JUUL, 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. This is of particular concern 

for young people, because it could make it easier for 

them to initiate the use of nicotine through 

these products.

FREQUENTLY ASKED QUESTIONS

www.CDC.gov/e-cigarettes

 WHAT IS JUUL?

• 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 nicotinecontaining 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. 

• News outlets and social media sites report 

widespread use of JUUL by students in schools, 

including classrooms and bathrooms.

• 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 PHIX, a nicotine 

delivery device, and the PAX Era, a marijuana 

delivery device that looks like JUUL.
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FREQUENTLY ASKED QUESTIONS

• 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 over the manufacturing, marketing, 

and sale of e-cigarettes. 

• However, the FSPTCA does not prevent states 

and communities from adopting many strategies 

related to e-cigarettes. There are also many 

strategies that FDA does not have authority to 

implement and that states can do, such as including 

e-cigarettes in smoke-free policies, pricing 

strategies, and increasing the age of sale for tobacco 

products to 21. 

 ARE THERE ANY NATIONAL 

• 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.

• The Truth Initiative® launched the “Safer ≠ Safe” 

campaign in 2018, focusing on correcting youth 

misperceptions and providing accurate information 

about e-cigarettes and youth. The campaign is 

being promoted on digital and social media, 

including the Safer ≠ Safe website, which features 

videos, articles and interactive activities for youth. 

 WHAT ELSE CAN BE DONE BY 

• Regulating the sale, distribution, and marketing of 

tobacco products, coupled with proven populationbased strategies, can reduce youth tobacco product 

use and initiation. 

• These proven strategies include increasing prices 

of tobacco products, protecting everyone from 

exposure to secondhand smoke and e-cigarette 

aerosol, and sustaining hard-hitting media 

campaigns like FDA’s “The Real Cost” campaign that 

warns youth about the dangers of tobacco product 

use, including e-cigarettes.

WHAT CAN PARENTS DO TO PROTECT 

AND PREVENT THEIR CHILD FROM 

USING E-CIGARETTES?

• Parents can set a positive example by being tobaccofree, and ensuring that their kids aren’t exposed 

to the secondhand emissions from any tobacco 

products, including e-cigarettes. 

• We know e-cigarettes are now the most commonly 

used tobacco product among youth and that many 

youth aren’t aware of the dangers of these products, 

including the negative impacts of nicotine exposure 

on the developing adolescent brain. Therefore, 

ensuring that youth are aware of the risks of using 

all forms of tobacco products, including e-cigarettes, 

is critical.

www.CDC.gov/e-cigarettes
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WHAT DO WE KNOW ABOUT HEATED 

TOBACCO PRODUCTS?

• 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 recently 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 current 

smokers surveyed) had ever used HTPs. Youth use of 

HTPs is unknown, but monitoring is underway.

• 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 substances. 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.

FREQUENTLY ASKED QUESTIONS

www.CDC.gov/e-cigarettes
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KEY RESOURCES

www.CDC.gov/e-cigarettes

The web pages and reports listed below provide evidence-based information and media and communications 

materials about e-cigarettes and youth. The content of this toolkit draws from these resources, and many of the 

media and communications materials are referred to throughout the toolkit. 

• CDC Office on Smoking and Health e-cigarette web pages.

• CDC Vital Signs: Tobacco Use By Youth Is Rising, including this podcast summarizing key findings 

and calls to action.

• Surgeon General Know the Risks: E-Cigarettes & Young Peoplewebsite

• 2016 Surgeon General’s Report: E-Cigarette Use Among Youth and Young Adults

• FDA Center for Tobacco Products “The Real Cost” Youth E-Cigarette Prevention Campaign 

• National Academies Publication on Public Health Consequences of E-Cigarettes

• Free cessation resources for youth who use tobacco products:

» Truth Initiative® E-cigarette Quit Program (Text QUIT to 202-804-9884)

» National Cancer Institute’s SmokefreeTeen website

Information and links to non-federal organizations are provided solely as a service. Information and links do not constitute an endorsement of any 

organization by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content found at non-federal links or at links 

from other federal agencies.

Centers for Disease Control and Prevention, Office on Smoking and Health

www.CDC.gov/e-cigarettes
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U.S. Department of 

Health and Human Services

Centers for Disease

Control and Prevention

U.S. Department of

Health and Human Services

Centers for Disease 

Control and Prevention