page_title: Usage of electronic cigarettes
section_title: Youth
hierarchical_section_title: Usage of electronic cigarettes / Use / Youth
caption_attribution_description: English: Accompanying description: E-cigarettes are very popular with young people. Their use has grown dramatically in the last five years. Today, more high school students use e-cigarettes than regular cigarettes. The use of e-cigarettes is higher among high school students than adults.
context_page_description: Since the introduction of electronic cigarettes to the market in 2003, their global usage has risen exponentially. In 2011, there were approximately seven million adult e-cigarette users globally to 41 million of them in 2018. Awareness and use of e-cigarettes greatly increased over the few years leading up to 2014, particularly among young people and women in some parts of the world. Since their introduction vaping has increased in the majority of high-income countries. E-cigarette use in the US and Europe is higher than in other countries, except for China which has the greatest number of e-cigarette users. Growth in the UK as of January 2018 had reportedly slowed since 2013. The growing frequency of e-cigarette use may be due to heavy promotion in youth-driven media channels, their low cost, and the belief that e-cigarettes are safer than traditional cigarettes, according to a 2016 review. E-cigarette use may also be increasing due to the consensus among several scientific organizations that e-cigarettes are safer compared to combustible tobacco products.
context_section_description: The prevalence of vaping among adolescents is increasing worldwide. There is substantial variability in vaping in youth worldwide across countries. Over the years leading up to 2017 vaping among adolescents has grown every year since theses devices were first introduced to the market. There appears to be an increase of one-time e-cigarette use among young people worldwide. The frequency of vaping in youth is low. The result of youth e-cigarette use leading to smoking is unclear. Most e-cigarette users among youth have never smoked. Many youth who use e-cigarettes also smoke traditional cigarettes. Some youths who have tried an e-cigarette have never used a traditional cigarette; indicating e-cigarettes may be a starting point for nicotine use. Adolescents who would have not been using nicotine products to begin with are vaping. Twice as many youth vaped in 2014 than also used traditional cigarettes. Vaping seems to be a gateway to using traditional cigarettes in adolescents. Youth who use e-cigarettes are more likely to go on to use traditional cigarettes. The evidence suggests that young people who vape are also at greater risk for subsequent long-term tobacco use. E-cigarettes are expanding the nicotine market by attracting low-risk youth who would be unlikely to initiate nicotine use with traditional cigarettes. Data from a longitudinal cohort study of children with alcoholic parents found that adolescents (both middle and late adolescence) who used cigarettes, marijuana, or alcohol were significantly more likely to have ever used e-cigarettes. Adolescents were more likely to initiate vaping through flavored e-cigarettes. Among youth who have ever tried an e-cigarette, a majority used a flavored product the first time they tried an e-cigarette. Vaping is the most common form of tobacco use among youth, as of 2019. There is a greater likelihood of past or present and later cannabis use among youth and young adults who have vaped.
  Most youth are not vaping to help them quit tobacco. Adolescent vaping is unlikely to be associated with trying to reduce or quit tobacco. Adolescents who vape but do not smoke are more than twice as likely to intend to try smoking than their peers who do not vape. Vaping is correlated with a higher occurrence of cigarette smoking among adolescents, even in those who otherwise may not have been interested in smoking. Adolescence experimenting with e-cigarettes appears to encourage continued use of traditional cigarettes. A 2015 study found minors had little resistance to buying e-cigarettes online. An emerging concern is that nicotine, fruit flavors, and other e-liquid additives could incite teenagers and children to start using traditional cigarettes. Teenagers may not admit using e-cigarettes, but use, for instance, a hookah pen. As a result, self-reporting may be lower in surveys. Experts suggest that candy-like flavors could lead youths to experiment with vaping. E-cigarette advertisements seen by youth could increase the likelihood among youths to experiment with vaping. A 2016 review found "The reasons for the increasing use of e-cigarettes by minors (persons between 12 and 17 years of age) may include robust marketing and advertising campaigns that showcase celebrities, popular activities, evocative images, and appealing flavors, such as cotton candy." A 2014 survey stated that vapers may have less social and behavioral stigma than cigarette smokers, causing concern that vaping products are enticing youth who may not under other circumstances have used these products. The frequency of vaping is higher in adolescent with asthma than in adolescent who do not have asthma.
caption: Today, more high school students use e-cigarettes than regular cigarettes.[148] The use of e-cigarettes is higher among high school students than adults.[148]
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