This report focuses on research conducted among youth and young adults because of the implications of e-cigarette use in this population, particularly the potential for future public health problems. Understanding e-cigarette use among young persons is critical because previous research suggests that about 9 in 10 adult smokers first try conventional cigarettes during adolescence. Similarly, youth e-cigarette experimentation and use could also extend into adulthood; however, e-cigarette use in this population has not been examined in previous reports of the Surgeon General. The first Surgeon General’s report on the health consequences of smoking was published in 1964; of the subsequent reports, those published in 1994 and 2012 focused solely on youth and young adults. More recently, the 2012 report documented the evidence regarding tobacco use among youth and young adults, concluding that declines in cigarette smoking had slowed and that decreases in the use of smokeless tobacco had stalled. That report also found that the tobacco industry’s advertising and promotional activities are causal to the onset of smoking in youth and young adults and the continuation of such use as adults. However, the 2012 report was prepared before e-cigarettes were as widely promoted and used in the United States as they are now. Therefore, this 2016 report documents the scientific literature on these new products and their marketing, within the context of youth and young adults. This report also looks to the future by examining the potential impact of e-cigarette use among youth and young adults, while also summarizing the research on current use, health consequences, and marketing as it applies to youth and young adults.

Evidence for this report was gathered from studies that included one or more of three age groups. We defined these age groups to be young adolescents (11–13 years of age), adolescents (14–17 years of age), and young adults (18–24 years of age). Some studies refer to the younger groups more generally as youth. Despite important issues related to e-cigarette use in adult populations, clinical and otherwise (e.g., their potential for use in conventional smoking cessation), that literature will generally not be included in this report unless it also discusses youth and young adults.

Given the recency of the research that pertains to e-cigarettes, compared with the decades of research on cigarette smoking, the “precautionary principle” is used to guide actions to address e-cigarette use among youth and young adults. This principle supports intervention to avoid possible health risks when the potential risks remain uncertain and have been as yet partially undefined. Still, the report underscores and draws its conclusions from the known health risks of e-cigarette use in this age group.

Contents

• Message from Sylvia Burwell, Secretary, U.S. Department of Health and Human Services
• Foreword
• Preface, from the Surgeon General
• Acknowledgments
• Chapter 1. Introduction, Conclusions, and Historical Background Relative to E-Cigarettes
  • Introduction
  • Major Conclusions
  • Chapter Conclusions
  • Historical Background
  • The E-Cigarette
  • E-Cigarette Companies
  • Federal Regulation of E-Cigarettes
  • Summary
  • References
• Chapter 2. Patterns of E-Cigarette Use Among U.S. Youth and Young Adults
  • Introduction
  • Key Findings
  • Evidence Summary
  • Conclusions
  • References
• Chapter 3. Health Effects of E-Cigarette Use Among U.S. Youth and Young Adults
  • Introduction
  • Conclusions from Previous Surgeon General’s Reports
  • Health Effects of E-Cigarette Use
  • Evidence Summary
  • Conclusions
  • References
• Chapter 4. Activities of the E-Cigarette Companies
  • Introduction
  • Manufacturing and Price
  • Marketing and Promotion of E-Cigarettes
  • Evidence Summary
  • Conclusions
  • References
• Chapter 5. E-Cigarette Policy and Practice Implications
  • Introduction
  • Critical Issues Related to Policies on E-Cigarettes in 2016
  • Potential Public Policy Approaches
  • Case Studies
  • Summary and Recommendations
  • Conclusions
  • References
• The Call to Action
  • The Call to Action on E-Cigarette Use Among Youth and Young Adults
  • Goal 1. First, Do No Harm
  • Goal 2. Provide Information About the Dangers of E-Cigarette Use Among Youth and Young Adults
  • Goal 3. Continue to Regulate E-Cigarettes at the Federal Level to Protect Public Health
  • Goal 4. Programs and Policies to Prevent E-Cigarette Use Among Youth and Young Adults
  • Goal 5. Curb Advertising and Marketing that Encourages Youth and Young Adults to Use E-Cigarettes
  • Goal 6. Expand Surveillance, Research, and Evaluation Related to E-Cigarettes
  • Conclusions
  • References
• List of Abbreviations

Suggested citation:

U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.

Use of trade names is for identification only and does not constitute endorsement by the U.S. Department of Health and Human Services.