The "iPhone" of ENDS


Youth and ENDS

A primary concern surrounding ENDS is youth targeted advertisements1. Research has found that most adolescents who report trying ENDS have never used traditional cigarettes1. There is concern that the variety of flavors available for ENDS attract youth, and studies show that ENDS use in youths can lead to tobacco use later in life.1 Prevalence of ENDS use is highest in Hispanic and white males, especially young adults2. ENDS advertisements that target youth and young adults are especially problematic because nicotine is very addictive and can be harmful to brain development until the age of 25.3

According to the CDC, approximately 42% of students nationwide have tried an ENDS product, with about 3% having frequent use of such products.4 Because ENDS product use began to be recorded by the CDC in 2015, not much longitudinal data is available; however, there does not seem to be a statistically significant change in prevalence of ever trying or frequent use of ENDS by students nationwide from 2015 to 2017.4

Almost 14% of students who currently use ENDS products were able to buy these items in stores themselves5. The ease with which youths are able to buy ENDS in stores has been brought to the attention of concerned parents, educators, and public health officials – with the FDA Commissioner Scott Gottlieb, M.D. announcing “the largest single enforcement action in [FDA] history” in which it aims to cease the retail and online sales of e-cigarettes to minors.6 In the same press release, Commissioner Gottlieb also referred to the increase in prevalence of ENDS usage in youths as an “epidemic” as it has become “an almost ubiquitous… trend among teens.”6


Photo Credit: Sarah Johnson


USB-like ENDS: A new type of ENDS that resembles a USB has become popular among youth and teens. JUUL was first company to develop USB-like ENDS, and other products, such as the MarkTen Elite and Pax Era, have followed7. The act of using a USB-like ENDS is sometimes referred to as JUULing7.These devices come in a variety of flavors and are easy to disguise or hide.8 Prior research on nicotine product use among adolescents suggests that ENDS usage in general could be potentially dangerous and addictive for the developing brains of youth and teenagers and can encourage adolescents to abuse nicotine9.

USB-like ENDS are particularly concerning due to the fact that they are able to deliver high levels of nicotine, comparable to that of cigarettes, with fewer deterrents than other forms of tobacco products due to their use of nicotine salt solutions.10 Traditional ENDS utilize free-base nicotine which can cause aversive user experiences, such as dizziness or nausea, if the nicotine concentration is high which does not occur with the nicotine salt solutions used in USB-like ENDS.10 When compared to cigarettes, nicotine salts in USB-like ENDS are able to deliver similar levels of nicotine without the harsh taste that discourages some youths from continuing to smoke. 10  

  1. Amiri, A., & Vazquez, K. (2017). Electronic Nicotine Delivery Systems: Are You Prepared to Have a Conversation With Your Patients?. Alabama Nurse, 44(1), 14-16.
  2. Stratton, K., Kwan, L. Y., and Eaton, D. L. (2018). Summary. In Public Health Consequences of E-Cigarettes. Retrieved from
  3. Center for Disease Control. E-Cigarettes Shaped Like USB Flash Drives: Information for Parents, Educators, and Health Care Providers. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
  4. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ 2018;67(No. SS-8):1-114. DOI:
  5. United States Department of Labor, Occupational Safety and Health Administration. (n.d.). Flavorings-Related Lung Disease, Diacetyl and 2, 3-Pentandione. Retrieved from
  6. United States Food and Drug Administration. (2018, September 12). Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to address epidemic of youth e-cigarette use [Press release]. Retrieved from
  7. Kim SA, Smith S, Beauchamp C, Song Y, Chiang M, Giuseppetti A, et al. (2018) Cariogenic potential of sweet flavors in electronic-cigarette liquids. PLoS ONE 13(9): e0203717. https://doi. org/10.1371/journal.pone.0203717
  8. American Academy of Pediatricians Julius B. Richmond Center of Excellence. JUULing: What Pediatricians and Families Need to Know. Retrieved from:
  9. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General-Executive Summary. 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.
  10. Barrington-Trimis, J. & Leventhal, A. (2018, August 22). Adolescents’ Use of “Pod Mod” E-Cigarettes – Urgent Concerns. The New England Journal of Medicine. 379, 1099 – 1102. DOI: 10.1056/NEJMp1805758.