Vaping Epidemic By the Numbers

1 in 4
high school students
currently vape1
5.3 million
youth in the U.S. vape2
of all youth who vape
want to quit1
e-cigarette flavors are on the
on the market3
$1.3 billion
USD in annual e-cigarette
retail sales in 2017 4
$650+ million
USD in annual sales by JUUL
alone in 2017 4


Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control. A recent CDC study found that 99% of the e-cigarettes sold in in the United States contained nicotine.5
Nearly all habitual tobacco use begins during youth and young adulthood. Among adults who are daily smokers, nearly 90% first used of cigarettes by 18 years of age.5
E-cigarettes contain harmful chemicals (like formaldehyde and acrolein), and we don’t yet know the long-term effects of these chemicals.6
There may be increased cough and wheeze in adolescents who use e-cigarettes, and an association with e-cigarette use and increased asthma issues.5,6
Exhaled aerosol from e-cigarettes can expose users and bystanders to harmful compounds and ultrafine particles which can be inhaled deeply into the lungs.5
Exposure to e-liquids (from drinking, eye contact, or dermal contact) can result in adverse health effects including but not limited to: seizures, anoxic brain injury, vomiting, and lactic acidosis.6
Youth largely know that e-cigarettes have nicotine and are addictive, but they don’t understand the harmful consequences of addiction. Youth want more information on why e-cigarettes are bad, and want to see specific facts.7


Health communication – when done effectively – can create lasting public health improvements by preventing tobacco use initiation and increasing cessation.

Want to communicate about a vaping-related issue that is impacting your community? Below is a road map of best practices to help you:

Step 1. Develop a plan.

A plan will inform how you roll out your communications campaign, and should include:
  • WHO you want to target (i.e. your audience)
  • WHAT evidence you are using to build your campaign, as well as the goals or desired impact of your campaign
  • WHEN you plan to roll-out and evaluate your campaign
  • WHERE you will reach your audience (i.e. your communication strategies or channels for sending your messages)
  • HOW you will evaluate if the campaign is working
  • The budget you have for your campaign

Step 2. Understand your audience.

  • Researching the people you want to reach will help you to better understand how to communicate effectively with them. It is critical to take some time to talk with members of your audience directly to understand their experience and perceptions of the health problem before you begin crafting your messages. Their answers and feedback may surprise you.
  • Use already-existing population-level data like census information or health department data to understand your audience’s health issue.
  • Narrow your target audience as much as possible so you can target your strategies and messaging for a more successful campaign.
  • Representation is essential. Make sure your team represents the audience you’re trying to reach, that you are culturally competent, and are including members of your target audience in the development process.

Step 3. Develop and pre-test your messages.

  • Messages should be hard-hitting and should be targeted to your specific target audience.
  • Try developing a mix of messages for your campaign. This will help make sure you reach as many members of your audience as possible. The messages you choose should be based on your campaign goals, your audience’s preferences, and your budget.
  • Test your ads with your audience. After you create your message ideas, use focus groups, surveys, or other methods to refine your messages, ensure they are well-received, seem to achieve the desired impact, and will be placed in locations where your audience will see them.
  • Your messaging should include information about additional support resources — for example, linking to state or national vaping prevention and cessation resources, or your state Quitline.
  • You may have the option to re-use ads or make new ones. Decide what works best for your budget, your campaign goals, and your audience. Make sure the reach and frequency of exposure to the ads is at an appropriate level to have an impact.

Step 4. Get ready for launch!

Review your plan, update your timeline, choose a spokesperson, problem-solve for potential questions or press that might come up, and get ready to respond to the potential opposition.

Implement your plan:

  • Develop and place paid media: TV, radio, billboards, etc. Interacting with your audience will help you decide which type of media to use and the frequency.
  • Generate earned media (media that you do not pay for) – such as writing op-eds, pitching to the news media to cover your campaign, or hosting newsworthy events that the news will want to cover.
  • Share messages on social media. Create a social media plan, pick your channels, develop messages, and start posting!
  • Develop interactive program communications. This might be a website or involve interactions between your organization and the community that build relationships with your stakeholders.

Step 5. Adjust and respond.

  • Monitor and evaluate the dissemination of your campaign and the audience response. This can include tracking where and how many ads have been disseminated, monitoring the numbers of visitors to a website over the timespan of your campaign, and evaluating the behavioral impact you’re hoping to make.
  • Make adjustments to your ad deployment where necessary. For example, you can adjust the frequency of messages or media channels to increase the impact of your campaign.

Step 6. Evaluate.

  • Evaluating all aspects of the campaign, from development to implementation, will inform how the campaign is working, help you understand longer-term impact on behavior change, and help you and your team create future campaigns.
  • Share your results with your team and stakeholders.


  • Nice job! Your campaign is now addressing a vaping-related health issue in your community.

For more detailed information, visit the CDC’s health communication guide:


  1. Wang TW, Gentzke AS, Creamer MR, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — United States, 2019. MMWR Surveillance Summaries. 2019;68(12):1-22.
  2. Cullen KA, Gentzke AS, Sawdey MD, et al. e-Cigarette Use Among Youth in the United States, 2019. JAMA. 2019;322(21):2095-2103.
  3. Zhu, S-H, et al. Evolution of Electronic Cigarette Brands from 2013-2014 to 2016-2017: Analysis of Brand Websites. Journal of Medical Internet Research. 2018;20(3).
  4. Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tobacco Control. 2019;28(2):146-151.
  5. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. In: U.S. Department of Health and Human Services CfDCaP, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, ed. Atlanta 2016.
  6. National Academies of Sciences E, Medicine. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press; 2018.
  7. Roditis ML, Dineva A, Smith A, et al. Reactions to electronic nicotine delivery system (ENDS) prevention messages: results from qualitative research used to inform FDA’s first youth ENDS prevention campaign. Tobacco Control. 2019:tobaccocontrol-2019-055104.