Introduction Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. Methods We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6–12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. Results Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24–2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. Conclusion In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes.

of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States. § NATS is a stratified, random-digit-dialed landline and cellular telephone survey of noninstitutionalized U.S. adults aged ≥18 years. The 2013-2014 NATS included 75,233 respondents (70% landline, 30% cellular); the overall response rate was 36.1% (landline 47.6%, cellular 17.1%). Based on established conventions regarding patterns of tobacco product use (3), NATS questions used varying thresholds of lifetime use to separate established users from experimenters and nonusers. Four tobacco product types assessed in NATS had lifetime usage thresholds: cigarettes (≥100 cigarettes); cigars/cigarillos/ filtered little cigars (≥50 times); regular pipes (≥50 times); and chewing tobacco/snuff/dip (≥20 times). Water pipes/hookahs, e-cigarettes, snus, and dissolvable tobacco products did not have usage thresholds. Respondents who met the respective thresholds for cigarettes, cigars/cigarillos/filtered little cigars, Continuing Education examination available at

A substantial number of EU adults have ever used e-cigarettes. Ever users were more likely to be younger, current smokers, or past-year quit attempters. These findings underscore the need to evaluate the potential long term impact of e-cigarette use on consumer health, cessation and nicotine addiction and formulate a European framework for e-cigarette regulation within the revised EU Tobacco Product Directive.

BACKGROUND: Electronic cigarette (e-cigarette) use among US students increased significantly during 2011 to 2014. We examined the association between e-cigarette advertisement exposure and current e-cigarette use among US middle school and high school students.

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