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CANCER APRIL 1, 2018 1 A YouTube video shows images of teenagers engaging in typical teen activities: carrying skateboards, bowling, going out to eat, ... and vaping. It concludes with the message, “Vaping can deliver nicotine to your brain, reprogramming you to crave more and more. Don’t get hacked.” The digital media spot, which aired on multiple social media channels and other online sites last fall, is part of the new US Food and Drug Administration (FDA) campaign to discourage kids from using electronic cigarettes, or “e-cigarettes,” and other electronic nicotine delivery systems (ENDS). These devices may be called “vapes,” “vaporizers,” “vape pens,” “hookah pens,” or “e-pipes,” but they all involve a liquid that is heated into an aerosol that the user inhales. That liquid may contain nicotine, as well as flavorings, propylene glycol, vegetable glycerin, and other ingredients in varying quantities. The FDA is developing more public education ads targeting youth about the risks of e-cigarettes and other ENDS devices, and plans to roll out a full-scale campaign this fall. The effort is an extension of the agency’s “Real Cost” campaign, launched in 2014 to educate youth about the dangers of smoking cigarettes, and shown to have prevented nearly 350,000 youth from 11 to 18 years of age nationwide from initiating the habit. Tobacco control advocates point to great success in reducing youth smoking rates. Cigarette smoking among high school students has fallen to an all-time low of 8% in 2016, a 72% decrease from 1999 levels according to the federal government’s 2016 National Youth Tobacco Survey.1 “We believe we’ve made significant strides in driving down smoking and reaching an incredibly high level of awareness about the health consequences, and we wanted to apply that same strategy toward reducing teen e-cigarette use,” says Kathleen Crosby, director of the office of health communication and education at the FDA’s Center for Tobacco Products. The data show that more than 2 million middle and high school students used e-cigarettes and other ENDS in 2016, and that approximately half of current users in this age group also used 2 or more tobacco products last year. Youth usage rates of ENDS have increased since the products came on the market. For example, from 2011 to 2015, e-cigarette use rose from 1.5% to 16% among high school students and from .6% to 5.3% among middle school students. And, although that 16% figure for high school students did decline to 11.3% in 2016 according to the 2016 National Youth Tobacco Survey, progress is far from over, notes Matthew Myers, president of the Campaign for Tobacco-Free Kids. He points out that 1 in 5 high school students still use some form of tobacco.1 “When it comes to kids, we don’t think there’s any safe level of tobacco use,” Crosby says. “No one understands the long-term consequences of teens starting to use ENDS now and what [those consequences] will mean for them.”