Strengthening the evidence base to support stronger regulation of social media based advertising of e-cigarette products to youth

Despite the early promise of e-cigarettes as a potential smoking cessation tool, the actual uptake of these products has been the source of much controversy. There have been growing concerns about the exponential rise in the use of e-cigarettes and vaping products among youth and adolescents, with the proportion of those aged 11–15, 16–17 and 18 years in Great Britain using e-cigarettes more than doubling between 2021 and 2023 to reach 4.6%, 15.0% and 18%, respectively.1 The 2023 US Annual National Youth Tobacco Survey has reported more than 2.1 million current e-cigarette users in the US, with 25% being daily users.2 E-cigarettes represent the most popular tobacco products among American youth for the 10th year in a row, feeding growing concerns from public health agencies worldwide about the potential health effects of e-cigarettes in this vulnerable demographic. In an era when direct tobacco advertising targeting youth has long been banned and strict regulation has led to smoking combustible cigarettes going largely out of fashion among youth,3–5 this begs the question: why are e-cigarettes so popular in this demographic? Aside from the obvious factors related to the fact that nicotine is addictive and e-cigarettes are discreet, cheap and easy to obtain, the answer may lie in the subtle and creative ways e-cigarette manufacturers have …