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On a global scale, the WHO suggested stopping the promotion of electronic cigarettes to non-smokers and young people, and restricting the possibilities of advertising and indoor use.100 Likewise, the American College of Preventive Medicines Prevention Practice Committee recently issued a consensus-based statement recommending that electronic nicotine delivery systems should be screened in the general population, with special emphasis on electronic nicotine delivery systems initiation prevention among youth, but also in smokers intending to quit.101 In 2016, the US Food and Drug Administration (FDA) firmly regulated cigarettes and smokeless tobacco, including electronic cigarettes, prohibiting their sale to teens and even distribution of free samples

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Among middle school students, current e-cigarette use more than tripled from 1.1% in 2013 to 3.9% in 2014an increase from approximately 120,000 to 450,000 students