confirms that exposing children to different e-cigarette advertisements (glamorous, healthful, flavored, or non-flavored) lowers their perceived harm of occasional tobacco smoking. the us fda in july 2009 expressing major concerns that vaping may be marketed at young people and fall short of relevant health warnings. e-cigarettes are promoted to a certain extent to foster a vaping culture that entices youth. this could lead to producing a whole new group of young people who are dependent on nicotine. evidence has not shown that unrestricted access to e-cigarettes and intensive marketing that attracts youth are required elements of an approach to minimize combustible tobacco use. e-cigarette marketing with themes of health and lifestyle may encourage youth who do not smoke to try e-cigarettes, as they may believe that e-cigarettes are less harmful and more socially acceptable. this belief may decrease ones concerns relating to nicotine addiction. several marketing and design product features seem to be more attractive for young people. for example, flavorings or lack of age regulation restricting laws have been implicated as reasons for youth susceptibility to e-cigarettes. an analysis of e-cigarette retail websites, marketing, and promotional campaigns demonstrated frequent appeals to adolescents such as use by celebrities, feature cartoons, and enhanced social activity as well as sexual appeal. e-cigarette websites regularly contain marketing statements that might appeal to a younger audience. the ease to get past the age verification system at e-cigarette company websites allows underage individuals to access and be exposed to marketing. around half of e-cigarette company websites have a minimum age notice that prohibited underage individuals from entering. e-cigarette websites often made unscientific health statements in 2012. the long-term success of any market is dependent on recruiting new generations of consumers. in the case of tobacco, these beginners are typically children – few adults take up smokings – and the tobacco industry's dependence on selling to the young has become notorious. similar concerns are apparent for e-cigarettes, with the production of variants such as e-shisha and flavoured and coloured offerings (with or without nicotine). cancer research uk for e-cigarettes, independent e-cigarette businesses targeting youth present them in creative packaging as well as a variety of flavors, among other things. marketing efforts by independent e-cigarette businesses targeting youth include using social media platforms to give cost incentives. promoting them online include using competitions and sales apps, directed at youth. the money spent in e-cigarette marketing has been accompanied with a rise in vaping in youth. marketing tactics are partly responsible for the considerable and dramatic increase in vaping among adolescents. a 2016 review found "the reasons for the increasing use of e-cigarettes by minors (persons between 12 and 17 years of age) may include robust marketing and advertising campaigns that showcase celebrities, popular activities, evocative images, and appealing flavors, such as cotton candy." marketing of e-cigarettes is often misleading and highly appealing to teens. aggressive marketing has led to an increase in e-cigarette use and experimentation by youth. e-cigarettes are popular among teens and their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they are safer than traditional cigarettes have helped make them appealing to this age group. a 2017 review found that "the tobacco industry sees a future where ends accompany and perpetuate, rather than supplant, tobacco use, especially targeting the youth." marketing approaches employed by e-cigarette businesses include the use of flavors that are enticing to children. a 2016 study found 11–16-year-olds english children exposed to e-cigarette advertisements highlighting flavored, in contrast to flavor-free products, did result in increased appeal and interest in obtaining and experimenting with e-cigarettes. in 2014, about 7 in 10 middle school and high school students – more than 18 million youth – said they had seen e-cigarette advertising. retail stores were the most frequent source of this advertising, followed by the internet, television and movies, and magazines and newspapers. tobacco companies have historically enlisted convenience stores, the type of store most frequented by youth, as their most important partners in marketing tobacco products and opposing policies that reduce tobacco use. more than 60% of convenience stores sold e-cigarettes in 2013, with almost one third selling e-cigarettes near candy, ice cream, slushie machines, or soda machines. drug stores and pharmacies (other than cvs pharmacy which will no longer sell tobacco as of september 2014), are also selling e-cigarettes at a rate higher than the state average in california (56% versus 44%), with 88% of those stores placing e-cigarettes visibly in the main check-out area. marketing, especially through social media, has a salient role in vaping promotion among adolescents; whereas retail stores are a prominent source of e-cigarette display. four scottish communities participated in a recent observational study in which a potential concern has emerged due to the placement of e-cigarettes, in 36% of stores, near to products popular to children. youth exposure to e-cigarette marketing occurs at locations where products are purchased. numerous flavors for e-cigarettes such as gummy bear, cotton candy, peanut butter cup, and cookies 'n cream appear as if they have an association with a candy shop or ice cream parlor. these flavored products with vivid packaging and sugary flavors are sometimes difficult to tell apart from the candy displays close to which they are commonly located in retail stores. children are more frequently than older people to have made impulsive buys as a result of e-cigarette advertising at places where products are purchased. graphic from the 2019 us surgeon general's report entitled business trends. youth exposure to e-cigarette advertising adolescents are exposed to e-cigarette marketing in a number of ways, many of which are not available to traditional tobacco. since 2011 youth seeing television advertisements for e-cigarettes has risen, as of 2017. in 2016, the relative absence of restrictions to date in the us has led e-cigarette marketing to permeate most media outlets through the likes of celebrity endorsements, images associated with youth culture, and statements encouraging consumers to reclaim lost freedoms. the increasing frequency and reach of advertising on television raises concerns about the potential impact of promoting nicotine products and renormalizing smoking through that medium, particularly for youth. e-cigarette advertisements seen by youth could increase the likelihood among youths to experiment with vaping. exposure to e-cigarette advertisements is associated with higher odds of current e-cigarette use among us middle and high school students. most of the methods being used today by e-cigarette businesses were used long ago by tobacco businesses to market traditional cigarettes to youth. it is not known the extent to which vaping appeals to youth that resulting from the various e-cigarette flavorings and advertising. the leading e-cigarette brands have taken the position that their products should not be sold or marketed to youth, but advertising industry data showed that 73% of 12-17 year olds were exposed to e-cigarette advertising from blu, the most heavily advertised e-cigarette brand, a 2014 report indicated. many television networks with a substantial proportion of youth viewers, are airing e-cigarette television advertising. e-cigarette advertisements have appeared on highly viewed broadcasts, including the 2013 and 2014 super bowls, which had more than 110 million viewers. e-cigarette businesses advertised to a large television audience in the us which included 24 million youth. between 2011 and 2013, youth and young adults viewing e-cigarette television advertising had risen considerably. the channels to which e-cigarette advertising reached the largest numbers of youth (ages 12–17) were amc, country music television, comedy central, wgn america, tv land, and vh1. from january 2013 to september 2013, blu advertised the most to youth and young adults, followed by fin, starfire, njoy, and other brands. e-cigarette commercials ran in the course of the evening shows that were popular with teenagers and children, such as the televised show breaking bad. instyle, us weekly, star, entertainment weekly, and rolling stone are some of the tabloids and magazines with e-cigarette advertisements reaching millions of youth and young adults. in school-based surveys in 2015 of middle and high school students in connecticut in the us, gas stations and television were the dominant channels in which students reported recently seeing e-cigarettes advertised or sold. a different pattern was observed in a convenience sample in 2015 of college students in hawaii, where the figures for seeing advertisements were 59%, online; 58%, television; 71%, malls; 41%, gas stations; and 47%, convenience stores. overall, exposure to e-cigarette advertising from at least one source increased each year during 2014–2016 (2014: 68.9%, 18.3 million; 2015: 73.0%, 19.2 million; 2016: 78.2%, 20.5 million) in the us. in 2016 in the us, exposure was highest for retail stores (68.0%), followed by the internet (40.6%), television (37.7%), and newspapers and magazines (23.9%). during 2014–2016 in the us, youth exposure to e-cigarette advertising increased for retail stores (54.8% to 68.0%), decreased for newspapers and magazines (30.4% to 23.9%), and did not significantly change for the internet or television. among us middle and high school students during 2014–2016, exposure to e-cigarette advertisements from any source increased from 68.9% (18.3 million) to 78.2% (20.5 million). in 2016 in the us, exposure was highest for retail stores (68.0%, 17.7 million), followed by the internet (40.6%, 10.6 million), television (37.7%, 9.7 million), and newspapers and magazines (23.9%, 6.2 million). in 2016 in the us, exposure to advertising from any source was more prevalent among females (79.9%) than males (76.5%); non-hispanic whites (79.6%) than hispanics (77.0%) and students of other non-hispanic races/ethnicities (73.6%); 8th (78.5%), 10th (81.0%), 11th (79.3%), and 12th graders (79.0%) than 6th graders (75.0%); high school students (79.2%) than middle school students (76.9%); current e-cigarette users (82.8%) than non-users (77.9%); and current users of other tobacco products (82.7%) than non-users (77.6%). exposure to each advertising source was higher among current e-cigarette users and other tobacco product users than non-users during 2014, 2015, and 2016 in the us. overall in 2016 in the us, 28.3% of students reported exposure to e-cigarette advertising from one source, 21.2% from two sources, 16.7% from three sources, and 12.0% from four sources. retail stores were the most common exposure source every year (2014: 54.8%; 2015: 59.9%; 2016: 68.0%), whereas newspapers and magazines were the least common exposure source (2014: 30.4%; 2015: 31.0%; 2016: 23.9%) in the us. the internet was the second most common exposure source in 2014 (39.8%) and 2016 (40.6%); in 2015, television (44.5%) exceeded the internet (42.6%) as the second most common exposure source in the us. during 2014–2016, us middle and high school students' exposure to e-cigarette advertising significantly increased for retail stores (from 54.8% to 68.0%), significantly decreased for newspapers and magazines (from 30.4% to 23.9%), and did not significantly change for internet and television. in 2016, an estimated four in five (20.5 million) us youths, including 8.9 million middle school students and 11.5 million high school students, were exposed to e-cigarette advertisements from at least one source, a 13% increase over 2014. exposure in retail stores increased 24% in 2016 compared with 2014, and was the primary factor responsible for the increases in exposure from any source during 2014–2016 in the us. nearly seven in 10 youths (17.7 million) were exposed to e-cigarette advertising in retail stores in 2016; approximately two in five were exposed on the internet (10.6 million) or television (9.7 million), and nearly one in four (6.2 million) were exposed in newspapers and magazines in the us. given the us surgeon general has established that a causal relationship exists between traditional tobacco advertising and youth tobacco product initiation, and given the association between e-cigarette advertising exposure and e-cigarette use among youths, efforts to reduce youth e-cigarette advertising exposure are an important component of comprehensive youth tobacco prevention efforts, according to a 2018 morbidity and mortality weekly report. the dual use of ecs and tobacco cigarettes is rising, and the growing popularity of ecs may promote the use of tobacco cigarettes in adolescents. furthermore, despite ec manufacturer's claims of using marketing campaigns that target adults, not adolescents, ecs have achieved substantial penetration into youth markets worldwide. cardiology in review during 2014–2016 in the us, current users of e-cigarettes and other tobacco products reported higher prevalence of exposure to e-cigarette advertising than non-users. this is consistent with research documenting an association between e-cigarette advertising exposure and e-cigarette use. however, this relationship might not be limited to e-cigarettes; previous research has demonstrated that among us youths aged 12–17