The following is a Public Health Advisory from the Wisconsin Department of Health Services (DHS).

This health advisory is being issued by the State Health Officer to inform the public about the alarming statistics on current e-cigarette use among youth in Wisconsin. In Wisconsin, current e-cigarette use among Wisconsin high school students increased 154% between 2014 and 2018. In 2014, just under 8% of Wisconsin high school students were using e-cigarettes. In 2018, that number has skyrocketed to 20% (or one out of every five students[i]).

As Surgeon General Jerome Adams recently described in his Advisory Report, nicotine exposure during adolescence can harm the developing brain, which continues to develop until around age 25,[ii] and can impact learning, memory, and attention.[iii]

The e-cigarette aerosol that users inhale and exhale can expose both the user and those around the user to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deep into the lungs.[iv]

E-cigarettes now take many forms. Some e-cigarettes resemble flash drives, while others are about the size of a credit card. E-juice bottles resemble eye droppers and vape pens come in a variety of colors and resemble pens or lip gloss. E-cigarettes can also be used to deliver other drugs, like marijuana.[v] In 2016, a third of U.S. middle and high school students who had ever used e-cigarettes reported using them for marijuana.[vi]

JUUL, a flash drive look-a-like tobacco product popular with teens, comes in kid-friendly flavors like Mango, Fruit, Creme, and Mint. There are also over 15,500 unique e-cigarette flavors available online.[vii] In Wisconsin, 89% of high school students say they would not try tobacco products that were not flavored.[viii] Even more concerning, the chemicals used to make certain flavors—diacetyl and 2,3-pentanedione—have been shown to cause irreparable lung disease.[ix]

The epidemic use of e-cigarettes is a complicated problem which requires a cooperative effort between partners, organizations, and communities. Many are already working on efforts to combat this crisis, and we now ask for redoubled efforts and increased coordination. We are all in this together. Below are recommended actions that different groups can take to address this issue.


  • Visit to learn about the new tobacco products that are tempting teens into a lifelong addiction. The site also provides tips for talking to your kids about these products and allows you to contact the tobacco-free coalition in your area.
  • Go tobacco-free and set a good example for your kids. You and your kids can get free help to quit by calling 1-800-QUIT NOW (784-8669). If you’re enrolled in Medicaid, talk to your doctor about how the Medicaid Cessation Benefit can help you quit.
  • Make your home and vehicles tobacco-free, including e-cigarettes.


  • Contact the tobacco-free coalition in your area to learn more about the products and the risk they pose. You can find contact information at
  • Develop, implement and enforce comprehensive tobacco-free school policies.
  • Update substance use prevention curriculum to include e-cigarettes and other tobacco products.

Health Professionals

  • Visit www.tobaccoischanging to learn more about e-cigarettes and other tobacco products, and the health harms they pose.
  • Ask about e-cigarettes, including devices like JUUL, when screening patients for tobacco use.
  • Tell patients about the risks of all forms of tobacco use, including e-cigarettes, for young people.
  • Encourage your patients to seek help to quit. Refer them to the Wisconsin Tobacco Quit Line at 1-800-QUIT NOW (784-8669), or if they’re on Medicaid, let them know about the free support provided through the Medicaid Cessation Benefit.

Community and State Leaders

  • Update definitions in local smoke-free workplace ordinances to include e-cigarettes and other nicotine smoking devices.
  • Implement strategies to curb e-cigarette advertising and marketing that appeal to youth.
  • Implement strategies to reduce youth access to flavored tobacco products.


[i] 2018 Wisconsin High School Youth Tobacco Survey

[ii] Office of the Surgeon General. E-cigarette Use among Youth and Young Adults: A Report of the Surgeon General. Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.




[vi] Trivers KF, Phillips E, Gentzke AS, Tynan MA, Neff LJ. Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth. JAMA pediatrics. 2018;172(11):1097-1099.

[vii] Zhu, S-H, et al., “Evolution of Electronic Cigarette Brands from 2013-2014 to 2016-2017: Analysis of Brand Websites,” Journal of Medical Internet Research, 20(3), published online March 12, 2018.

[viii] 2018 Wisconsin High School Youth Tobacco Survey