The landscape of adolescent tobacco use is rapidly changing, with recent declines in combustible cigarette smoking and overall increases in the use of e-cigarettes and other nicotine delivery devices such as shisha. Approximately 40 million U.S. adults smoke cigarettes, and about 4.7 million middle and high school students use at least one tobacco product. In the past few years, electronic nicotine delivery systems (ENDS) have become increasingly popular among youth. It is estimated that ENDS use increased by 78% between 2017 and 2018. Additionally, recent data from the National Youth Tobacco Survey showed that, between 2017 and 2018, the current use of e-cigarettes increased from 11.7% to 20.8% among high school students and from 3.3% to 4.9% among middle school students. Various social and environmental factors can influence ENDS use among youth. Several studies conducted over the last decade have discovered that an acceptable attitude toward nicotine products can increase the use or promote initiation of nicotine products for their users. Most of the young
people might have limited, inadequate, contradictory, or misleading knowledge of nicotine products. Many of them have a positive perception of nicotine products’ properties and effects, which increases the likelihood of a young person for smoking. It is of paramount importance to prevent the initiation and reduce the prevalence of nicotine products use among youth. By assessing knowledge and understanding attitudes of youth towards ENDS, healthcare professionals could predict their smoking behavior, which may facilitate the design of appropriate interventions for promoting initiatives to reduce initiation of use of nicotine products as well as smoking cessation among youth. Various factors influence the use of e-cigarettes among youth including intrapersonal, interpersonal and contextual. Understanding the factors that contribute to use of ENDS among youth is crucial for developing effective prevention strategies and public health interventions.