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- advertising and promotion
- electronic nicotine delivery devices
- low/middle-income country
- non-cigarette tobacco products
Electronic cigarette (e-cigarette) availability and use has increased worldwide since they were first introduced around 2007 and became increasingly popular among youth starting around 2014.1 2 In the USA, Mexico and Guatemala, the prevalence of last 30-day use of e-cigarettes among adolescents is higher than for conventional cigarettes.3–5 In Guatemala, in a sample of 2870 adolescents, 28% were current users of e-cigarettes.3 Experimental evidence suggests that e-cigarettes appeal to adolescents due to their variety of flavours and lower perceived harm than cigarettes.6 7 Furthermore, the e-cigarette market (eg, nicotine content, flavours, voltage, device type) is rapidly evolving making it challenging to regulate.8–10 E-cigarettes are also highly accessible by youth, through friends, e-cigarette shops and the internet and social media.11 12
Guatemala, an upper-middle-income country, …
Contributors JB conceived the idea to write this manuscript. SM wrote the first draft. JM, JT, JB and SM contributed to the revision and edits of this manuscript.
Funding This study was funded by Fogarty International Center of the National Institutes of Health (R01 TW010652).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.