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Candy flavors. Feels cool. Seems harmless. Kills it on Instagram. Easily concealed from parents and teachers. For these reasons and more, electronic cigarettes have exploded in popularity among children and teens in the last few years.

“They honestly don’t think they’re using a nicotine delivery device,” Erika Westling says. Westling leads a study at Oregon Research Institute in Eugene that examines tobacco use among eighth graders in Woodburn and Creswell. E-cigarettes are ubiquitous, but kids told her they call them vape pens or mods.