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Article Text Statistics from Altmetric.com 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.35 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.810 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, Footnotes Twitter @mishoo8 Contributors JB conceived the idea to write this manuscript
