College health professionals have worked hard to decrease traditional tobacco use on campuses by implementing policy and providing education and programming aimed at prevention. The progression from occasional to daily smoking almost always occurs by age 26(1), making college environments an excellent place to engage folks in cessation and prevention strategies. However, e-cigarettes pose a new challenge to college health. The 2018 Monitoring the Future Survey(2) shows that e-cigarette use by youth has reached alarming levels. Among 12th graders, students who reported vaping nicotine in the past 30 days increased by 90% (from 11-20.9%), by 96% among 10th graders (8.2-16.1%), and by 74% among 8th graders (3.5-6.1%). This means that many students coming to our campuses will already be engaging in e-cigarette behavior and may have been for several years.