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While Germany is still fairly smoker-friendly compared to the States and other European countries, the government and the trade associations that run the machines have been working to reduce the availability of cigarettes to minors, Kroll said

This approach can be used to authentically engage with populations at greatest risk for tobacco-related disease and ensure their voices and wisdom are prioritized during policy development and implementation

"It's also important to treat any other underlying health issues such as pre-diabetes (when fasting blood sugar levels are 100-125 mg/dL) and high blood pressure," she says

In Michigan, 29.1 percent of high school youths said they used tobacco products, including e-cigarettes, and 10 percent said they smoke cigarettes, according to the CDCs National Youth Risk Behavior Survey