The recent increase in e-cigarette usage among middle and high school aged adolescents has become alarming. The profound effect of nicotine on the developing brain and increased likelihood to smoke traditional cigarettes cannot be discounted. The purpose of this study was to understand the factors associated with the initiation of e-cigarette use in adolescents. The MEDLINE database was accessed and the keywords of e-cigarette, adolescents, and risk factors were utilized in the search. The four major themes which emerged repeatedly were: the effect of e-cigarettes on the renormalization of traditional cigarettes, the effect of e-cigarette advertising, perceptions associated with e-cigarette use, and social influence of e-cigarettes