Numerous health consequences for cigarette smoking have been thoroughly documented. The top negative health causes that have been causally linked to cigarette smoking include cancers of the upper digestive tract, lung cancer, and chronic diseases including diabetes, coronary heart diseases, pneumonia, and overall poorer immune function. While many of these cancers and diseases can develop when an individual is of an older age, changes in one's physical well being contributing to these diseases may begin during adolescence. In a study examining nearly 10,000 males and females ranging in age from ten to eighteen across the United States, adolescents who smoked cigarettes exhibited impaired pulmonary function. Adolescent smokers exhibited delayed growth in lung function, as well as mild airway obstruction. While heart disease and stroke are consequences more commonly seen in adulthood, early signs of these effects can often be found in adolescent smokers. In addition, resting heart rate of young adult smokers is estimated to beat two to three minutes faster than non-young adult smokers. Youth smokers are also less likely to visit a doctor regularly, and suffer from greater shortness of breath and build up phlegm, than non-youth smokers. In addition to physical negative health consequences, adolescent smoking has also been linked to negative psychological consequences. Heavy cigarette smoking throughout adolescence was associated with increased risk of generalized anxiety disorder, panic disorder, and agoraphobia in early adulthood. They are also less likely to visit a mental health care provider for emotional or psychological concerns that may arise. In addition to psychological consequences, adolescent cigarette use has also been linked with subsequent drug use. The Gateway Hypothesis proposes that drug use develops in stages, with early drug use consisting of drugs such as alcohol and tobacco and later dug use consisting of more illicit drug use. Nicotine itself use itself has been shown to be an early ‘gateway’ drug that increases risk for subsequent cocaine use. One popular trend among adolescent cigarette smokers is the recent rise of e-cigarettes. This phenomena is also known as vaping but has many other names as well. In 2020, approximately, 1.3 million of kids in America smoke. For the first time in 2014, e-cigarette use was higher among adolescents than smoking traditional cigarettes. The most common reasons for using e-cigarettes was to experiment, followed by others reporting e-cigarettes taste good and e-cigarettes to aid in quitting smoking conventional cigarettes. Less students associate e-cigarette with serious risk in comparison to smoking conventional cigarettes. In a nationwide examination as part of the National Youth Tobacco Survey 2011 and 2012 cohort, e-cigarette use was associated with a greater likelihood of having a history or currently being an active cigarette smoker.