WAPC e cigaretteE-cigarette use is growing among teenagers. Vaping is on the rise among high-school students in particular, with rates increasing steadily each year. I still think of e-cigs as the gateway to the gateway drug. In my experience, teens remain confused. They hear about health benefits (harm reduction) in adults and they may think that confers safety. In addition, some teens have reported to me they have heard it will improve their sports and school performance.

Nope. No data to show e-cigs are good for anything in teens, in fact we know nicotine increases HR and BP which in the end could decrease sport skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry with teen use) could have secondary health effects leading athletes to cigarettes which we know won’t improve their talent on the field.

Rates of e-cig use rose from 4.7% in 2011 to 10% in 2012, now a recent Pediatrics study of 1900 high-schoolers in Hawaii shows 29% have tried e-cigarettes. Only 15% of the same group reported trying a cigarette. These e-cigs are getting around.

It’s not just use among teenagers that’s cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their curiosity and lagging judgment and ultimate exposure. The first child death related to exposure of liquid nicotine was reported last week. A child in NY has died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from 1 report in September of 2010 to 215 calls in February of 2014.  This NY death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can’t forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, “The products smell very sweet, akin to a jolly rancher so they’re enticing to a number of different senses in kids. The packaging is very colorful as well.” All these things draw a child to experiment and possibly ingest.

Protecting children from this toxin, I would say, is a true failure of pediatric public health.

The Rise Of E-Cigarettes:

  • It’s a rapid growing industry with $11.7 billion in US in 2013 alone.
  • E-cigs contain cartridges of nicotine with flavoring and added scents. The electronic device burns the nicotine into a vapor and it’s inhaled.
  • “No smoke” supporters believe they may offer a healthier alternative to traditional cigarettes but data remains murky. E-cigs are seen by some as a way to help smokers quit but they make it easier to use nicotine, there’s less social stigma with e-cigs when compared to tobacco cigarettes, only 3 states prohibit indoor use for example.
    • 16 million children live in states where purchase of e-cigarettes is legal
    • Celebrity endorsements, advertising is not currently regulated by FDA
  • New Pediatrics study of >1900 high-schoolers (grade 9, 10) in Hawaii showed:
    • 67% considered e-cigarettes healthier than traditional cigarettes
    • 29% tried them at one point and 18% students reported having used them in the past month while only 15% had tried cigarettes (18% marijuana) at any point!

Dangers of Liquid Nicotine:

  • One year-old New York boy ingested liquid nicotine and passed away on Tuesday, 12/9 from liquid nicotine ingestion and toxic side effects.
  • Nicotine is highly toxic, must be diluted before use in cigarettes
    • Less than a teaspoon can be lethal for child
  • E-cigarette exposure calls to national poison control (see pie chart above)
    • 1 in September 2010, 215 February 2014
    • More than half of calls about children 5 and under
  • In Washington: 2 calls in 2010, 170 in 2014 (as of 12/12)
    • 121 pediatric exposures with toddlers at biggest risk, 82% of calls were for children age 1-3 years.
  • No regulation for packaging (not child-proof)

What Parents Need To Know

  • Recent fatality in NY a wake-up call, until liquid nicotine is better regulated, dispensed in child-proof containers, and controlled nicotine has to be up and out of reach in homes with children.
  • Child Nicotine Poisoning Prevention Act of 2014 — congress must act
  • In all, 40 different states (including Washington) prohibit Electronic Nicotine Devise Systems (ENDS) sale of to minors
    • High visibility to these products remains in media and at school, around the neighborhood and by high profile celebrities.
  • Liquid nicotine is a toxin