One of the biggest public health successes of the past half century has been the decrease in cigarette smoking, particularly among new, teen smokers. Cigarette smoking peaked in the 1980s, when more than 600 billion cigarettes were consumed in the U.S. annually, an amount that has since been cut in half. Today, less than 20 percent of teens report smoking cigarettes. The progress is largely due to public understanding of the risks of smoking and effective interventions, including media campaigns, cessation aids, purchasing and advertising restrictions, and cigarette taxes.
Yet, teens are under threat of the most addictive ingredient in tobacco — nicotine. New users are being introduced daily. Nicotine is now being sold in colorful containers, disguised with delicious flavors in the form of e-cigarettes, and adolescent use is climbing exponentially.
Nicotine, the main active ingredient of e-cigarettes (or regular cigarettes), is addictive and psychoactive. In addition to nicotine, electronic cigarettes contain an aerosol, various additives and flavorings. Though some users mistakenly believe they are inhaling (and exhaling) harmless water vapor, this is not necessarily so. The ingredients vary, are not well reported or researched, and quality regulation is minimal. Studies have begun to suggest that the user, or “vaper,” and people exposed second-hand are breathing lung irritants, particulate matter, heavy metals, even carcinogens and teratogens, which are chemicals that can harm the unborn.
We don’t fully understand yet exactly how dangerous these chemicals are to either the user or people around the vaper. We certainly don’t understand the impact for young children, nor for users and those exposed for many years, such as those who will become addicted to the nicotine. The chemicals that irritate the lungs can be dangerous for anyone, but could be far more damaging for those with lung diseases, such as asthma.
The combination of what’s not known, what is potentially detrimental and what is very addictive to the adolescent brain is concerning for teens — now and into their future. The appeal, however, is strong. Vaping shops and advertisements abound, with tastes for all palates, including the very young. E-cigarettes come in a rainbow of bright, colorful packages with flavors such as Cotton Candy, Sweet Tart, Gummy Bears and Vanilla Cupcake. For the more advanced adolescent, there are sophisticated, mature-themed advertisements to catch their attention.
Studies have shown that seven in 10 middle school and high school students have noted an e-cigarette advertisement. The marketing seems to be working; high school use tripled over the past year.
Toddlers are also at significant risk, though of a different sort. Two young children have died from ingesting just a small amount of the e-cigarette liquid. It is concentrated and highly toxic. It can cause seizures in a matter of seconds, and not just if they get it in their mouths, but also from skin contact.
E-cigarettes are a small pen-like device with a rechargeable battery and a reservoir for the nicotine-containing liquid. That reservoir can be refilled. The containers for the nicotine liquid are often colorful, and there is no law that requires child-proof packaging. There should be. Children pick up those containers, as they pick up everything.
Children also put everything in their mouths. That’s normal. That is how those two babies died. Containers that don’t look like candy, have child-resistant packaging and don’t contain enough nicotine to give a lethal dose could save future lives. Of course, the same colorful packages appeal to pre-teens and teenagers, who may leave them around the house where a younger sibling or cousin can spill the contents on their skin or drink it and have a seizure, or worse.
Finally, there are documented reports of e-cigarette lithium batteries exploding, causing fires and tissue damage during use or re-charging. Some cases have resulted in significant injury and hospitalization. E-cigarette batteries are stronger than other commonly used electronics, such as those in laptops and cell phones. Currently, there is no regulation or law applying safety standards to these batteries.
When it comes to e-cigarettes, where there is smoke — or vapor — there may be toxins, lung inflammation, addiction, second-hand exposure, ingestion or skin contact with a fatal dose of poison by a young child. Given these concerns, at UHealth – the University of Miami Health System, it is our policy not to permit use of e-cigarettes, any tobacco-derived or nicotine delivery system product on our campus for health reasons. Parents may want to discuss the same with their pediatrician and their children.
Judy Schaechter, M.D., is Chair of the Department of Pediatrics at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.