E-Cigarette Use in Adolescents and Teens: A public health threat

The U.S. Surgeon General, the leading voice in U.S. public health, released a report last week addressing the current public health threat of electronic cigarette use in adolescents and teens. This report is a public education report to teach health care providers, parents and patients about the dangers of e-cigarettes and to dispel the misinformation already present. This is another great step forward for those concerned adolescent and teen use of e-cigarettes in a year that has already shown great strides for promoting safety and health in this age group.

This year has brought welcome changes to the e-cigarette market, which includes e-cigars, vape pens, e-hooka. Prior to May 2016, there was no regulation of any electronic nicotine delivery systems. There were almost 500 brands and more than 7500 distinct flavors, with no regulation for production standards. The use of e-cigarettes in high school students has risen at an alarming rate — from 1.5% to 16% in the last 4 years. The FDA’s Deeming regulations, launched in May 2016, banned the sale of e-cigarettes to anyone younger than 18 years old and required all products that were put on the market after 2007 to undergo FDA approval within the next two years. Experts viewed the Deeming regulations as a huge victory for pediatric health advocates. However, putting an age restriction on substances does not solve the problem. Adolescents will continue to find ways to access them, so education is essential. This is where the Surgeon General’s report will have its biggest effect.

The report may help influence adolescents and teens who can still get e-cigarettes even with the sales ban in place. It also provides education on the reasoning behind the FDA Deeming Regulations. The risks discussed in the report include the following.

The addictive nature of nicotine and its effects on the brain

The human brain is not fully developed until 25 years of age — which explains many of our decisions as teenagers and college students. While the brain is still developing, there are more synapses, or connections between cells, being developed than in adult brains. Addiction to a substance is a type of learning, and the developing brain of adolescents of teens can learn the “behavior” of addiction more rapidly than an adult brain. This leads to earlier and more deep-rooted addiction.

The harmful effects of ingredients within e-cigarettes

One of the main arguments used by advocates of e-cigarettes is that the vapor inhaled with e-cigarettes is a harmless water vapor, but the word harmless is misleading. Some flavorings include the chemical diacetyl, which has been linked to cases of bronchiolitis. There have also been links between several other components of e-cigarettes and cell death; while users of e-cigarettes may be decreasing a person’s exposure to the harmful components of tobacco smoke, there are still risks to e-cigarette smoking that are quite dangerous.

The dangers of multiple smoking exposures (e-cigarettes and tobacco cigarettes)

The argument most often used in defense of e-cigarettes is that they help those who smoke tobacco cigarettes stop smoking by weaning themselves off of nicotine. There are smokers who have been able to stop completely by using e-cigarettes, but studies have not shown that the use of e-cigarettes is a reliable smoking cessation tool. In adolescents, recent studies have shown that up to 40 percent of teenage e-cigarette users have never smoked tobacco cigarettes. The current concern is that e-cigarettes themselves can act as a “gateway” to tobacco cigarettes. According to the Surgeon General report, nearly three out of five adolescent smokers are also e-cigarette users as well.

The information put forward in this report will hopefully serve as education to those who provide care to the patients, their caregivers who are concerned with their children’s health and adolescents who may be thinking of trying e-cigarettes. More research is needed to fully understand the long-term side effects of these devices, which will be forthcoming with increasing FDA regulations over these devices.

A summary of the e-cigarette report and full e-cigarette report can be found on the Surgeon General's website.

Refrences 1. Zhu SH, Sun JY, Bonnevie E, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23 Suppl 3:iii3-9.

2. 1. Singh T, Arrazola RA, Corey CG, et al. Tobacco Use Among Middle and High School Students--United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367.