by Katherine Roberts, MD
E-cigarettes, also called Electronic Nicotine Delivery Systems (or ENDS), are battery-powered devices that warm and vaporize a flavored nicotine-containing solution, or “e-juice”. With increasing popularity among youth, the “vaping” culture has spread into pop culture and marketing with a fury. TV and social media ads carrying the face of glamorized models proudly proclaim that e-cigarettes are the healthy alternative to traditional cigarette smoking and are the new wave in helping smokers to quit.
So what’s the big deal? A healthy way to help smokers quit? How can it be bad, right?
As a pediatrician, I have watched this growing trend with trepidation about how this “safe” new drug will affect our youth. I now have added e-cigs to the list of recreational drug use I ask teens about during their well visits, and too often I hear, “I don’t smoke, just e-cigs sometimes”. I sigh, then the teen education begins.
So here you go- the facts. What we know, what we don’t know, and my suggestions for navigating this yet uncharted and unregulated territory driven by the tobacco industry.
First, a few key points, which I will explain below:
- Nicotine is a tobacco product
- E-cigarettes are not federally regulated
- E-liquid, or e-juice, is not safe. Liquid nicotine is not safe, and the chemicals in the e-juice are not safe.
- There is no solid evidence that e-cigs help smokers to stop smoking, and there is growing evidence that they reduce the likelihood to quit.
- Middle and high school student use of e-cigs is skyrocketing, tripling from 2011 to 2013.
What is in e-juice and is it safe?
E-juice is a mix of a preservative called humectant, flavoring, and nicotine. There are some e-liquids that do not contain nicotine. As e-cigarettes are unregulated, the chemicals in the humectant vary greatly between products, making it hard to study the safety of each product. Most of the chemicals are generally thought to be safe when ingested in small amounts, but when smoked can irritate the respiratory system causing chronic lung diseases and may lead to cancer, both to the vaper and those nearby inhaling the vape secondhand.
Now on to nicotine. First of all, nicotine is a tobacco product. I have seen it stated otherwise in pro-vaping marketing. Nicotine comes from the tobacco plant – it is a tobacco product. Enough said. And it is not safe. Nicotine in any form is highly addictive and causes lung and brain cell damage from a developing infant through adolescence. And liquid nicotine is a highly concentrated form of nicotine that is highly toxic when ingested or absorbed through the skin, causing nausea, vomiting, elevated blood pressure, rapid heart rate, dizziness, seizures, and death. This occurs thousands of times every year whether you are the unfortunate toddler who licks or drinks the sweet-smelling fruity flavored e-juice in easy-to-open packaging (we will get to that in a moment), or you are the teen pouring your e-liquid of choice into your e-cig device and spill some on your skin. In 2014, there were 4,000 harmful accidents from liquid nicotine called into Poison Control. Tragically, this December 2014, an 18-month-old boy in New York drank his mom’s e-juice while she was in the room with him and was turning on his favorite TV show. He immediately had a seizure, became unconscious, and died.
Lastly, as for the flavoring, its safety is unknown. But what we do know is that enticing flavors like Pina Colada, Razzwow, and Captain Crunch are a lure for teens and toddlers alike. It is important to note here that fruit and candy flavors have been banned in traditional cigarettes for many years. So essentially we have a highly toxic and addictive substance that has sweet and tempting flavors to the most vulnerable population: our children.
Package Safety – Keeping our Toddlers Safe
This is a key point. There is NO federal regulation on childproof packaging for e-liquids. You know that bleach you have been warned about keeping away from kids? It would take a lot more bleach than the 1 teaspoon it takes for nicotine to be lethal to a toddler, and yet between the two liquids only bleach is required to have childproof packaging.
Think about this: 80% of tobacco users start using before 18 years of age. So if you are a tobacco company who sells e-cigarettes and you have no regulations on your product or marketing, wouldn’t you target as many youth as you could before the big, bad government stepped in to protect children’s health? That is exactly what they are doing. For the first time in over 40 years, tobacco products are being advertised on TV, and once again they are the new wave of cool and glamorous. Not only do these ads of fashionable actors puffing clouds of vape make e-cigs look cool, they normalize smoking behavior as they mimic conventional cigarette use. This isn’t just speculation – it is happening now and fast. Middle and high school use tripled in one year from 2013 to 2014. Tripled! Can you imagine what that number will look like in one more year?
What about helping smokers who want to quit?
This is the vaping community’s key argument, that e-cigarettes can help smokers quit smoking, and we shouldn’t regulate away their one big chance for success. First of all, no one wants to stop smokers from quitting, lastly doctors. I am that nagging pediatrician that asks at every visit if a parent or parents are moving forward to stop smoking when I know my patient’s parents smoke. Second, all of the proposed regulations state or nationwide do not inhibit any adult who wants to use e-cigarettes. The regulations are to protect children, whether it is accidental toddler ingestions or a curious 12-year-old trying to look cool in front of her peers and who will become a lifelong customer of the tobacco industry. Lastly, there is no solid evidence that e-cigarettes help smokers to quit, while there is significant growing evidence that e-cigarettes decrease their likelihood to quit.
What are the federal regulations on e-cigarettes?
There are none. Seriously. There are no regulations on child-proof packaging, where e-cigs can be used in public places, sales to minors, and how and where they are marketed. I could bore you with the legislative details of the FDA’s glacial speed of e-cigarette regulation which the tobacco companies have attempted to block. But instead I will tell you that the American Academy of Pediatrics is working at both the state and federal levels to get e-cigarette regulation out there as quickly as possible.
Here are the four main goals outlined by the American Academy of Pediatrics regarding e-cigarettes:
- Require child-proof packaging on e-liquids
- No sales to minors under 18 years of age
- Ban flavors
- Extend “smoke-free environments” in public places to include e-cigarettes (that is, if you can’t smoke cigarettes there, you can’t smoke e-cigarettes there either)
Recommendations for Parents
If you or someone you know uses e-cigarettes (such as your friends or other caregivers for your child/children), here are some tips to keep in mind regarding e-cigarettes:
- Keep out of reach of children and dispose of properly
- Fill and use away from children, and protect your skin when handling
- Call Poison Control immediately if exposure to skin or mouth occur (1-800-222-1222)
- If your children are pre-teens or teens, talk with them about what they know about e-cigarettes and help educate them about the dangers of use and exposure. The earlier you talk to them, the more positive influence you can have on shaping their view of e-cigs before media does.
If you smoke traditional cigarettes…
Lastly, as I often tell my patients’ parents who smoke, what you may not be able to do for your own health, you may be able to do for your children’s health. There are treatments to help you quit and help reduce your nicotine cravings. 1-800-NO-BUTTS may sound cliché, but it is a great place to start. Also talk to your primary care doctor about medications that can help, such as Chantix which has shown significant benefit in reducing cravings. Whether it is your first or fifth attempt to quit, you can make it your last and be successful.
The contents of this web site are provided as an informational tool. This is not intended to replace medical advice or care administered by a healthcare professional. Common sense should always be used when referencing this site. If, at any time, you feel your child is experiencing a medical emergency, call 911 immediately.