The E-cigarette Epidemic

A Summary of E-Cigarettes and Similar Devices, an article published in the February 2019 issue of Pediatrics.

By Rayyan Anwer, MD, FAAP

The E-cigarette Epidemic: A Summary of E-Cigarettes and Similar Devices, an article published in the February 2019 issue of Pediatrics.

Several years ago, during the introduction of e-cigarettes to the marketplace, the general appeal was the possible reduction of negative health impacts in relationship to cigarette smoking, the “number one cause of preventable death in the United States, killing 480,000 people every year.” At the same time, e-cigarettes do not contain as many carcinogens as traditional cigarettes, but they still have harmful toxins and carcinogens. It can be so addictive that in a recent meta-analysis, “adolescents and young adults (14–30 years of age) who have used e-cigarettes are 3.6 times more likely to report using traditional cigarettes at follow-up compared with those who had not.”

The most concerning aspect of e-cigarettes is that their use has increased dramatically over the past decade, making them the most common tobacco product used among youth. “According to 2018 data, one in five high school students and one in 20 middle school students use e-cigarettes, a 75% increase from 2017. Increasing overall tobacco use and reversing a decline observed in recent years.” This is especially problematic as “Nicotine is a highly addictive drug that can have lasting damaging effects on adolescent brain development.”

“In early adolescence, executive function and neurocognitive processes in the brain have not fully developed or matured. Adolescents are more likely to engage in experimentation with substances such as cigarettes, and they are also physiologically more vulnerable to addiction.” “The earlier in childhood an individual uses nicotine-containing products, the stronger the addiction and the more difficult it is to quit.” “Furthermore, adolescents perceive that e-cigarettes with flavors are less harmful than those with tobacco flavors, creating a potential misperception that e-cigarettes with flavors do not contain nicotine.”

A point e-cigarette manufacturers exploit is targeting the youth with many enticing candy and fruit flavors and targeted ad campaigns. It is no surprise that in 2016, the “US Surgeon General’s Report on e-cigarette use among youth and young adults concluded that e-cigarettes are unsafe for children and adolescents.” Knowledge, education, and surveillance are key in battling this malignant epidemic. In this regard, much of the above information and some important key points below have been taken from an article published in the February 2019 issue of Pediatrics titled, E-Cigarettes and Similar Devices:

e-cigarettes are “handheld devices that produce an aerosol from a solution typically containing nicotine, flavoring chemicals, and other additives for inhalation through a mouthpiece by the user.
More recent e-cigarette products are more diverse in their design, sometimes resembling common items such as a pen, flashlight, or computer flash drive. (see image)
“Currently, there are no federal quality standards to ensure the accuracy of e-cigarette constituents as advertised or labeled.
“There are often wide discrepancies between the labeled amount and actual nicotine content within the solution. Reported nicotine concentration in e-cigarette solution ranges widely and, depending on how the product is used, can be comparable to or exceed the amount of nicotine in a single conventional cigarette.”
“Refillable cartridges allow the user to deliver other psychoactive substances, including marijuana.”
“Numerous toxicants and carcinogens have been found in e-cigarette solutions, including aldehydes, tobacco-specific nitrosamines, metals, tobacco alkaloids, and polycyclic aromatic hydrocarbons. E-cigarette solution has also been shown to be cytotoxic to human embryonic stem cells.”
“homes, cars, and places where children and adolescents live, learn, play, work, and visit should have comprehensive tobacco-free bans that include e-cigarettes as well as combustible tobacco products.