New AAP Policy Looks to Combat Rise in Youth E-Cigarette Use

(U.S.) – Despite continued warnings that e-cigarettes are dangerous for youth, they continue to be the most common tobacco product our children are using.

According to studies conducted in 2018, one in five high school students and one in 20 middle school students use e-cigarettes, that’s a 75% increase from 2017. In an article published by the AAP, authors Brian P. Jenssen, M.D., M.S.H.P., FAAP, and Susan C. Walley, M.D., CTTS, FAAP, explain “As a trusted source of health information, pediatricians can educate patients and parents about the harms of these products to prevent youth initiation and guide treatment options for tobacco users.”

In the updated AAP policy statement, E-Cigarettes and Similar Devices, officials announce the latest evidence on the health harms of e-cigarettes.

The 2016 US Surgeon General’s Report on e-cigarette use among youth and young adults concluded that e-cigarettes are unsafe for children and adolescents. Furthermore, strong and consistent evidence finds that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes – a product that kills half of its long-term users. E-cigarette manufacturers target children with enticing candy and fruit flavors and use marketing strategies that have been previously successful with traditional cigarettes to attract youth to these products.

In-depth studies of e-cigarettes show that they encompass a wide variety of devices known as vapes, mods, tanks and pod systems, including popular brands like JUUL. Solutions found in these products contain numerous toxicants and carcinogens. Nicotine, the major psychoactive component of e-cigarette solution, is a highly addictive drug that can damage brain development and has been linked to adverse health outcomes, according to the article by Jenssen and Walley. The increasing use of e-cigarettes among youths threatens five decades of public health gains in deglamorizing, restricting and decreasing the use of tobacco products.

Specifically, the authors note JUUL as being the brand of e-cigarette known as a pod system that is extremely popular with adolescents and young adults and holds 70% of the market share. Jenssen and Walley suggested this may be due in part to the discreet design (i.e., looks like a flash drive0 and sweet flavors. But, parents should realize that the AAP indicates the nicotine concentration in JUUL is higher than other e-cigarette brands, with each pod containing the same amount of nicotine as a pack of cigarettes.

The latest policy report from the AAP notes, nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. To prevent children, adolescents, and young adults from transitioning from e-cigarettes to traditional cigarettes and minimize the potential public health harm from e-cigarette use, there is a critical need for e-cigarette regulation, legislative action, and counter promotion to protect youth.

Jenssen and Walley note “federal laws and regulations have not appropriately restricted the advertising of e-cigarettes to youth. Furthermore, child-friendly flavors are available and marketed to youth.”  It is relevant to also note that in November 2018, the FDA announced steps to protect young people by restricting the availability of some flavored e-cigarettes in certain locations. This was preceded by a warning letter to JUUL and other e-cigarette manufacturers in September 2018 to voluntarily take actions to curb youth appeal.

But, the latest report from the AAP suggests more still needs to be done. The public policy recommendations include:

  • Reduce youth access to e-cigarettes
    • The FDA should act immediately to regulate e-cigarettes like traditional cigarettes to protect public health.
    • Ban the sale of e-cigarettes to individuals younger than 21-years.
    • Ban internet sales of e-cigarettes and e-cigarette solution.
  • Reduce youth demand for e-cigarettes:
    • Ban all flavors, including menthol, in e-cigarettes.
    • Ban all e-cigarette product advertising and promotion that are accessible to children and youths.
    • Tax e-cigarettes at rates comparable to conventional cigarettes.
  • Incorporate e-cigarettes into tobacco-free laws and ordinances where children and adolescents live, learn, pay, work and visit.

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