By Ben Rossavik, DO, PGY2 Pediatrics Resident at OSU Pediatrics
The American Academy of Pediatrics (AAP) has already called electronic cigarettes – or e-cigarettes – a public health crisis. Many of us have seen or heard of e-cigarettes. They’re much more than those annoying, brightly colored, smoking pens that have likely at some point annoyed you at the grocery store or ruined a movie experience in theaters. Sometimes called JUULs, “vapes,” “vape pens,” electronics nicotine delivery systems (ENDS), etc., e-cigarettes are now the most commonly used tobacco product among kids, despite having been around for only about a decade now. There are calls for increased FDA scrutiny and oversight against the companies making these products, as we’re facing what many are calling an epidemic against our nation’s young people. Several years ago, in 2014, the NY Times even highlighted in an article, “Where Vapor Comes Sweeping Down the Plain,” how Tulsa and Oklahoma became one of the early vaping hubs in the industry due to our already high concentration of smokers and early boom of stores. Given the sheer volume of tobacco product users in this state, it takes little imagination to understand how easy it is for our children to get their hands on these products. It’s important to engage in discussion with our patients and families to do our best to mitigate potentially life threatening consequences directly linked to e-cigarettes.
Electronic cigarettes (e-cigarettes) heat a liquid into an aerosol that the user inhales. These liquids have various flavorings and additives, which include nicotine – one of the many dangerous ingredients. They are considered tobacco products because of the presence of nicotine – a derivative of tobacco. Despite there being obvious age restrictions on tobacco, it wasn’t until August 8th, 2016 that it became illegal to sell e-cigarettes to people younger than 18.
Since then, the FDA has issued thousands of letters and warnings to retailers and manufacturers about these products, including their largest coordinated enforcement effort in the agency’s history to combat the rise of a dangerous product in the hands of children. Manufacturers are facing more and more scrutiny, but we need to do our part as providers to talk about these risks with our patients and families. We can start with telling them just why these products are dangerous.
Aside from the dangers of nicotine and these smoking behaviors, potentially harmful ingredients include ultrafine particles that can be embedded in lung tissue, flavorants such as diacetyl which are directly linked to lung disease, volatile organic compounds, and heavy metals – which include, but are not limited to, nickel, tin and lead. Many kids are getting their hands on these products, which is why it should be our top priority to prevent this by education and increasing our own awareness of these products and business practices in our communities. Young people across the nation are already experiencing the damages of these products. There are multiple cases of teens having already been hospitalized in general inpatient and critical care settings for lung injury linked to e-cigarettes. We are talking about children and young people in intensive care units, sedated, paralyzed and requiring ventilator support for respiratory failure, with deaths already being reported.
The vaping industry obviously denies that their products are targeted to children, but that doesn’t stop what’s happening. With flavors like bubble gum, pineapple, French toast, shapes like juice boxes, and aggressive marketing where users still live with their parents, there’s plenty of evidence to suggest that these companies’ products appeal to kids. There is even wearable clothing that conceals smoking systems for e-cigarettes in the strings of hoodies, for example. There’s also the risks of second-hand exposure which we’re only starting to realize – one-quarter of US youth were exposed to second hand e-cigarette aerosols between 2015 and 2017, a new study by JAMA reveals. State leaders in other US states are already taking legal action against these companies. North Carolina Attorney General Josh Stein recently announced he will be filing lawsuits against multiple e-cigarette companies in his state under the North Carolina Unfair or Deceptive Trade Practices Act. He alleges companies are aggressively targeting children and do not require appropriate age verification when selling these products.
As healthcare providers to children, it is imperative we continue to remain vigilant of health and lifestyle practices of our nation’s youth and address these risks in patient encounters, especially in well child checks. We can do this in our own practices or by taking a step further by reaching out to our local government agencies and supporting FDA and NIH research into this growing public health crisis.
Dr. Ben Rossavik is a member of the American Academy of Pediatrics and local state chapter Resident Liaison and Committee Champion for Pediatric Emergency Care. He is currently a 2nd year resident at Oklahoma State University’s Pediatrics residency program in Tulsa, OK, funded by the Osteopathic Medical Education Consortium of Oklahoma (OMECO).
Resources:
AAP State of the Art Review Article:
https://pediatrics.aappublications.org/content/143/6/e20182741
NY Times Article commenting on early market in OK:
https://www.nytimes.com/2014/04/27/business/e-cigarettes-take-hold-in-oklahoma.html
Surgeon general’s warning and information on e-cigs:
https://e-cigarettes.surgeongeneral.gov
https://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html
FDA regulation on e-cig’s:
https://www.fda.gov/news-events/fda-voices-perspectives-fda-leadership-and-experts/how-fda-regulating-e-cigarettes
How the FDA is putting together research on e-cigs:
https://www.fda.gov/news-events/fda-brief/fda-brief-national-academies-sciences-engineering-and-medicine-releases-fda-commissioned-report
Pediatric lung injury cases already being reported in local media outlets:
https://wqad.com/2019/07/29/8-wisconsin-teens-hospitalized-with-seriously-damaged-lungs-after-vaping-officials-say/
NC Attorney General to file suit against e-cig firms:
https://www.npr.org/2019/08/28/754962656/north-carolina-to-file-suit-against-8-firms-that-sell-vaping-products
JAMA article on prevalence of exposure to e-cigarettes in middle and high school students:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749049