Pediatricians Group Aims to Vaporize Kids' Access to E-Cigs

Janis C. Kelly

November 03, 2015

The skyrocketing use of e-cigarettes by children and teens in middle and high school has sparked an aggressive push by the American Academy of Pediatrics (AAP) for federal, state, and local crackdowns on the currently unregulated devices, and for tighter restrictions on advertising and marketing for all types of tobacco products.

"We know that 95% of adults who are tobacco-dependent began smoking before age 21, and most before age 18," said Karen Wilson, MD, from the Children's Hospital of Colorado in Aurora and chair of the AAP Section on Tobacco Control.

"If present trends continue, 5.6 million of today's youth will die prematurely of tobacco-related diseases," she said.

The policy statement was released during a press briefing at the AAP 2015 National Conference in Washington, DC, and published in the November issue of Pediatrics.

"There is no safe level of tobacco smoke exposure," Dr Wilson said. The developing brains of children and teens are particularly vulnerable to nicotine and tobacco dependence.

Tobacco is the only consumer product that, when used as intended, causes disease and death. It is also heavily promoted to children and teens through the addition of sweet flavorings and the use of novel electronic nicotine delivery systems.

Electronic Nicotine Delivery Systems

"Electronic nicotine delivery systems have the potential to addict an entire new generation of youth to nicotine and to reverse the progress we have made over 50 years of tobacco control," said Dr Wilson. The devices are attracting youth who might not otherwise have used tobacco products, and research has shown that those who start with electronic devices are more likely to move on to smoking combustible tobacco, she explained (JAMA Pediatr. 2014;168:610-617).

Emissions from electronic nicotine delivery systems are not water vapor, but rather an aerosol suspension of fine particles that can be inhaled by nearby nonusers. These have been found to include polycyclic aromatic hydrocarbons, nicotine, volatile organic compounds, and metal and silicate particles, she reported.

Another policy statement released at the same time addresses the dangers of these systems.

From 2011 to 2014, there was a 650% increase in the use of electronic nicotine delivery systems by middle-school students — from 0.6% to 3.9%, according to the statement. And in high-school students, there was an 890% increase — from 1.5% to 13.4%.

Currently, electronic nicotine delivery systems that do not purport to help with tobacco cessation are not regulated at all, and there are no restrictions on selling them to teens too young to buy cigarettes, Dr Wilson reported. Consequently, they are widely available in vape shops, malls, gas stations, convenience stores, grocery stores, pharmacies, and over the internet.

The AAP is recommending a ban on the sale of such devices to anyone younger than 21 years, and a ban on flavoring agents.

Unregulated vials of concentrated, and often flavored, nicotine solution that are sold for use with electronic devices are dangerous. "There has already been one child death from exposure to nicotine-containing solution," Dr Wilson pointed out.

To address that issue, the policy statement calls for solutions containing nicotine to be dispensed in child-resistant packaging and in containers small enough to ensure that amounts would not be lethal if swallowed by a small child.

It also recommends that any advertising of the devices and solutions that can be viewed by youth be banned, that all internet sales be banned, and that any movie, television show, or video game that depicts an electronic nicotine delivery system have an adult rating.

Proposed FDA Rule

The AAP statements parallel regulations proposed by the US Food and Drug Administration (FDA) Center for Tobacco Products, which would greatly expand the agency's authority to regulate tobacco products and delivery devices.

The proposed rule would cover electronic nicotine delivery systems, cigars, little cigars and cigarillos, dip, chew snus, pipe tobacco, waterpipe tobacco, nicotine gels and dissolvables, e-cigarette cartridges, air and smoke filters, tubes, papers, pouches, and flavorings.

However, the proposal was hit by a storm of objections that included more than 135,000 comments, many from 71 different write-in campaigns objecting to the regulation of "premium" cigars.

The final revised rule was submitted to the Office of Management and Budget on October 19, according to FDA Press Officer Michael Felberbaum.

That office "is required to review all significant regulatory actions and has 90 calendar days to review rules. However, this timeframe can be extended to allow for additional interagency discussion. At this time, the FDA cannot provide any further comment until the final rule is published," Felberbaum told Medscape Medical News.

An AAP clinical practice policy to provide guidance to clinicians on the screening of children's tobacco exposure has also been released. It recommends routine screening for electronic nicotine delivery systems, anticipatory guidance to prevent smoking initiation, counseling for youth and parents about the risks associated with electronic systems, and the treatment of tobacco dependence in parents and caregivers.

Dr Wilson has disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2015 National Conference. Presented October 23, 2015.

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