The dangers of e-cigarettes - and how to protect your kids

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"Smoking cigarettes?"

"No, doc, not smoking."

"How about e-cigs – are you vaping?"

"Yep."

Health care providers – including pediatricians like me who counsel adolescents – have conversations like this more and more often. People often believe that e-cigarettes are a good alternative to regular cigarettes – but are they? Health experts worry about serious downsides of using these devices, especially when it comes to young people.

Electronic cigarettes (also known as "e-cigarettes," "e-cigs," "hookah pens" or "vape pens"), formally called "electronic nicotine delivery systems" or "ENDS," usually have the same shape, size and general appearance as traditional cigarettes. E-cigarettes use a battery to vaporize a nicotine-containing solution, creating an aerosol that's inhaled. The tips of some e-cigarettes have a light that looks like the burning ash of a regular cigarette. Using e-cigarettes is called "vaping."

E-cigarettes don't contain the thousands of other chemicals – many of them cancer-causing – found in regular cigarettes, but they do contain nicotine, the substance responsible for causing addiction to tobacco products, as well as other chemicals, including flavorings.

Why should we be concerned? Because more young people are now using e-cigarettes compared to any other tobacco product, including conventional cigarettes. Recently, the U.S. Centers for Disease Control and Prevention reported that from 2013 and 2014 – just one year – current e-cigarette use among middle school and high school students tripled. Current e-cigarette use (use on at least one day in the past 30 days) among high school students rose from 4.5 percent in 2013 to 13.4 percent in 2014 – that's an increase from approximately 660,000 to 2 million students. Experts worry that e-cigarette use will contribute to a new generation of young people becoming dependent on nicotine.

Nicotine is highly addictive, and addiction to nicotine usually starts early in life – about 90 percent of people who smoke cigarettes start before age 19. About 3 of every 4 teen smokers continue into adulthood. Adolescence is a crucial time for brain development. Research suggests that when nicotine addiction starts in adolescence (rather than at older ages), it's harder to kick the habit. Unless a smoker can quit, this addiction creates a lifetime of tobacco dependence. Tobacco users face higher risks of developing lung cancer and other cancers, heart disease and other debilitating diseases. In the U.S., 480,000 people die from smoking each year – about 1,300 deaths per day – a huge number.

Health care providers are concerned that e-cigarettes are being heavily promoted and marketed, similar to the way that traditional cigarettes were promoted in the past. Companies employ young, attractive celebrities to market e-cigarettes, making them appear glamorous and cool. They are touted as being better smelling, cheaper and a guilt-free way to smoke. Teens may find these products especially appealing because they are available in fruit, candy and dessert flavors, such as "Belgium waffle," "Gummi Bear," cherry, cotton candy and chocolate.

Unlike regular cigarettes (and nicotine replacement products used to help smokers quit), e-cigarettes are not regulated by the U.S. Food and Drug Administration. However, the FDA has expressed "great concern" over the dramatic rise in e-cigarette use among youth and is discussing regulating these products. Currently 44 states, including New York and New Jersey, have prohibited the sale of e-cigarettes to minors.

E-cigarettes can be extremely hazardous to young children. Parents of young children sometimes tell me they're using e-cigarettes when trying to cut down on traditional cigarette use. Most parents don't know that nicotine poisoning can be fatal. Federal law does not yet require liquid nicotine or "e-liquid," which is used to refill the reusable products, to have childproof packaging. Last year, the CDC reported on the rising number of exposures to e-cigarettes called in to Poison Control Centers. Whereas in 2010 there was only one report per month of an adverse e-cigarette effect, there were 215 reports in February 2014. More than half of exposures occurred in young children.

Even one teaspoon of liquid nicotine can be lethal to a child, and smaller amounts can cause severe illness. Because the e-liquid containers vary in size and are not required to be childproof, it's likely that ingestions by small children and deaths will rise. Tragically, in December 2014, a 1-year old boy from Fort Plain, New York, died from ingesting liquid nicotine.

This unanticipated consequence highlights just one of many problems with this relatively new, largely unstudied and unregulated product.

There's also the concern about possible effects of inhaling secondhand e-cigarette vapor. Advertisers often claim that the secondhand aerosol is "harmless water vapor." However, not only does the vapor contain nicotine, but it's also been shown to contain toxins, metals and cancer-causing chemicals. These emissions may be especially harmful to children, whose organ systems are still growing and developing.

More research must be done to fully understand the consequences of smoking e-cigarettes and whether they are really useful to people wanting to quit regular cigarettes. Meanwhile, the American Academy of Pediatrics has called for immediate action to address the child health concerns associated with exposure to e-cigarettes and has called upon the federal government to prohibit the sales and marketing of these products to children under the age of 18.

If you're a parent, how can you protect your children? Make sure to start talking to kids and teens about the powerful effects of nicotine and how it's hard to stop smoking once you start. E-cigarettes may prove to be as addicting as regular cigarettes, so it's just as important to avoid them. You can tell teens they face the possibility of a lifetime of addiction if they start using any nicotine-containing product – whether it's a traditional or an electronic cigarette, or smokeless tobacco products such as chew or Snus.

If you're a parent who smokes tobacco, quitting is one of the best things you can do for your health and the health of your family. You can get help from your own doctor, or by calling, e-mailing or texting your state's quit-smoking site. Talk to your doctor about using FDA-approved quit-smoking products such as the nicotine patch, lozenge or gum available over-the-counter, or other products available with a prescription. I don't recommend using e-cigarettes, but if you're already using them, you should know that scientific research has not yet proven that e-cigarettes are effective in helping people quit.

If you can't quit smoking right now, don't smoke inside your home or car, which helps protect your kids from secondhand tobacco smoke exposure or exposure to secondhand e-vapor.

If you're already using e-cigarettes and are the parent of a young child, it's important that you store any e-liquid well out of children's reach – your child's life may depend on it.

Copyright 2015 U.S. News & World Report

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