E-Cigarettes, also called personal vaporizers, vape pens, e-cigars, e-hookah, vaping devices, mod systems or pod systems, are products that produce an aerosolized mixture containing flavored liquids and nicotine that is inhaled by the user. E-Cigarettes can resemble traditional tobacco products like cigarettes, cigars, pipes, or common gadgets like flashlights, flash drives, or pens.
These products have grown rapidly, particularly among youth and young adults. Youth use of e-cigarettes is a significant public health concern.
Quick Facts about E-Cigarettes
E-Cigarettes are the most commonly-used tobacco products among youth, and use is rising at an alarming rate. In 2018, 21% of high school students and 5% of middle school students reported having used e-cigarettes in the last 30 days. This represents an increase of 1.5 million youth from 2017-2018.1
Youth who use e-cigarettes are more likely to use cigarettes or other tobacco products.2,6
E-Cigarettes contain a liquid solution that is usually flavored. Flavors, which are appealing to children, can include fruit flavors, candy, coffee, piña colada, peppermint, bubble gum, or chocolate. You can read more about the ways the Tobacco Industry uses flavors to lure kids into using tobacco products in “The Flavor Trap,” a report issued by AAP and four partner organizations.
E-Cigarette solution has chemicals (ie, anti-freeze, diethylene glycol, and carcinogens like nitrosamines).3
E-Cigarette devices mimic conventional cigarette use and help re-normalize smoking behaviors.
E-Cigarettes are not approved for smoking cessation, and the long-term health effects to users and bystanders are still unknown. The chemical compounds in an e-cigarette device can vary between brands.3
E-liquid from e-cigarettes and refill packs can contaminate skin, leading to nicotine poisoning. Symptoms of nicotine poisoning include vomiting, sweating, dizziness, increased heart rate, lethargy, seizures, and difficulty breathing.3
In 2014, poison centers in the US reported 3,783 exposures to e-cigarette devices and nicotine liquid, compared to only 1,543 exposures in 2013. In 2015, 3,073 exposures were reported.4
Some states have enacted legislation to require child-resistant packaging for e-cigarettes and liquids, and a bill to do this at the national level was signed into law by President Obama in early 2016.
E-Cigarette users should always keep e-cigarettes and liquid nicotine locked up and out of the reach of children and follow the specific disposal instructions on the label.5
In 2016, US Surgeon General Vivek Murthy, MD MBA released a report, "E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General." The report concluded that youth should not use e-cigarettes due to the health effects on users and on others exposed to secondhand e-cigarette aerosol.6
E-Cigarette Videos from AAP and FDA
These brief educational videos feature advice from pediatricians about recognizing e-cigarettes, understanding health effects, and intervening with youth who are using these products.
AAP Resources about E-Cigarettes
New AAP E-cigarette Curriculum
This curriculum describes clinical and community strategies to address youth e-cigarette prevention and cessation, based on current evidence and best practices.
Vaping, JUUL and E-Cigarettes Presentation Toolkit
This toolkit contains a powerpoint presentation and related resources about vaping, JUUL, and e-cigarettes. These resources can be used by AAP members and tobacco control advocates for grand rounds or other educational presentations. To obtain an editable version of the powerpoint, please email the Richmond Center.
State-of-the-Art Review Article: A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL
This review article presents a state-of-the-art review of the current data around electronic cigarettes and vaping. The article describes the variety of e-cigarettes currently on the market, provides an overview of health effects, and includes recommendations for protecting youth and families from these products. The article was authored by pediatricians from the AAP Richmond Center and AAP Section on Tobacco Control.
Supporting Youth who are Addicted to Nicotine: Advice for Pediatricians
This factsheet provides information for pediatricians about how to support adolescents who are addicted to nicotine from cigarettes, vaping, or other tobacco products. The content includes tips for screening, counseling, and helping youth with a cessation attempt.
This factsheet is also available in Spanish
Nicotine Replacement Therapy and Adolescent Patients: Information for Pediatricians
This document provides information for pediatricians about how to use nicotine replacement therapy (NRT) to support adolescents who are addicted to nicotine from cigarettes, vaping , or other tobacco products.
JUULing: What Pediatricians and Families Need to Know
Other E-Cigarette Resources
1) Cullen, KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Increase in use of electronic cigarettes and any tobacco product among middle and high school students--United States, 2011-2018, MMWR Morbin Mortal Wkly Rep. 2018;67(45)
2) Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatr. 2014;168(7):610–617pmid:24604023
3) American Academy of Pediatrics Section on Tobacco Control. Policy statement: Electronic Nicotine Delivery Systems.
Pediatrics. 2015; 136(5):1018—1026.
4) American Association of Poison Control Centers. January 31, 2016. Electronic Cigarettes and Liquid Nicotine Data. Accessed February 10, 2016.
5) American Association of Poison Control Centers. E-Cigarette Devices and Liquid Nicotine. Accessed October 16, 2015.
6) US Department of Health and Human Services (2016). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health