AAP Voices Blog

Cotton candy. Gummy bear. Chocolate. Flavors like these are what first tempted 16-year-old Tyra Nicolay to try e-cigarettes. As she explained at a press conference this month to announce the U.S. Surgeon General's report on e-cigarettes, the New Mexico teenager assumed e-cigarettes emitted tasty but harmless water vapor.

Tyra, who has stopped using e-cigarettes and has become a tobacco control advocate, was not alone in her attraction to e-cigarettes. Use of the battery-operated devices, also known as vape pens, increased by 900 percent among high school students between 2011 to 2015, according to the report, E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.

​I had the opportunity to join Surgeon General Vice Admiral Vivek Murthy, MD, MBA, at the press conference, emphasizing the importance of the report for the public health community and pediatricians' role in educating and protecting patients from the harms of e-cigarettes. I've also spoken with several local and national news outlets about why these findings are so important for our youngest citizens.

​"Nicotine—regardless of its source—is highly addictive and has clear neurotoxic effects, especially on the developing brains of adolescents."​​

I was moved by Tyra's story and could not help but think about the other children and teenagers across the country who might have a similar one. With all of the progress we have made in decreasing smoking rates, e-cigarettes have posed a new challenge – and one that we must address in order to prevent other young people like Tyra from falling victim to what they may believe to be a harmless product but actually exposes them to harmful and addictive chemicals.

The Surgeon General's report represents not only a comprehensive resource detailing the health effects of e-cigarettes, but also a call to action for all physicians – our country's strongest advocates for the health of children and adults. On the heels of the report release, the Academy joined with its fellow physicians from the American Academy of Family Physicians, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, and the American Medical Association, representing a total of 630,000 physicians across the country, reasserting our dedication to keeping our patients safe from tobacco products.

Nicotine—regardless of its source—is highly addictive and has clear neurotoxic effects, especially on the developing brains of adolescents. Doctors—especially those of us who treat children and adolescents—must be vigilant and proactive in explaining the harms of all tobacco products to our patients.

As referenced in the Surgeon General's report, e-cigarette use has grown exponentially, fueled in part by extensive marketing campaigns to make the products more appealing to young people. E-cigarettes have quickly surpassed cigarettes as the most common tobacco product used by youth: 16 percent of high school students have reported using an e-cigarette in the last month. This has raised alarm among pediatricians and has the potential to addict the next generation to nicotine.

In fact, in 2015 the Academy issued a policy statement recommending that pediatricians regularly screen our patients for e-cigarette and other tobacco product use, counsel them about risks and urge them to quit. A new AAP technical report​ published Dec. 19 provides additional information and resources to equip pediatricians for these conversations.

​"The aerosol from e-cigarettes is not harmless; it includes nicotine and other harmful and potentially harmful chemicals, including heavy metals and carcinogens."​​

Having these discussions with our patients has never been more important than it is now. Liquid nicotine used in e-cigarettes comes in more than 8,000 different flavors, many of which are appealing to children. The aerosol from e-cigarettes is not harmless; it includes nicotine and other harmful and potentially harmful chemicals, including heavy metals and carcinogens. Since children's brains and lungs are still developing, it is especially important to protect children and non-users from secondhand e-cigarette aerosol.

​The conversation should include the poisoning hazards associated with these products. Liquid nicotine is highly potent and extremely toxic. If a child accidentally comes into contact with liquid nicotine, it can result in a trip to the emergency room and has even resulted in the death of a toddler. Child-resistant packaging and adequate labels can both help address this risk. Both the Surgeon General's report and the AAP recommend children live in homes free from tobacco products of any kind.

I would encourage you to visit this website to learn more about the report. The AAP Julius B. Richmond Center of Excellence also has information about electronic nicotine delivery systems, as well as resources for physicians, including a fact sheet on the Surgeon General announcement, and resources for parents.

As pediatricians, parents and those who care about children, we all have a role to play in keeping our youngest generations safe from e-cigarettes and free from addiction.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.