Studies look at dangers of e-cigarettes; AAP continues push for regulations

Adolescents who used e-cigarettes were more likely to go on to use marijuana, according to new research.

The study was one of two on e-cigarettes released in Pediatrics today.

The devices have been growing in popularity, but so has the evidence that they pose numerous dangers to youths. The Academy is continuing to push for swift, strict regulations.

Researchers looking at e-cigarette users’ risk of moving on to other drugs analyzed data from the Population Assessment of Tobacco and Health survey, which included 10,364 youths ages 12-17 years who had never used marijuana.

When they followed up a year later, 8.7% of the adolescents had used marijuana. Nearly 27% of those who had used e-cigarettes went on to use marijuana compared to just under 8% of those who had not used e-cigarettes. The link was stronger for those ages 12-14 than 15-17, according to the study “Electronic Cigarettes and Future Marijuana Use: A Longitudinal Study” (Dai H, et al. Pediatrics. April 23, 2018, https://doi.org/10.1542/peds.2017-3787).

Authors said there could be a variety of reasons e-cigarette users were more likely to go to on to use marijuana, including a propensity to take risks, nicotine exposure leading to dependence on other drugs, easy access to marijuana and misconceptions that it is safe.

In the second study, researchers looked at another danger of e-cigarettes — liquid nicotine exposure among young children.

The team analyzed data from the National Poison Data System on children under 6 years and found 8,269 liquid nicotine exposures from January 2012 to April 2017, of which 84% involved children under 3 years old, according to “E-Cigarette and Liquid Nicotine Exposures Among Young Children” (Govindarajan P, et al. Pediatrics. April 23, 2018, https://doi.org/10.1542/peds.2017-3361).

The annual exposure rate spiked 1,400% from 2012-’15, going from 0.7 per 100,000 children to 10.4 per 100,000. It then fell 20% in 2016 to 8.3 per 100,000.

In July 2016, the federal Child Nicotine Poisoning Prevention Act began requiring child-resistant packaging for liquid nicotine. Monthly liquid nicotine exposures dropped 19% in the nine months that followed, according to the study.

On average, each state without its own packaging law saw about 4.4 fewer liquid nicotine exposures during the nine months after the federal law took effect compared to the nine months before.

Researchers could not say for certain how much the federal law impacted the decline. Other factors like state laws and public health campaigns also may have played a role.

Researchers from both studies called for additional policies to protect children and teens from the dangers linked to e-cigarettes. To curb teen use, authors suggested raising the purchase age to 21 and providing additional education about the dangers. To protect young children from liquid nicotine, authors recommended child-resistant devices, flow restrictors, bans on flavors and regulations on the concentration of the liquid.

In 2016, the Food and Drug Administration (FDA) expanded its authority to regulate tobacco products to include e-cigarettes and cigars, raising the purchase age to 18. However, it has since delayed a thorough review of these products. The Academy and other health groups recently filed a lawsuit saying the delay is putting children at risk by allowing the products to stay on the market without adequate information about their impact.

Last week, the Academy and other health groups also sent a letter to the FDA, urging it to immediately address the dramatic rise in adolescent use of JUUL brand e-cigarettes, which resemble a USB flash drive and are easy to hide. They come in fruit flavors that appeal to youths and have high concentrations of nicotine.