By Dr. Susan Walley
By many if not most measures, Alabama is one of the least healthy states in the nation. As a pediatrician, I am particularly concerned about youth tobacco use and secondhand smoke exposure in our state. Pneumonia, bronchiolitis and asthma attacks are the most common illnesses I care for in hospitalized children, and all are caused or worsened by exposure to tobacco smoke.
Tobacco use and secondhand smoke exposure is the number one cause of preventable death and disease. The rates of tobacco use in Alabama are among the highest in the country with 21.1 percent of adults and 17.7 percent of high school students current cigarette smokers. Instead of throwing our hands up in desperation, however, I would like for you to take action to protect the health of children in Alabama.
Tobacco companies spend billions of dollars to encourage children to become “replacement” smokers, replacing those who have died from their tobacco and nicotine addiction. Electronic cigarettes (also known as e-cigarettes or vaping devices) are now the most popular tobacco product being used by young people, even more popular than traditional cigarettes. The explosion in the popularity of e-cigarettes is alarming to health professionals like me who worry that decades of progress fighting tobacco and nicotine addiction in youth could go up, literally, in vapor.
One of the most concerning issues around electronic cigarettes is the current lack of regulation and information of the devices and the e-cigarette liquid itself. This liquid is typically advertised to contain concentrated nicotine, flavorings and vegetable glycerin or propylene glycol. Electronic cigarette liquid comes in many flavors that appeal to youth, such as “gummy bear,” “sour Skittles” and “strawberry daiquiri.” The e-cigarette aerosolizes the liquid into the “vapor” that is inhaled. There are no product standards, however, that regulate what is advertised is what the product contains. The same toxicants and cancer-causing chemicals in traditional cigarettes have been found in e-cigarette liquid. There is scientific evidence that use of e-cigarettes has negative health effects on the respiratory, cardiovascular and immunologic systems. Although the Food and Drug Administration deemed authority to regulate e-cigarettes in the spring of 2016, these regulations may not go into effect for years due to legal challenges from the tobacco industry.
For youth in particular, a major concern about tobacco product and electronic cigarette use has to do with the developing brain. We know children’s brains are particularly susceptible to the addictive potential of nicotine, the substance in tobacco products that causes addiction. This means adolescents can become addicted even with experimentation or occasional use of nicotine. There is also growing evidence that youth that use e-cigarettes are more likely to go on to use traditional cigarettes. Nicotine can act as a “gateway” drug to other drugs, including cocaine. Thus, it is extremely dangerous for our adolescents to experiment or use any tobacco product, including e-cigarettes.
Electronic cigarettes also pose health risks to children due to accidental exposures. A study recently published in the journal Pediatrics found that reports of e-cigarette accidental exposures to Poison Control Centers increased 1,500 percent between January 2012 and April 2015. Every three hours, a poison control center in this country receives a call about a child exposed to nicotine-containing e-cigarette liquid. At Children’s of Alabama, our Regional Poison Control Center has seen an increase from just two calls in 2012 to 95 calls in 2015. Tragically, one child in the United States has already died from ingesting a nicotine containing e-cigarette liquid.
Last but not least, another health risk for our children is the “vapor” produced by e-cigarettes. The vapor from e-cigarettes can be breathed in by anybody nearby, like cigarette smoke. It is not harmless water vapor as is often claimed. In addition to nicotine, this vapor has been shown to contain aldehydes, tobacco-specific nitrosamines, metals, tobacco alkaloids and polycyclic aromatic hydrocarbons. Secondhand smoke exposure is known to cause many diseases in children and adults. One of the most effective ways to decrease secondhand smoke and secondhand vapor exposure is to pass comprehensive smoke-free policies that include electronic cigarettes.
We are making some headway. Recently, The Wall Street Journal reported that e-cigarette sales started slowing last year, after five years of triple-digit growth. But there’s more to do. The American Academy of Pediatrics recently published a policy statement on e-cigarettes. The recommendations for public policy changes included:
Protect children, youth and adults from exposure to secondhand smoke and vapor by passing comprehensive smoke-free policies, which include electronic cigarettes. This should include all public spaces where children are cared for, learn, work and play.
► Ban sales of all tobacco products, including e-cigarettes, to young people under 21 years old
► Ban sales of e-cigarettes and the e-cigarette liquid over the Internet
► Ban flavors in e-cigarettes
► Ban advertising of e-cigarettes that can reach young people
► Restrict depictions of e-cigarettes in the media and games aimed at youth
As always, parents have the toughest job. They must educate their children on the hazards of tobacco products, including e-cigarettes, and take a strong stance not to use tobacco products. That starts with awareness. Think about it, talk about it and pass the information on to others.
Walley is a Vestavia Hills resident and associate professor of pediatrics at the University of Alabama at Birmingham (UAB) and a pediatric hospital medicine physician at Children’s of Alabama.
