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“What Flavors Do You Have?” :

April 21, 2020

Rashes in children can often be challenging to diagnose due to myriad reasons.

Cherry, strawberry, vanilla, mint, chocolate, cotton candy. The list of flavors goes on. This would be a common question children would ask at an ice cream store or a candy shop. The scene, however, was vape shop with a 15-year-old asking about different flavors of electronic cigarettes. With the effect of brazen marketing targeted towards youngsters for the first time in years, the use of tobacco products by adolescents increased in 2018. Although the Food and Drug Administration (FDA) has recently published a policy banning production of some flavors of e-cigarettes, it will take time to harness the epidemic of electronic cigarette addiction in young people.

Addiction to electronic cigarettes is a relatively new problem addressed in Dr. Farber’s In Brief article, New Understanding of the Health Hazards of Electronic Cigarettes and Vaping.” In it, Dr. Farber discusses how electronic cigarettes—originally created to help treat nicotine addiction—are more addictive than their traditional combustible counterparts. In 2019, about a quarter of middle and high school students reported that they used electronic cigarettes. Surprisingly, children and adolescents who have never used combustible tobacco may start to use it on a regular basis once they start using e-cigarettes. The author also reports that the World Health Organization (WHO) “does not endorse e-cigarettes as a (tobacco) cessation aid.”

The article describes how the device works, using an atomizer to aerosolize nicotine and other chemicals and creating a toxic vapor that contains products like formaldehyde and other known carcinogens as well as metallic nanoparticles. Dr. Farber states that pod-based systems containing high concentrations of nicotine benzoate are more dangerous and addictive, are most popular, and are being used by almost three quarters of young electronic cigarette users.

Initially several case reports had described serious effects of e-cigarette use, including burns, facial injuries from explosions, acute nicotine poisoning, and a variety of pneumonias. However, the severity of lung damage caused by use of these devices, particularly when being used for tetrahydrocannabinol use, was brought to light by a 2019 CDC report that identified more than two thousand cases of lung injury requiring hospitalization and, in some cases, causing death. Long-term effects on the lungs and a possible relationship with myocardial infarction are also highlighted.  The effects are thought to be related to the chemicals and flavoring agents used in these devices.

Dr. Farber states that it is difficult to treat nicotine dependence in adolescents who are addicted to e-cigarettes.  Withdrawal symptoms can occur, and strategies to treat the addiction may include counseling and behavioral approaches. Medications used to treat tobacco dependence in adults may also be used, but results are not predictable.

Finally, the author recommends that pediatricians can play a part in reducing vaping and its consequences by asking about e-cigarette use by adolescents and their parents at preventive visits, having children commit to never using tobacco or electronic cigarettes, never utilizing electronic cigarettes as tobacco cessation devices, and advocating at a policy level to ban use of electronic cigarettes. 

Let us hope that efforts by pediatricians and the policies of enforcement outline by the FDA will be able to stem the tide of rising nicotine dependency in children and adolescents.

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