Editor’s Note: Dr. Elif Ozdogan (she/her) is a second-year resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research and hopes to pursue further training in Transplant Medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Screening for tobacco and nicotine use constitutes an integral component of our HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) assessment during well visits with adolescents and young adults (AYAs). Upon hearing a tentative “Yes” response for any of these categories, we delve deeper into the specifics.
For our patients who use e-cigarettes, one pertinent factor that we should ask about is whether the device is disposable or not.
In an article being early released in Pediatrics this week entitled, “Disposable E-cigarette Use and Subsequent Usage Patterns in Adolescents and Young Adults,” by Dae-Hee Han, PhD, and colleagues from University of Southern California, University of Rhode Island, and University of Pennsylvania, the patterns of use for disposable e-cigarettes (as opposed to non-disposable forms) among AYAs is explored (10.1542/peds.2023-063430).
The authors combine survey data from two longitudinal high school cohorts in Southern California—Happiness & Health and the ADVANCE Study—and analyze the e-cigarette usage patterns in approximately 400 participants who reported use in the past 30 days.
The authors find that, compared with teens who used non-disposable or rechargeable e-cigarettes, those who used disposable forms of e-cigarettes (such as Puff bar, Elf bar, or Plum):
- Had almost double the likelihood of continued e-cigarette use at 8 months
- Were more likely to use more e-cigarettes per day
- Had a lower likelihood of cutting back on e-cigarettes.
While the surveys do not ask about reasons for using e-cigarettes, the authors suggest that sweet flavors and colorful appearances of disposable products make them more palatable and socially acceptable. In fact, in 2020, the FDA banned flavored non-disposable e-cigarettes, and this resulted in shifting sales toward flavored disposable products.
Disposable e-cigarettes are also cheaper and more convenient, because they don’t have to be recharged or refilled.
In the accompanying commentary entitled “Suggestions to Avoid Perpetuating Tobacco Industry Reduced-Harm Marketing Tropes,” Robert Jackler, MD, and Bonnie Halpern-Felsher, PhD, from Stanford University also suggest that the language used in advertisements also plays a role (10.1542/peds.2023-064501). Jackler and Halpern-Felsher advocate that the term “nicotine” be required in marketing and labeling to counter the innocuous connotations of “smoke-free,” “heat-not-burn,” and clean “vaping.”
I particularly appreciate this commentary as it serves as a reminder of how the language we use, often without much consideration, can influence the youth's continuation or cessation of the use of any harmful substances.
Colorful and sweet-flavored e-cigarettes, coupled with innocent language, subtly shift the common perception of these products. The result may be prolonged and more intense use in adolescents and young adults.
Ultimately, safeguarding the health of our young individuals will require further research, labeling requirements, and large-scale policy changes to fight against these powerful industries. Until then, I am newly motivated to talk with my patients about nicotine use and to confront both the attractive physical characteristics and misperceptions about safety of these products.
For those wanting to learn more, I highly recommend that you read both the article and the commentary.
