Electronic Cigarettes: A Rising Concern in Youths

Smoking—and convincing Americans to quit smoking–is a topic of considerable interest to nurse practitioners and physician assistants. Many patients present with acute and chronic disease that could be avoided or much less severe if they did not smoke.

After decades of national campaigns to encourage smoking cessation, a recent National Youth Tobacco Survey indicates that youths are less likely to use traditional cigarettes that one would light with a match. Instead, electronic cigarettes have become their go-to nicotine delivery system.

A researcher from Loyola University in Chicago, Illinois has compiled a review that discusses hazards associated with electronic cigarette use. Published in theAdvanced Emergency Nursing Journal, the article addresses clinicians who work in emergency departments, but has messages germane to all health care providers.

Just short of one quarter of all high school students use tobacco products. The authors reported that 16% of high school students and 5.3% of medical school students currently use electronic cigarettes. Youths who use electronic cigarettes are also more likely to use alcohol, marijuana, illicit drugs, and prescription drugs for nonmedical uses.

Electronic cigarette devices are powered by rechargeable lithium ion batteries that feed a heating element. The heating element vaporizes liquid from a reservoir, sending it to a mouthpiece from which the user inhales. These products come in a vast assortment, with some refillable and others disposable. Youths also refer to them using many different terms including E hookahs, vape pens, tank systems, and many others.

The liquids inside electronic cigarettes generally include propylene glycol, glycerol, water, nicotine, flavoring, and other chemicals. Only recently, the FDA drafted regulations for this industry that will, when implemented, prohibit sale and distribution of electronic cigarettes to youths younger than 18. Once implemented, they also will provide more oversight.

The most critical thing for retail health care providers to know is that youths often perceive that electronic cigarettes are harmless. They are not. They also have a number of characteristics that attract youths, such as lower cost, better smell, convenience, and a smoother taste than traditional cigarettes.

Nicotine, regardless of the source, has well-documented adverse effects. Retail health care providers should counsel electronic cigarette users that the chemicals present in electronic cigarettes are also dangerous. Some users heat electronic cigarettes to very high temperatures, a process called "dripping," to increase nicotine yield. Doing this, however, can create concentrations of formaldehyde, acetate, and acetaldehyde at levels that are higher than those found in regular cigarettes.

The authors reported that electronic cigarettes represent a poisoning concern in very young children. Poison control centers across the country have reported an increasing number of calls related to pediatric exposures to electronic cigarettes. Note that electronic cigarettes are not packaged in child resistant packaging. In addition, these products have been associated with fires, burns, and other injuries.

Retail health care providers can screen all youths and ask specifically about electronic cigarettes when they ask about smoking status. When youths are identified as electronic cigarette users, counseling about associated dangers is prudent. In addition, clinicians should never recommend electronic cigarettes as a smoking cessation aid.

Reference

Simerson D. What the Advanced Practice Nurse in the Emergency Department Needs to Know About the Health Risks and Hazards of Electronic Cigarette Use by Youth.Adv Emerg Nurs J. 2018;40(1):36-44.