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Pediatricians Call for Raising Smoking Age to 21, Regulation of e-Cigs

Use of tobacco products among young people has declined since the 1970s, but the spreading popularity of electronic cigarettes, or e-cigarettes, is “threatening to addict a new generation to nicotine,” according to a strongly worded, policy statement [1] — released today — from the American Academy of Pediatrics.

Among its recommendations, the AAP urges U.S. health officials to raise the minimum legal age for purchasing any nicotine product, e-cigarettes included, from 18 to 21. The group of pediatricians is also calling for e-cigarettes to be tightly regulated.

“Tobacco use continues to be a major health threat to children, adolescents and adults,” said Karen Wilson, M.D., MPH, FAAP, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children’s Hospital Colorado. “The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health.”

FDA Should Regulate e-Cigarettes, Group Urges

The AAP urges the U.S. Food and Drug Administration (FDA) to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products. This includes age restrictions, taxes, bans on advertising to youth, and bans on flavored products that are particularly attractive to youth.

The FDA has indicated that it is working toward expanding its jurisdiction to include e-cigarettes. Those regulations would require “nicotine exposure warnings” and child-resistant packaging for tobacco products, including the liquid nicotine inserts used to refill e-cigarettes. But the FDA rule-making process can take years, so the AAP is endorsing legislation currently under consideration in both chambers of Congress that would allow immediate action to make liquid nicotine containers child-resistant.

Use of electronic cigarettes by teens and preteens has surged 300 percent in 2014, according to a federal report released earlier this year from the U.S. Centers for Disease Control and Prevention (CDC) and the FDA.

The vapors from e-cigarettes contain about one-tenth of the amount of nicotine found in the secondhand smoke from traditional tobacco products, but that’s enough to constitute a health hazard, says Javier Perez-Fernandez, M.D., a Baptist Health Medical Group physician, who specializes in pulmonary medicine.

“You’re still exposed to a toxic substance,” Dr. Perez says. ”It’s still poison.”

e-Cigs Not a ‘Treatment Product’

The group pediatricians also debunks one school of thought: That e-cigarettes help smokers quit as a transitional product.

“There is no scientific evidence that supports the efficacy or safety of e-cigarettes as a tobacco-dependence treatment product,” the AAP said. “In fact, e-cigarette use among teens is associated with a higher likelihood of using regular tobacco and lower rates of smoking cessation. In 2014, more young adults reported using e-cigarettes than any other tobacco product. Pediatricians should screen and counsel children, adolescents, parents and caregivers for e-cigarette use.

The controversy over e-cigarettes has intensified as companies craft marketing campaigns designed to appeal to teens and pre-teens. Manufacturers have even added candy and tropical fruit flavors to e-cigarettes, according to industry watchdogs and other critics.

“Those flavors can be very compelling to some individuals, including kids,” Dr. Perez cautions.

The AAP is also urging all pediatricians to bolster their counseling of parents and caregivers who smoke about treatment options. Physicians should also provide advice to all children and adolescents on the dangers of tobacco use before they experiment with smoking, the group says.

“Tobacco smoke exposure harms children from conception onward,” the AAP states. “There is no safe level of tobacco or tobacco smoke exposure.”