The Medical Minute: Electronic cigarette use rising among teenagers

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Use of electronic cigarettes — or e-cigs, for short — has increased among adolescents, but the jury is still out on how many young people are becoming addicted, and how harmful they are for both young people and adults, relative to cigarettes.

Jonathan Foulds, professor of public health sciences at the Penn State College of Medicine, says use of e-cigs among young people is escalating — as public health professionals continue to explore how dangerous it is.

“Thirteen percent of American high school students have tried an e-cig in the past 30 days, but the proportion using them most days is quite small,” Foulds said. “Of those who’ve tried an e-cig in the past month, 45 percent only used it on one or two days in the month and only 16 percent used on 20 or more out of the past 30 days. This means that around 2 percent of high school students are daily e-cig users.”

On one hand, current opinion is that e-cigs do much less damage than smoked cigarettes, the use of which has decreased to about 9 percent among adolescents, according to recent studies. However, that does not mean e-cigs are harmless. The nicotine itself is harmful to the unborn fetus when absorbed during pregnancy, and a recent study in Hong Kong found an association between adolescent e-cig use and respiratory symptoms.

Although the nicotine can still create or feed an addiction, there is great variability in the types and use of e-cigarettes. Foulds said among adolescents who use e-cigs, some studies have found that more than 40 percent say they use e-cig liquid that does not contain nicotine. “Many say they just tried it once or twice to see what it was like,” he said. “It’s not as simple as assuming that every teen who has tried an e-cigarette is going to end up becoming addicted.”

On the other hand, although many adults use e-cigs as a less harmful alternative to regular cigarettes or as a vehicle to help them quit their tobacco habit, Foulds said adolescents should not be using them for that reason.

“Most young people who smoke are not yet as addicted to nicotine as adults. They have to go to school and so they usually don’t yet have the time or money to smoke heavily,” he said. “Most should be encouraged and supported to quit smoking without any pharmacological aid and if that is unsuccessful, their doctor may recommend an approved smoking cessation medicine. Electronic cigarettes have not yet been shown to be safe and effective smoking cessation aids and so should not be recommended to kids.”

While the lack of solid data makes it hard to put policies and regulations in place for the devices, there are some things most people agree on, Foulds said.

“E-cigs should not be sold to people younger than those who can buy regular cigarettes,” he said. “And the liquid should be sold in leak proof and child proof containers.”

He also said most people believe marketing of e-cigs to minors and sale of flavors such as cotton candy should be curbed. “Adults like flavors, too, but we believe some flavors and marketing can be more attractive to kids and that is inappropriate,” he said.

Foulds would like to see Pennsylvania pass an age-of-sale law making it illegal to sell e-cigarettes and paraphernalia to individuals younger than 18 and require identification upon purchase.

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The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Last Updated November 24, 2015