Intended for healthcare professionals


E-cigarettes could addict a new generation of youth to nicotine, doctors are told

BMJ 2015; 351 doi: (Published 28 October 2015) Cite this as: BMJ 2015;351:h5728
  1. Michael McCarthy
  1. 1Seattle

The US Food and Drug Administration should regulate e-cigarettes and other electronic nicotine delivery systems (ENDS) as it does other tobacco products, imposing similar age restrictions and banning their advertising and media promotion, the American Academy of Pediatrics has said in a policy statement1 released on 26 October at its national conference, held in Washington, DC.

“There is a critical need for ENDS regulation, legislative action, and counter-promotion to protect youth. ENDS have the potential to addict a new generation of youth to nicotine and reverse more than 50 years of progress in tobacco control,” the academy said.

ENDS are increasingly popular devices that produce an aerosol of nicotine-containing solution that can be inhaled like cigarette smoke. They include such devices as e-cigarettes, e-hookahs, and “vape” pens. The devices are widely available for sale in the United States at retail “vaping” shops, gas stations, grocery and convenience stores, and mall kiosks, as well as over the internet.

Use of ENDS by young people in the US has increased markedly in recent years, and their current use—defined as use for at least one day in the past 30 days—has risen among high school students, from 1.5% in 2011 to 13.4%—an 890% increase.

The academy said that ENDS were currently being aggressively marketed to young people through various media including television, movies, video games, social media, and promotional events. “Although tobacco advertisements on television have been legally banned since 1971 because of the Public Health Cigarette Smoking Act, there are no current regulations in place limiting ENDS advertisements,” the report noted.

Although ENDS manufacturers market their products with claims that they are “healthier” and “safer” than conventional cigarettes, the claims have not been scientifically validated, the academy warned. In fact, it added, ENDS aerosols include numerous potentially harmful “intoxicants and carcinogens” such as aldehydes, nitrosamines, tobacco alkaloids, and polycyclic aromatic hydrocarbons.

Of particular concern were the potential neurotoxic effects of nicotine on the adolescent brain, the academy said, especially on the development of executive function and neurocognitive processes. Nicotine, the academy warned, may serve as a “gateway drug” that makes adolescents more vulnerable to addiction, including to cocaine and other illicit drugs.

The academy recommended that paediatricians should screen children, adolescents, parents, and caregivers for ENDS use and should counsel children and adolescents about the harms of ENDS use and the importance of avoiding products that contain nicotine. Because of the risk of nicotine poisoning, paediatricians should be familiar with the symptoms of acute nicotine poisoning and should urge parents and caregivers to store the devices and nicotine-containing solutions in child resistant packaging and out of children’s reach, the academy said.

In terms of public policy, the statement called for a ban on sale of ENDS to under 21s, a ban on flavourings that appeal to young people, a ban on advertising that can be seen by younger viewers, and a ban on depictions of ENDS in movies, television shows, and video games viewed by young people.


Cite this as: BMJ 2015;351:h5728


View Abstract