On Monday, we learned that the number of teenagers smoking cigarettes is declining. That good news is tempered by statistics that find that delivering tobacco’s principle psychoactive ingredient in other ways is becoming more popular than ever. A new report from the AAP, published in the November issue of Pediatrics, comes down hard on electronic nicotine delivery systems (ENDS):

Electronic nicotine delivery systems (ENDS) are rapidly growing in popularity among youth. ENDS are handheld devices that produce an aerosolized mixture from a solution typically containing concentrated nicotine, flavoring chemicals, and propylene glycol to be inhaled by the user. ENDS are marketed under a variety of names, most commonly electronic cigarettes and e-cigarettes. In 2014, more youth reported using ENDS than any other tobacco product.


Here is what the report tells us:

  • Last year, teenagers reported using ENDS more than any other tobacco product.
  • Like cigarettes and cigars, ENDS produces secondhand and thirdhand emissions of toxicants, creating health risks to involuntarily exposed non-users like children.
  • The nicotine present in ENDS solutions is as highly addictive and toxic as cigarettes.
  • Other toxicants, carcinogens, and heavy metal particles have been detected in solutions and vapors of ENDS.
  • The concentrated nicotine in ENDS solutions are usually flavored — a potential poisoning risk for young children. U.S. poison control centers report increasing numbers of children diagnosed with acute nicotine toxicity due to unintentional exposure to ENDS solutions.
  • Aggressive marketing strategies geared directly for youth consumption in popular media “threaten to renormalize and glamorize nicotine and tobacco product use.”


If you wonder what a real “gateway” drug looks like, look no further than nicotine’s effect on the developing brain:

Nicotine is highly addictive and is the primary psychoactive component causing addiction in tobacco products. Nicotine has neurotoxic effects on the developing brain. In early adolescence, development of executive function and neurocognitive processes in the brain has not fully matured. Adolescents are more likely to engage in experimentation with substances such as cigarettes, and they are also physiologically more vulnerable to addiction.


The AAP is calling on pediatricians to act aggressively to discourage the use of ENDS in children AND adults with more effective family screening, prevention counseling, and appropriate nicotine cessation counseling that does not include ENDS, which are unproven modes of therapy. Public policy recommendations to reduce youth access to and demand for electronic nicotine delivery systems are just as strong, with a sense of urgency thrown in for good measure. They include:

  • Reducing the easy access kids have to ENDS by banning their sale to people under 21 years old and banning all Internet sales of ENDS and nicotine solutions.
  • Reducing youth demand by banning all flavors (there are more than seven thousand flavors on the market!) which attract older kids to begin vaping and lure very young children to accidentally ingest ENDS solutions.
  • Banning advertising of ENDS directed towards young people.
  • Restricting movie, TV, and video game depictions of ENDS by giving them adult ratings.
  • Protecting children from unintended harm by preventing involuntary secondhand and thirdhand aerosol exposures; preventing unintentional nicotine poisonings utilizing effective childproof packaging protections.
  • Imposing taxes on ENDS at the same rate as cigarettes and applying that revenue for public health efforts to protect children and teenagers, and for research into the health effects of electronic nicotine delivery systems on users and non-users.


The AAP is afraid that without regulatory and legislative action to counteract the growing popularity of these devices, electronic nicotine delivery systems “have the potential to addict a new generation of youth to nicotine and reverse more than 50 years of progress in tobacco control.”

I don’t think many of us want to see that happen.