"We know that 95%
of adults who are tobacco-dependent began smoking before age 21, and most
before age 18," said Karen Wilson, MD, from the Children's Hospital
of Colorado in Aurora and chair of the AAP Section on Tobacco Control.
"If present trends
continue, 5.6 million of today's youth will die prematurely of
tobacco-related diseases," she said.
The policy statement was released
during a press briefing at the AAP 2015 National Conference in Washington, DC,
and published in the November issue of Pediatrics.
"There is no safe
level of tobacco smoke exposure," Dr Wilson said. The developing brains of
children and teens are particularly vulnerable to nicotine and tobacco
dependence.
Tobacco is the only
consumer product that, when used as intended, causes disease and death. It is
also heavily promoted to children and teens through the addition of sweet
flavorings and the use of novel electronic nicotine delivery systems.
Electronic Nicotine Delivery Systems
"Electronic
nicotine delivery systems have the potential to addict an entire new generation
of youth to nicotine and to reverse the progress we have made over 50 years of
tobacco control," said Dr Wilson. The devices are attracting youth who
might not otherwise have used tobacco products, and research has shown that
those who start with electronic devices are more likely to move on to smoking
combustible tobacco, she explained (JAMA Pediatr.).
Emissions from
electronic nicotine delivery systems are not water vapor, but rather an aerosol
suspension of fine particles that can be inhaled by nearby nonusers. These have
been found to include polycyclic aromatic hydrocarbons, nicotine, volatile
organic compounds, and metal and silicate particles, she reported.
Another policy statement released at
the same time addresses the dangers of these systems.
From 2011 to 2014,
there was a 650% increase in the use of electronic nicotine delivery systems by
middle-school students — from 0.6% to 3.9%, according to the statement. And in
high-school students, there was an 890% increase — from 1.5% to 13.4%.
Currently, electronic
nicotine delivery systems that do not purport to help with tobacco cessation
are not regulated at all, and there are no restrictions on selling them to
teens too young to buy cigarettes, Dr Wilson reported. Consequently, they are
widely available in vape shops, malls, gas stations, convenience stores,
grocery stores, pharmacies, and over the internet.
The AAP is recommending
a ban on the sale of such devices to anyone younger than 21 years, and a ban on
flavoring agents.
Unregulated vials of
concentrated, and often flavored, nicotine solution that are sold for use with
electronic devices are dangerous. "There has already been one child death
from exposure to nicotine-containing solution," Dr Wilson pointed out.
To address that issue,
the policy statement calls for solutions containing nicotine to be dispensed in
child-resistant packaging and in containers small enough to ensure that amounts
would not be lethal if swallowed by a small child.
It also recommends that
any advertising of the devices and solutions that can be viewed by youth be
banned, that all internet sales be banned, and that any movie, television show,
or video game that depicts an electronic nicotine delivery system have an adult
rating.
Proposed FDA Rule
The AAP statements
parallel regulations proposed by the US Food and Drug Administration (FDA)
Center for Tobacco Products, which would greatly expand the agency's authority
to regulate tobacco products and delivery devices.
The proposed rule would cover
electronic nicotine delivery systems, cigars, little cigars and cigarillos,
dip, chew snus, pipe tobacco, waterpipe tobacco, nicotine gels and
dissolvables, e-cigarette cartridges, air and smoke filters, tubes, papers,
pouches, and flavorings.
However, the proposal
was hit by a storm of objections that included more than 135,000 comments, many
from 71 different write-in campaigns objecting to the regulation of
"premium" cigars.
The final revised rule
was submitted to the Office of Management and Budget on October 19,
according to FDA Press Officer Michael Felberbaum.
That office "is
required to review all significant regulatory actions and has 90 calendar days
to review rules. However, this timeframe can be extended to allow for
additional interagency discussion. At this time, the FDA cannot provide any
further comment until the final rule is published," Felberbaum told Medscape
Medical News.
An AAP clinical practice policy to
provide guidance to clinicians on the screening of children's tobacco exposure
has also been released. It recommends routine screening for electronic nicotine
delivery systems, anticipatory guidance to prevent smoking initiation,
counseling for youth and parents about the risks associated with electronic
systems, and the treatment of tobacco dependence in parents and caregivers.
Dr Wilson has disclosed
no relevant financial relationships.
American Academy of
Pediatrics (AAP) 2015 National Conference. Presented October 23, 2015.
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