What are the consequences of electronic cigarette (e-cigarette) use in pediatric patients?

From the Guidelines

Vaping among pediatric patients poses significant health risks, including acute nicotine poisoning, seizures, and long-term consequences like nicotine addiction and impaired brain development, emphasizing the need for immediate attention and preventive measures. Children and adolescents who vape face a range of health consequences that can have lasting impacts on their morbidity, mortality, and quality of life. The use of electronic nicotine delivery systems (ENDS) has been rapidly growing among youth, with these devices often containing high concentrations of nicotine and other toxic substances 1.

Key Health Risks

• Acute risks: nicotine poisoning, seizures, respiratory distress, and e-cigarette or vaping product use-associated lung injury (EVALI) 1.
• Long-term consequences: nicotine addiction, impaired brain development, reduced lung function, and increased risk of transitioning to traditional cigarettes 1.
• Nicotine exposure during adolescence can permanently alter brain development, affecting attention, learning, and impulse control 1.

Recommendations for Healthcare Providers

• Screen all pediatric patients for vaping use starting at age 10-12 1.
• Provide clear education about the risks associated with vaping and offer cessation support when needed 1.
• Treatment approaches may include behavioral counseling, consideration of nicotine replacement therapy in severe cases (though not FDA-approved for patients under 18), and family-based interventions 1.
• Parents should be educated about the various vaping devices and the importance of a tobacco-free environment for their children 1.

Prevention and Intervention

Prevention remains the most effective strategy, requiring collaboration between healthcare providers, parents, schools, and communities to address this growing public health concern among youth 1. Brief prevention and intervention efforts, including addressing the nature and risk related to vaping, along with the use of motivational interviewing, are non-resource-intensive approaches available to providers 1. By prioritizing the detection of vaping use and providing timely interventions, healthcare providers can play a critical role in mitigating the long-term harms associated with vaping among pediatric patients.

From the Research

Vaping Consequences in Pediatrics

• The use of electronic cigarettes (e-cigarettes) or vapes among adolescents and young adults has dramatically increased over the past several years, with e-cigarettes being the most used form of tobacco among youth 2.
• Complications resulting from vaping include e-cigarette or vaping product use-associated lung injury (EVALI) and thrombotic events, with data suggesting that vaping can lead to both short- and long-term respiratory morbidity in the pediatric population 2, 3, 4.
• Youth vaping is associated with increased risk for tobacco and other substance use, mental health problems, pulmonary and cardiovascular disease, and unintentional injuries 5, 6.
• Vaping should not be used as a smoking cessation tool for youth due to lack of effectiveness and evidence of harm, and many preventive and treatment strategies used for tobacco cessation can be adapted to help youth quit vaping 5.
• The pulmonary risks of vaping are rapidly emerging, with extrapulmonary effects including cardiovascular, immunologic, and neuro-developmental effects, many of which are likely dose-dependent 3.
• Public health efforts are urgently needed to decrease or eliminate new e-cigarette initiation, and support should be established to assist current e-cigarette users with cessation, including the elimination of e-cigarette flavorings and advertising directed at adolescents 3.

Health Risks Associated with Vaping

• Physical health risks associated with vaping include EVALI, respiratory morbidity, and cardiovascular disease 2, 6, 3, 4.
• Behavioral health risks associated with vaping include increased risk for tobacco and other substance use, mental health problems, and unintentional injuries 5, 6.
• The long-term health consequences of vaping remain unknown, but recent research demonstrates physical and behavioral health risks associated with vaping as well as methods for assessment, counseling, and intervention 6.

Prevention and Cessation Strategies

• Preventive strategies for youth vaping include limiting access to retail sites, restricting online purchasing, and eliminating e-cigarette flavorings and advertising directed at adolescents 2, 5, 3.
• Treatment strategies for youth vaping include adapting tobacco cessation strategies, such as behavioral and pharmacological options, to help youth quit vaping 5.
• Clinicians should be aware of the different devices and products available, ask their pediatric patients regularly about use, and counsel and educate on the potential harmful effects of vaping 2, 6.