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

From the Guidelines

Vaping among pediatric patients carries significant health consequences that require immediate attention, and healthcare providers should screen all pediatric patients for vaping starting at age 10-12, provide clear education about risks, and offer cessation support including behavioral counseling and, in select cases, nicotine replacement therapy under careful supervision. Children and adolescents who vape face acute risks including nicotine poisoning, severe lung injury (EVALI), and respiratory distress that may require hospitalization 1. The developing brain is particularly vulnerable to nicotine addiction, with adolescents becoming dependent more quickly than adults, often after just minimal exposure. Long-term consequences include impaired brain development affecting attention, learning, and impulse control; respiratory issues like chronic cough, asthma exacerbation, and increased susceptibility to respiratory infections; and cardiovascular effects including elevated blood pressure and heart rate. Additionally, vaping serves as a gateway to traditional cigarette use and other substance abuse. Some key points to consider when addressing vaping in pediatric patients include:

• The importance of open communication with adolescents and consistent, routine screening with validated tools to detect ECPO use 1
• The need for brief prevention and intervention efforts, including addressing the nature and risk related to ECPOs, along with use of motivational interviewing 1
• The role of parents in recognizing vaping devices, monitoring for behavioral changes, and maintaining open communication with their children about substance use 1
• The critical need for regulation, legislative action, and counter promotion to protect youth from the harmful effects of vaping 1 Healthcare providers should be aware of the different nicotine delivery systems marketed and available, and should provide anticipatory guidance to prevent smoking initiation and reduce tobacco smoke exposure 1. The most effective approach combines prevention through education with early intervention, as the developing organs and tissues of young people are particularly susceptible to the harmful chemicals in vaping products.

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.