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    1 Comment for this article
    There is a still insufficient prevention awareness initiative to minimize adolescents up taking e-cigarette
    Aki Nilanga Bandara, Mehara Seneviratne, and Dr.Vahid Mehrnoush | Global coalition to empower adolescent and youth on harmful therapeutic interventions to prevent combustible tobacco use.
    As of February 4, 2020, 2,758 cases of hospitalized e-cigarette, or vaping, product use-associated lung injuries (EVALI) and 64 deaths have been reported from all 50 states. Meanwhile, states continue to report new cases to CDC (1).
    E cigarette use is rapidly growing in North America and is now more prevalent than conventional cigarette usage in adolescent populations. These products pose respiratory and other serious health risk to adolescent patients. While further evidence has emerged that e-cigarette use can be fatal and is associated with serious lung injury ( 2, 3 ).These growing evidence shows adverse effects of e
    cigarette on human health (3). 
    There is research to suggest that the physicians infrequently screen or counsel their adolescent patients about e-cigarette use, even though e-cigarettes often come up during visits (4). Additional efforts by physicians could help prevent future use by adolescents. Evidence-based clinical guidelines must be made available and e-cigarette related adverse events must be communicated to pediatrician and the primary care physicians in order to facilitate prevention. Constant monitoring of the adherence of these guidelines together with the provision of continuous medical education (CME) training must be implemented.
    Pediatricians and primary care practitioners should adapt patient centered strategy to incorporate e- cigarette counseling and screening into their daily consultation routine. Health care community need to advocate for their pediatric patients' offering education and awareness programs and promote e-cigarette cessation efforts.
    Health care providers are well positioned to intervene to prevent adolescents’ e-cigarettes use, as they do with other adolescent risk behaviors (5). Organizations like the American Academy of Pediatrics (AAP) have guidelines on best practices for preventing and treating tobacco use (6).
    Innovative and holistic strategy that intends to address and solve the e-cigarette epidemic of our vulnerable children will require careful planning and implementation with the students. We need to involve students in the process of development of prevention plan and active involvement of students in this whole process is critical for success.

    (1). CDC. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products-https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
    (2). Stanbrook MB. Vaping-associated lung illnesses highlight risks to all users of electronic cigarette. CMAJ. 2019; 191(48):E1319-E1320.
    (3). Landman ST, Dhaliwal I, Mackenzie CA, Martinu T, Steele A, Bosma KJ. Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth. CMAJ. 2019; 191(48):E1321-E1331
    (4). Pepper JK, Gilkey MB, Brewer NT. Physicians’ counseling of adolescents regarding e cigarette use. J Adolesc Health. 2015; 57(6):580-6.
    (5). Kulig JW. Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention, identification, and management of substance abuse. Pediatrics. 2005;115:816–821.
    (6). Hagan JF, Shaw JS, Duncan PM, editors. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3. Elk Grove Village, IL: American Academy of Pediatrics; 2008.

    Aki Nilanga Bandara, Mehara Seneviratne,and Dr.Vahid Mehrnoush
    Global coalition to empower adolescent and youth on harmful therapeutic interventions to prevent combustible tobacco use.
    Original Investigation
    Substance Use and Addiction
    February 19, 2020

    Prevalence of Electronic Cigarette Dependence Among Youth and Its Association With Future Use

    Author Affiliations
    • 1Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
    • 2Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles
    • 3Department of Psychology, University of Southern California, Los Angeles
    JAMA Netw Open. 2020;3(2):e1921513. doi:10.1001/jamanetworkopen.2019.21513
    Key Points español 中文 (chinese)

    Question  What are the prevalence, symptom presentation, and future vaping patterns associated with youth electronic cigarette (e-cigarette) dependence?

    Findings  In this cohort study of 444 youths aged 16 to 18 years with past-year e-cigarette use, 11.7% of youth reported experiencing at least 1 e-cigarette dependence symptom. While less common and severe than combustible cigarette dependence, e-cigarette dependence had a similar symptom profile and was positively associated with vaping continuation, frequency, and intensity 6 months later.

    Meaning  These findings suggest that e-cigarette dependence among youth may be an expression of tobacco use disorder that is associated with use escalation.


    Importance  Understanding the prevalence and symptoms of electronic cigarette (e-cigarette) dependence and its association with future e-cigarette use among youth may help to guide pediatric clinical services and health policy.

    Objectives  To examine the cross-sectional prevalence and symptom presentation of e-cigarette dependence and to determine whether e-cigarette dependence is associated with subsequent e-cigarette use patterns 6 months later among youth with baseline past-year e-cigarette use.

    Design, Setting, and Participants  This prospective cohort study used baseline and 6-month follow-up surveys among students in the 12th grade during the 2016 to 2017 school year who reported any past-year e-cigarette use. Surveys were conducted on site in 10 high schools in Los Angeles, California. Data were analyzed from March 2019 to December 2019.

    Main Outcomes and Measures  Self-reported checklist of 10 tobacco product dependence symptoms reflecting loss of control over use, craving or urge, or withdrawal symptoms while abstinent, completed at baseline and administered separately for e-cigarettes and combustible cigarettes. Reporting 1 or more symptoms indicated a positive screen for dependence. Vaping continuation, defined as any past 6-month vaping, and past 30-day nicotine vaping days (range, 0-30), sessions per vaping day (range, 0-20), and puffs per session (range, 0-20) at 6-month follow-up were assessed.

    Results  Among 3168 twelfth-grade students who completed the baseline survey, 444 youths (mean [SD] age, 17.48 [0.39] years; 217 [48.9%] female) reported past-year e-cigarette use. Among these, 52 youths (11.7%) reported at least 1 e-cigarette dependence symptom. Among youth who reported past-year dual e-cigarette and combustible cigarette use, combustible cigarette dependence, reported by 43 youths (29.7%), was more prevalent than e-cigarette dependence, which was reported by 24 youths (16.4%). The most common symptoms, craving, urge, and need to use, and least common symptoms, abstinence-related concentration and emotional problems, were similar in both combustible and e-cigarette dependence. The prevalence of e-cigarette dependence was higher among youth who reported vaping in the past month than among those who did not (41 youths [17.6%] vs 11 youths [5.2%]; P < .001) and among youth who used e-cigarettes with nicotine than among those who used e-cigarettes without nicotine (42 youths [15.2%] vs 10 youths [6.0%]; P = .004). After adjusting for baseline vaping and e-cigarette dependence risk propensity scores, baseline e-cigarette dependence symptom status was associated with vaping continuation (adjusted odds ratio, 2.30 [95% CI, 1.07-4.94]; P = .02) and past 30-day number of nicotine vaping days (adjusted rate ratio, 2.17 [95% CI, 1.44-3.28]; P < .001), vaping sessions per day (adjusted rate ratio, 2.41 [95% CI, 1.52-3.83]; P < .001), and puffs per session (adjusted rate ratio, 1.70 [95% CI, 1.09-2.66]; P = .02) at 6-month follow-up.

    Conclusions and Relevance  These findings suggest that e-cigarette dependence may be an expression of tobacco use disorder associated with future use persistence and escalation among youth. Electronic cigarette dependence may be a behavioral health consequence of adolescent vaping that warrants consideration in pediatric patient care and public health policy.