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JAMA Pediatrics Patient Page
December 2017

What Parents Need to Know About Electronic Cigarettes

JAMA Pediatr. 2017;171(12):1236. doi:10.1001/jamapediatrics.2017.3802

In the past decade, electronic cigarettes (e-cigarettes), as well as other electronic nicotine delivery systems (ENDS), have grown in popularity.

How ENDS Products Work

These devices all use electronics to heat liquids made up of flavors and nicotine; in most devices, the act of puffing triggers a battery-powered heater to heat the liquid, which then becomes a vapor that is inhaled by the user. Thus, many of these products have “vape” or “vaping” as part of their name, referring to inhaling vapor rather than traditional smoke. Many of the ENDS resemble traditional tobacco products such as cigarettes, cigars, or pipes or common gadgets such as pens. These devices include personal vaporizers, vape pens, electronic cigars, and electronic hookah. Electronic nicotine delivery systems have been used to smoke nicotine as well as marijuana. Their main purpose is to deliver nicotine, which is a highly addictive drug.

Safety of ENDS

Because these devices do not include traditional smoke, there have been false assumptions that they are safer than smoking cigarettes or other tobacco products. Parents need to know that:

  • The liquid in ENDS devices as well as the vapor that is inhaled contains harmful chemicals (including anti-freeze [diethylene glycol]) and carcinogens (including nitrosamines, which can cause cancer)

  • The nicotine in ENDS is addictive and can harm brain development

  • It is not recommended to use ENDS to try to quit smoking

  • Electronic nicotine delivery systems have occasionally exploded, causing burning or fires

  • Secondhand vapor from ENDS is harmful to growing lungs

  • The liquid in e-cigarettes can cause nicotine poisoning if someone drinks, sniffs, or touches it. There have been increases in poisoning cases in children younger than 5 years as well as concerns for pets.

Because ENDS are a newer product, the long-term health effects on users, as well as bystanders who inhale secondhand vapor, are still unknown.

Electronic Nicotine Delivery Systems and Teenagers

Unfortunately, ENDS are common among teenagers: almost 1 in 4 high school students reported current ENDS use in 2015. The liquid in ENDS is commonly flavored, often in flavors that are appealing to children such as bubble gum or peach. Youths who use ENDS are more likely to smoke traditional cigarettes in the future. While it is illegal for ENDS to be sold to children younger than 18 years, ENDS can be ordered online.

Talk to Your Children About ENDS Early and Often

Talk with your children early on about the dangers of nicotine in any form and emphasize that it is highly addictive and harmful to anyone that uses it. Talking about avoiding nicotine is an important topic that can and should be discussed early and often. When you see movies or television shows with nicotine use, that is a good time to have another conversation about the harms of nicotine use. Some teenagers benefit from discussing how nicotine companies try to target teenagers via advertising or child-friendly flavors to get them hooked at an early age, so avoiding nicotine can be a way to “rebel” against these companies.

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Article Information

Published Online: October 23, 2017. doi:10.1001/jamapediatrics.2017.3802

Conflict of Interest Disclosures: None reported.

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