AAP Policy Cites Harm of E-cigarettes

ENDS (electronic nicotine delivery system), including e-cigarettes, are becoming more and more popular. One reason people are starting to use e-cigarettes is because they are touted to help people quit smoking. Note: ENDS have been shown to pose harms for users and non-users and are not approved by the Food and Drug Administration (FDA) as smoking cessation devices. They are considered a less harmful option, in same cases they are considered totally harmless. ENDS are handheld devices that produce an aerosol from a solution typically containing nicotine, flavoring chemicals and propylene glycol and/or glycerin to be inhaled by the user. ENDS include the wide range of products that are known as electronic cigarettes, e-cigs, e-hookah, vaping devices, vape pens and mechanical mods.

The AAP (American Academy of Pediatrics) is publishing a new policy about these systems, addressing pediatricians’ and pediatric health care providers’ questions about these products and the harms to youths. It is available here and will be published in the November issue of Pediatrics.

In 2014, more youths reported using ENDS than any other tobacco product. It has been found that ENDS contain numerous harmful toxicants and carcinogens. Nicotine is one such highly addictive toxicant. Use of nicotine-containing ENDS solution may lead adolescents to start smoking conventional cigarettes and other tobacco products. E-cigs and other devices normalize and make smoking acceptable culturally which can lead to other drug use.

ENDS secondhand vapor has been shown to contain nicotine, toxicants, metal and silicate particles, and carcinogens that can pose harm to non-users. The ENDS solution, or e-liquid, can contain very concentrated nicotine, which can be lethal when ingested even in small quantities. There has been an astronomical increase in calls to poison control centers from ENDS exposures, and one child died after ingesting concentrated nicotine solution.

Below are some FAQ’s about ENDS (source):

Common questions

How many children and adolescents are using electronic nicotine delivery systems (ENDS)?
Surveys of youths show an 890% increase in ENDS use over the past four years. In 2013, as many as 29% of high school students had tried (ever used) e-cigarettes, with use in the past month (current use) of 18%. In contrast, 8.5% of U.S. adults reported having tried an e-cigarette in 2013.

Why am I seeing ENDS commercials on television?
Unlike conventional cigarettes, there are no current regulations on ENDS advertisements on television, print media or point-of-sale (advertisements where ENDS are sold). ENDS are being marketed heavily; in 2013, 80% of U.S. youths ages 12-17 years were exposed to 13 television advertisements for ENDS.

What is in the ENDS solution (also known as e-juice or e-liquid)?
ENDS solutions are advertised to contain concentrated nicotine, flavoring chemicals and propylene glycol and/or glycerin. There are 7,760 flavors of ENDS solutions advertised, many of which are candy and dessert flavored and appealing to children. In addition to what is advertised, however, ENDS solution has been shown to contain numerous toxicants and carcinogens. The ENDS refillable cartridges also allow for addition of other substances to the solution, including marijuana.

What should I say when someone asks if I recommend ENDS?
ENDS have been shown to pose harms for users and non-users and are not approved by the Food and Drug Administration (FDA) as smoking cessation devices. ENDS should not be recommended to youths or their parents/caregivers. Parents and youths who are interested in tobacco dependence treatment should be directed to evidence-based smoking cessation counseling and FDA-approved tobacco dependence treatments (see resources).

Controlling Media Violence Exposures

As parents, we must take action in reducing our children’s exposure to media violence. Not only is this a children’s health issue but, unfortunately, also a public health issue. After a school shooting, politicians will examine gun control, mental health support, and media violence among other areas.  Extensive research has shown that media violence can contribute to aggression and real life violence.


What are some steps we can take as parents?


1.  Remove televisions, Internet, and video games from bedrooms and move them to common areas.

2.  Preview or coview media of concern with our children. Discuss what is inappropriate, why it is inappropriate, and what an alternative would be to the action if there are any exposures.

3.  Review music lyrics prior to purchase for both sexual and violent content.

4.  Limit screen time to no more than 1-2 hours day.

5.  Don’t allow video games with human targets or games in which points are awarded for killing. Kids will understand if you explain to them why these games don’t need to be purchased or played.

6.  Remember that we, as parents, are role models for our children of appropriate media and music use. 

7.  Avoid media in children less than 2 years old- not for violence but to prevent possible language delay.


It is time to take control of our children’s exposure to media violence. Speak up to our politicians. Tell the entertainment industry. There needs to be a more responsible way to portray violence and a simplified rating system to guide parents. We want to prevent any further gun tragedies against children in the future.



Elizabeth Chea MD