Protect Our Children from E-Cigarette Purchase and Secondhand Smoke

Electronic or e-cigarettes, also known as Electronic Nicotine Delivery Systems (ENDS) or personal vaporizers (PV), are an increasingly popular method of nicotine ingestion. E-cigarette sales are estimated to top $2 billion in 2014.

Exposure to tobacco, including secondhand smoke, harms the health of children in many ways. Adverse health consequences include low birth weight, sudden infant death, respiratory illness, infection, and decreased lung function. Preliminary results of e-cigarette analysis performed by FDA’s Center for Drug Evaluation demonstrate detectable amounts of human carcinogens and other tobacco-specific impurities suspected of being harmful to humans. Furthermore, e-cigarette cartridges labeled as not containing nicotine were found to have low levels of nicotine present. Therefore, exposure to currently unregulated e-cigarettes may have similar health consequences for children as conventional cigarettes.

E-cigarettes are marketed as a “safer” alternative to traditional cigarette smoking despite lack of evidence demonstrating this safety. E-cigarettes are touted as a smoking cessation aid though there are no rigorous scientific studies to support this claim. They are also marketed as being permissible where traditional smoking is prohibited. Liquid nicotine cartridges for e-cigarettes are available in several colors and flavors that appeal to adolescents. In addition to advertised claims, product contents and product labels are not required to be accurate.

The FDA has proposed a rule to deem products meeting the definition of “tobacco product” to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (link below). This rule is an important step forward in the regulation of e-cigarettes. However, until this rule is passed and implemented (which may take years), e-cigarettes continue to be sold and consumed ubiquitously.

Many but not all states prohibit the sale of e-cigarettes to minors. Currently, each individual state and even municipality regulates when and where e-cigarettes and similar products can be used and the location of stores selling e-cigarettes. If you believe children should not be involuntarily exposed to the unknown and potentially harmful health consequences of e-cigarettes, urge your state and city legislators to prohibit e-cigarette sale to minors, to prohibit e-cigarette use in enclosed public places, and to regulate the placement and density of stores selling e-cigarettes to minimize access by minors. Continue following the FDA proposal to ensure that the rule is passed and implemented, so that rigorous scientific studies are required to ensure the safety and appropriate packaging, labeling, and marketing of e-cigarettes.

Tiffany Lieu, MD

Information on your state’s actions pertaining to e-cigarettes:

Information on e-cigarettes from the American Academy of Pediatrics:

Tobacco’s health effects on children from the American Academy of Pediatrics:

FDA’s proposed rule:!documentDetail;D=FDA-2014-N-0189-0001

Laboratory analysis of e-cigarettes by FDA:

Information on e-cigarettes:


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