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Most smokers start in their adolescence, an age of increased nicotine addiction risk. Since virtually all cigarette smoking begins before the age of 18 (1), the effects of tobacco use on children is clearly of utmost importance. (2)
We applaud the American Academy of Pediatrics (AAP) for their clear stance against e-cigarette use by adolescents. (3) Despite these warnings, e-cigarettes have been treated as “A cool and a classy thing, less harmful with no nicotine by-product or as a smoking cessation tool” by many adolescents, as is often portrayed in social media. (3) In general, adolescent are confused and puzzled over the contradictory information on the health benefits and potential harm of using e-cigarettes. There are many reports including the most recent the UK's House of Commons Science and Technology Committee report on e-cigarettes, promotes e -cigarette as a healthy alternative to combustible cigarette. (4) Further, this report (4) has explicitly stated that there is growing evidence to support e-cigarettes and their effectiveness and safety for smoking cessation and harm reduction tool.(4) Accordingly, adolescents are more likely to believe that the e-cigarettes are less harmful than combustible cigarettes. (5, 6, 7) Not only adolescents are confused; many clinicians feel that they lack sufficient knowledge about the e-cigarette and express interest in learning more. (8, 9, 10)
There is no doubt that comprehensive prevention programs targeting adolescents are urgently needed. It is necessary to counteract the popular online media e-cigarette myth spreading machine. It is well known that this online propaganda is so powerful that adolescents simply cannot resist.
Meanwhile, the WHO urged for strict regulations to address health concerns associated with e-cigarette use. WHO specifically appeals that current e-cigarette advertising should not target youth and non-smokers. (11)
We would like to propose that prior to enactment of any potential evidence-based legislation or policy strategies to curtail e-cigarette use by adolescents, there needs to be a strong public educational and awareness campaign to counter common myths and misconceptions about e-cigarettes (12). This is a logical first step to follow because legislation won’t be successful unless children are convinced that e-cigarettes are not a therapeutic tool. We believe the campaign should essentially address the following questions about e-cigarettes:
• Whether there is sufficient evidence to support the claim that it is a safe, viable alternative to conventional tobacco?
• Whether it is a qualified or proven as a smoking cessation device, or simply effective as conventional nicotine replacement therapy?
Finding a realistic answer to these two questions is an urgent task, as e-cigarette misuse related lung disease has become a global epidemic. There are 26 deaths and 1, 299 serious lung injuries related to vaping. (13) The harms that e-cigarettes currently pose to non-smoking teens and young adults far outweigh the potential benefits. (14) It is very important to build solid evidence-based information on serious adverse effects of e-cigarettes.
It is our utmost duty as socially responsible clinicians to make sincere effort to prevent e cigarette marketing promotions and industries’ sophisticated tactics designed to make e-cigarettes more pleasant and appealing to adolescents. They are designed very carefully and it may very well appeal to non-smokers. Moreover, on popular social media sites such as YouTube, Instagram, Pinterest and Twitter, advertisements for e-cigarettes often unfairly target adolescents. Adolescents’ media literacy should be an important concern of primary care physicians and the paediatricians. We would urge that the topic of e-cigarette use be included in their advocacy efforts.
REFERENCES:
(1). U.S. Department of Health and Human Services. A Report of the Surgeon General. Atlanta, GA: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
(2). Peterson LA, Hecht SS. Tobacco, e-cigarettes, and child health. Curr Opin Pediatr. 2017;29(2):225-230. doi: 10.1097/MOP.0000000000000456.
(3). American Academy of Pediatrics (AAP). Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics, 2015 DOI: 10.1542/peds.2015-3108.
(4). UK parliament- House of Commons Science and Technology Committee’s report. Available at- https:// publications.parliament.uk/pa/ cm201719/cmselect/ cmsctech/505/505.pdf (accessed 10th Oct.2019)
(5). Ambrose BK, Rostron BL, Johnson SE, Portnoy DB, Apelberg BJ, Kaufman AR, et al. Perceptions of the relative harm of cigarettes and e-cigarettes among U.S. youth. Am J Prev Med 2014;47(2, Suppl 1):S53-60.
(6). Kowitt SD, Osman A, Ranney LM, Heck C, Goldstein AO. E-Cigarette Use Among Adolescents Not Susceptible to Using Cigarettes. Prev Chronic Dis 2018;15:170368.
(7). Makadia LD, Roper PJ, Andrews JO, Tingen MS.Tobacco use and smoke exposure in children: New trends, harm, and strategies to improve health outcomes. Curr Allergy Asthma Rep. 2017;17(8):55-59.
(8). Lazard AJ, Saffer AJ, Wilcox GB, Chung AD, Mackert MS, Bernhardt JM.E-Cigarette Social Media Messages: A Text Mining Analysis of Marketing and Consumer Conversations on Twitter JMIR Public Health Surveill 2016;2(2):e171.
(9). El-Shahawy O, Brown R, ElstonLafata J. Primary Care Physicians' Beliefs and Practices Regarding E-Cigarette Use by Patients Who Smoke: A Qualitative Assessment. Int J Environ Res Public Health. 2016; 26;13(5). pii: E445. doi: 10.3390/ijerph13050445.
(10). Pepper JK, Emery SL, Ribisl KM, Brewer NT. How U.S. adults find out about electronic cigarettes: implications for public health messages. Nicotine Tob. Res. 2014;16(8):1140–1144.
(11). WHO Backgrounder on WHO report on regulation of e-cigarettes and similar products. World Health Organization (2014) Available at: http://wwwwhoint/nmh/events/2014/backgrounder-e-cigarettes/en/ Accessed Oct 7, 2019.
(12). Bandara N. Would e-cigarette regulation alone improve adolescents' health? CMAJ. 2016; 18;188(15):1106.
(13) Reuters-US vaping related deaths rise to 26, illness to 1, 299-Available at: https://www.nytimes.com/reuters/2019/10/10/us/10reuters-usa-vaping-cdc.html accessed Oct 10, 2019.
(14). Soneji S, Sung HY, Primack BA, Pierce JP, Sargent JD. "Quantifying population-level health benefits and harms of e-cigarette use in the United States" PLOS ONE 2018; DOI: 10.1371/journal.pone.0193328.