1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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The Centers for Disease Control and Prevention (CDC, 2016) recently reported that "current e-cigarette use among middle and high school students tripled from 2013 to 2014." It is estimated that more than 2 million high school and almost half a million middle school students are users of e-cigarettes (CDC). Electronic cigarettes, also called e-cigarettes or electronic nicotine delivery systems, were first introduced in the United States in 2007 after having been manufactured in China since 2003. E-cigarettes are commonly marketed as a smoking cessation aid, an alternative to tobacco use, and safe. Although some countries have banned or strictly regulated e-cigarettes and the Canadian Food and Drug Administration (FDA) has classified them as drugs, the United States FDA has currently exempted them from regulation (Johnson & Pennington, 2015). The United States FDA has recently released proposed regulations that would prohibit e-cigarette sales to individuals under the age of 18, but presently adolescents and young adults are being specifically targeted for marketing (Quan & Velez, 2016).


Quan and Velez (2016) offered a comprehensive review of the problem and rapid increase in e-cigarette use by adolescents and young adults, a review of the anatomy and physiology of an electronic cigarette, the reasons for their increased popularity among teens, short- and long-term health effects, an overview of nicotine toxicity, and concluded the safety of e-cigarettes is seriously in question with need for research examining the relationship between use and long-term health effects. Little is known about long-term sequelae, but contrary to popular misconceptions, e-cigarettes deliver toxic levels of nicotine, do not aid in smoking cessation, and may serve as a gateway drug for more dangerous substances and addictive behaviors (Quan & Velez).


Johnson and Pennington (2015) reviewed the limited research from 2009 to 2014 that specifically addressed health concerns related to e-cigarette use. Although the latest data from the CDC (2016) highlight negative effects of e-cigarette use, conflicting valid and reliable studies were found that suggested e-cigarettes could reduce or eliminate tobacco use, with some support for the conclusion that e-cigarettes were a safer and healthier option to conventional tobacco products. There is limited research specifically addressing negative effects but poison control data report that e-cigarettes are responsible for 41.7% of monthly calls to centers (Chatham-Stephens et al., 2014). Many other short-term negative effects were also reported including suicide, hypertension, tachycardia, nausea, diaphoresis, shortness of breath, and diarrhea.


Well-child visits present an opportunity to educate teens and parents on short-term negative effects as well as to warn them of uncertainty of longer-term consequences of e-cigarette use. Johnson and Pennington (2015) conclude that "it is clear from all available research that electronic cigarettes have the potential to cause negative health effects. In addition to the potential negative impact of nicotine on adolescent brain development, there is also risk from addiction and concomitant use of conventional cigarettes and other tobacco products" (Johnson & Pennington). Quan and Velez (2016) present a succinct review of effects of nicotine, signs of acute nicotine toxicity, and management of acute nicotine toxicity that could serve as a valuable reference for all pediatric providers. In addition to anticipatory guidance and education, nurses play a valuable role in leading policy and legislative initiatives to ban e-cigarette use for adolescents until further research can demonstrate safety.




Centers for Disease Control and Prevention. (2016, April 25). A new study shows link between e-cigarette ads and use among youth. Retrieved from Accessed January 5, 2016. [Context Link]


Chatham-Stephens K., Law R., Taylor E., Melstrom P., Bunnell R., Wang B., ..., Schier J. G. (2014). Notes from the field: Calls to poison centers for exposures to electronic cigarettes-United States, September 2010-February 2014. Morbidity and Mortality Weekly Report, 63(13), 292-293. [Context Link]


Johnson M., Pennington N. (2015). Adolescent use of electronic cigarettes: An emergent health concern for pediatric nurses. Journal of Pediatric Nursing, 30(4), 611-615. doi:10.1016/j.pedn.2014.11.006 [Context Link]


Quan D., Velez L. I. (2016, February). Electronic Cigarette and Nicotine Toxicity. Primary Health Care Reports. AHC Media. [Context Link]