The 'e-juice' that fills the cartridges usually contains nicotine (which is extracted from tobacco), propylene glycol, flavorings and other chemicals. They will inhale the particulates, the chemicals, and the nicotine all of which can be problematic exposures.E-cigarettes, aka JUULs and vape pens, use a battery to heat up a special liquid into an aerosol that users inhale. The Section on Tobacco Control has recently updated the AAP Policy Statement on E-Cigarettes and Similar Devices.įinally, since the aerosol that emits from the product contains harmful chemicals and nicotine, it is very important to counsel parents that it is not safe to use around their younger children. The AAP’s Richmond Center of Excellence website is an excellent source of up-to-date information on tobacco and electronic cigarettes, and the AAP’s Section on Tobacco Control connects pediatricians across the country interested in protecting children from tobacco. And remember, please let your local health department know, as they are still tracking cases. If you have a patient with nausea and vomiting, and/or respiratory symptoms, get a detailed vaping history, and keep VILI on your differential diagnosis. It can’t hurt to recommend exercise, a healthy diet, and stress reduction. You may need to use a few terms, like ehookah, vape pens, vape cartridges, or Juuling, to get across what you mean! For teens who have already started and are addicted, we don’t have a lot of evidence to go on, but certainly offer nicotine replacement therapy (patch, gum, or lozenge works best!) counseling may also be helpful. What can pediatricians and other health care providers do? First, ask teens specifically about use and counsel all teens and young adults to NEVER use e-cigarettes or any other vaping product. Juul and other companies are suddenly trying very hard not to appeal to teens, but the damage appears to be done. In fact, multiple studies have found that teens that try e-cigarettes are more likely to go on to use combusted tobacco. This strongly increases the risk of addiction, and while they claimed that they were only a product for adults looking to quit combusted tobacco, their marketing of flavors and using social media lead many teens to try e-cigarettes, even without having used combusted tobacco. Juul is an e-cigarette company that has had a lot of attention, primarily because it first used nicotine salts as a method for increasing the nicotine delivery to the lungs. These products have been marketed heavily using teen-age appearing “influencers” on social media all of these marketing tactics, taken straight from the tobacco company playbooks from the 1950s, have resulted in a huge increase in the percent of teens who are current users (27% in the last National Youth Tobacco Survey). In addition, while flavors in cigarettes have long been restricted to menthol and tobacco, e-cigarettes have not been regulated, and thus have adopted child-friendly versions like Cherry Crush, Mango, Cotton Candy, and Juice Roll Upz Strawberry. While early generation e-cigarettes were designed to mimic combusted tobacco, recent versions have built on technology and look like flash drives or other “cool tools”. The heating of the compounds in the liquid creates particulates, volatile organic compounds, and tobacco-specific nitrosamines, among other toxic chemicals, all of which can provoke inflammatory reactions in the lungs and circulation. While they have been marketed as producing a “harmless water vapor”, do not be fooled. THC-containing products usually use hash oil, but can also aerosolize marijuana leaf, as in this disturbing product, which is fortunately no longer on the market. E-cigarettes, and their like (ehookah, vape pens, etc), use a battery to heat up a liquid, usually containing a propylene glycol or vegetable glycerin, flavors, and nicotine. It is important to understand what these products are. While tetrahydrocannabinol (THC) containing cartridges have been implicated in the majority of the cases, a significant number were associated with nicotine-only use. The CDC is currently investigating the cause. While many of us in the pediatric tobacco control community have been worried about the impact of these products on the long-term health of teens and young adults, these new cases represent a significant risk of acute lung injury, hospitalization, and even death. Vaping and e-cigarettes have catapulted to the top of the fold in the last several months as we have seen a sudden outbreak of cases termed “Vaping Induced Lung Injury” or VILI.

Harmless water