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AAP policy statements urge stronger regulation of tobacco, e-cigarettes

WASHINGTON — In a series of policy statements issued during the national conference, the AAP’s Section on Tobacco Control recommended strong regulations of electronic cigarettes, due to their increasing popularity among teenagers, as well as restricting age of sale for all tobacco products to 21 years.

“Tobacco use continues to be a major health threat to children, adolescents and adults,” Karen M. Wilson, MD, MPH, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children’s Hospital Colorado, said in a press release. “The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health.”

Karen M. Wilson

While the statements outline general recommendations for public policy changes and guidance for physicians to counsel families on reducing tobacco exposure, particular focus was given in urging the FDA regulation of e-cigarettes and other electronic nicotine delivery systems to match other tobacco products. Advised regulations included age restrictions for purchasing cigarettes, taxes, bans on advertising to youth, and bans on flavored products that are particularly appealing to teenagers.

According to the statements, child-resistant packaging is necessary to protect children from exposure to liquid nicotine, which can be extremely toxic if ingested. In 2014, there were more than 3,000 calls to U.S. poison control centers for liquid nicotine exposure, with one fatality.

In addition, the AAP recommended that smoke-free laws already in place for secondhand smoke be extended to include e-cigarettes, as the aerosol emitted from them is not harmless but rather contains several toxic chemicals, including some carcinogens and significant amounts of nicotine.

“The increasing use of [electronic nicotine delivery devices (ENDS)] among youth threatens 5 decades of public health gains in successfully deglamorizing, restricting and decreasing the use of tobacco products,” Susan C. Walley, MD, a pediatrician at the University of Alabama at Birmingham, and colleagues wrote in a policy statement. “Health claims of ENDS as smoking cessation aids are currently unsupported by scientific evidence. There is a crucial need for effective local, state, and federal regulation to protect children and youth from ENDS use and exposure to ENDS secondhand and thirdhand aerosol and concentrated nicotine solution.”

The AAP also has proposed that the minimum age to purchase tobacco should be increased to 21 years. Since middle and high school students often acquire their first tobacco products from older children, this age limit can more effectively prohibit exposure to children.

“Because the vast majority of people who become tobacco-dependent do so before 21 years of age, increasing the minimum age of purchase from 18 to 21 years and enforcing this regulation will protect a larger proportion of the population from becoming tobacco dependent,” Harold J. Farber, MD, MSPH, a pediatric pulmonologist at Texas Children’s Hospital, and colleagues wrote in another statement. – by Bob Stott

References:

• AAP. Pediatrics. 2015;doi:10.1542/peds.2015-3108.
• AAP. Pediatrics. 2015;doi:10.1542/peds.2015-3109.
• AAP. Pediatrics. 2015;doi:10.1542/peds.2015-3222.

Disclosure: The researchers report no relevant financial disclosures.