A new research study published in the journal Pediatrics on May 9, 2016, finds that the e-cigarette exposure in children can have a 5.2 times higher odds of admission into a medical facility and 2.6 times higher odds of developing severe medical complications, when compared to the children exposed to regular cigarette smoke.
Recent global developments like the Royal College of Physicians, UK’s report endorsing the use of e-cigarettes to help people quit smoking and the United States Food and Drug Administration’s (FDA) announcement for the regulation of e-cigarettes, has raised the profile of the product along with increasing public interest in the subject.
Higher Pediatric Admissions
The recent study building on that profile reveals that exposure of the smoke from these e-cigarettes in children can cause greater damage than the regular cigarettes in terms of hospital admissions and severe medical outcomes. The researchers also made a note that the said exposure increased by 1,492.9% during the period of the study.
The researchers reviewing the literature observed that cigarette smoking is demonstrating a downtrend in recent years while the rate of e-cigarette consumption has gone up. The study aimed to study the effects of the said cigarettes on pediatric population since their introduction in 2007.
The team led by Dr Gary Smith, director, Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, collected the calls from the National Poison Data System (NPDS) over a 40-month period and observed that more than 60% of the calls were made as a result of cigarette poisoning. Nearly 14% were made for e-cigarettes exposure and 16% for other tobacco products. Nearly 95.5% of all the exposure was due to ingestion, while 1.7% was due to other reasons and in contrast nearly 9% of the e-cigarette exposure was due to reasons beside ingestion.
Most of the cases of exposure involved swallowing of the liquid nicotine by children. When ingested or absorbed symptoms like vomiting, a quickened heartbeat, and a jittery behavior are often observable. Most of the cases were managed at home, with less than 3% of them being admitted to a hospital. Out of the total nearly 2% had severe complications like coma, problems in breathing and seizures.
The study conducted during January 2012 to April 2015 then took a retrospective cohort of 29,141 calls into account where nicotine and tobacco exposure was detected in children under the age of six. Three types of symptoms of exposure were categorized as:
- Minor effects, including skin irritation
- Moderate effects, like not life threatening systemic effects without any residual disability
- Major effects, like life threatening events that can cause residual disability
Major and moderate effects were termed as severe outcomes of the exposure for the purposes of the study.
Further data analysis revealed that nearly 80% of the children exposed to e-cigarettes poisoning were under the age of two. The number of tobacco and nicotine exposures per month increased by 73.2% during the study duration. The relationship was highly significant with a reading of 0.01. The increase was primarily seen due to increase in e-cigarette exposures without any significant increase in the regular cigarettes exposure or other tobacco products.
The children, in addition to severe health outcomes and a higher possibility of admission into a healthcare facility, also saw a 23.4% increased rate of referrals from poison control centers to HCFs when contracting e-cigarettes poisoning.
Dr Smith termed the exposure rates as an ‘epidemic by any rate’.
He was not alone in his conclusions; the Chief Safety Officer at Texas Children’s Hospital at Houston, and the Head of American Academy of Pediatrics’ (AAP) Emergency Medicine Committee, Dr Joan Shook called the poisonings as a huge public health issue. She said that even emergency physicians are baffled due to the issue and are wondering what authorities are planning to do about the situation.
“If you use these products, you need to treat them as medication or toxins and keep them closed, locked and out of reach of children,” suggested Dr Shook, who was not a part of this study.
Recently imposed restrictions by the FDA on the e-cigarettes manufacturers, such as nicotine exposure warnings, child-resistant packaging, and similar policies like those imposed on the regular cigarettes manufacturers and distributors are seen as a welcome step by many healthcare providers and personnel.
Another significant step towards preventing future exposures of nicotine in children was taken in the form of the Child Nicotine Poisoning Prevention Law which would take effect this summer. The law passed in 2015 dictates that any nicotine container sold, manufactured, distributed or imported in to the United States of America must be in accordance with the Consumer Product Safety Commission’s (CPSC) standards of child-resistant packaging.