“The public health community is worried that an increase in e-cigarette usage can renormalize the use of cigarettes,” said Gordon Hildick-Smith, a third-year medical student at Weill Cornell Medical College and the lead author of the article published Sept. 29 in the Journal of Adolescent Health. “This is a major concern for adolescents who are especially sensitive to the effects of nicotine because of their developing brains. Hopefully this guide will help healthcare practitioners understand e-cigarettes better so that they can advocate for cessation.”
Research shows that adolescents are currently using electronic nicotine delivery systems (ENDS) — devices that provide users with inhaled nicotine through an aerosol mist — more than cigarettes, with monthly use having increased from 1.5 percent in 2011 to 13.4 percent in 2014.
“Usage has skyrocketed and is now higher than conventional cigarette use due to lax regulations and users perceiving that ENDS are not detrimental to their health,” Hildick-Smith said. “For many adolescents, their physicians represent their only source of accurate health information.” Adolescents may be more likely to follow advice from their physician than advice from their parents or other authority figures, he added.
Consisting of data from more than 50 peer-reviewed publications, the review article, “A Practitioner’s Guide to Electronic Cigarettes in the Adolescent Population,” is geared to pediatricians, family medicine doctors, nurse practitioners and others who care for adolescents.
The guide not only includes trends, risks and regulations of ENDS, but also three suggested steps that practitioners should apply during their routine substance use counseling: screen patients for ENDS use, identify and correct misconceptions and counsel patients about how to quit.
“Even in the setting of rapidly increasing use of ENDS products, there remains a paucity of knowledge in this area,” said senior author Dr. Lisa Ipp, an associate professor in pediatrics at Weill Cornell Medicine. “Our goal is that this publication will serve as a comprehensive guide to educate practitioners so that they can inform teens and their parents about these substances.”
Because ENDS were introduced in the United States in 2007 and use has only recently become widespread, many practitioners lack knowledge about these products, Hildick-Smith said. Survey results from 2014, showing 83 percent of family practitioners and pediatricians know “nothing at all” or “a little” about ENDS, served as the research team’s motivation for creating the guide, he added.
Hildick-Smith connected with Dr. Michael Pesko, the Walsh McDermott Scholar in Public Health and an assistant professor of healthcare policy and research, whose current research is focused on ENDS, to brainstorm ideas for a guide that would be useful to the healthcare community.
Long-term health risks of ENDS are still unknown and they are “likely not as dangerous as conventional cigarettes,” Hildick-Smith said. Despite that, he maintains that e-cigarettes are a serious concern. ENDS are addictive and research has shown that they are “not as benign as they are advertised and they may expose teens to new health hazards,” Hildick-Smith added.
Weill Cornell Medical College.