E-Cigarette and Liquid Nicotine Exposures Among Young Children

Govindarajan, Preethi; Spiller, Henry A.; Casavant, Marcel J.; Chounthirath, Thiphalak; Smith, Gary A.

doi:10.1542/peds.2017-3361

Cited by 36 publications

(25 citation statements)

References 29 publications

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“…Deaths have been reported in children following ingestion of earlier generation, much lower nicotine e-liquids 29. Calls to poison control centres due to childhood nicotine exposure have proliferated since the introduction of e-cigarettes 30. As nicotine will absorb through intact skin, even contact of a concentrated e-liquid with a child’s skin could lead to toxicity.…”

Section: Discussionmentioning

confidence: 99%

Nicotine arms race: JUUL and the high-nicotine product market

2019

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ObjectiveUntil recently, purveyors of vaping products marketed e-liquids in the 1%–3% range of nicotine concentration with those at 3% described as ‘super high’ intended for two packs/day smokers. The goal of this study is to evaluate the degree to which JUUL, with its 5% nicotine and 75% US market share, has spurred other e-liquid vendors to raise the nicotine levels of their products.MethodsOnline search to identify brands offering e-liquid in exceptionally high nicotine concentration (≥5%) and to catalogue the appearance of devices which emulate JUUL.ResultsJUUL compatible pods (14) and JUUL knock off devices (39) were identified which offer equal or higher nicotine than JUUL. More than 70 e-liquid brands sell high-nicotine products (≥5%) in bulk (≥30 mL) equivalent to >40 cigarette packs. All of these products come in multiple youth appealing sweet and fruity flavours. It was noted that nicotine percentage is inconsistently reported (eg, JUUL is 5% by weight vs 5.9% by volume).ConclusionsJUUL has triggered a widespread rush among aerosol purveyors to market e-liquid in unprecedentedly high nicotine concentrations. The rapidly rising popularity of high-nicotine e-liquids threatens to addict a generation of youth. When sold in large quantity bottles (eg, 30 mL) they represent a childhood poisoning risk. Labelling of nicotine concentration in e-liquids needs to be standardised to avoid consumer confusion. The addictiveness and toxicity of these products makes it imperative that regulators act swiftly to enact protective measures.

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Section: Discussionmentioning

confidence: 99%

Nicotine arms race: JUUL and the high-nicotine product market

2019

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“…Nicotine when administered at higher concentrations may also promote carcinogenesis (33,41). With the increase in use of e-cigs, the incidence of accidental nicotine poisoning has also increased tremendously (15,25,71,76). While uncommon, reports of nicotine-related fatalities are not rare (15,16,18,67).…”

Section: Introductionmentioning

confidence: 99%

Acute pulmonary effects of aerosolized nicotine

Ahmad

Zafar

Mariappan

et al. 2019

American Journal of Physiology-Lung Cellular and Molecular Phys

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Nicotine is a highly addictive principal component of both tobacco and electronic cigarette that is readily absorbed in blood. Nicotine-containing electronic cigarettes are promoted as a safe alternative to cigarette smoking. However, the isolated effects of inhaled nicotine are largely unknown. Here we report a novel rat model of aerosolized nicotine with a particle size (~1 μm) in the respirable diameter range. Acute nicotine inhalation caused increased pulmonary edema and lung injury as measured by enhanced bronchoalveolar lavage fluid protein, IgM, lung wet-to-dry weight ratio, and high-mobility group box 1 (HMGB1) protein and decreased lung E-cadherin protein. Immunohistochemical analysis revealed congested blood vessels and increased neutrophil infiltration. Lung myeloperoxidase mRNA and protein increased in the nicotine-exposed rats. Complete blood counts also showed an increase in neutrophils, white blood cells, eosinophils, and basophils. Arterial blood gas measurements showed an increase in lactate. Lungs of nicotine-inhaling animals revealed increased mRNA levels of IL-1A and CXCL1. There was also an increase in IL-1α protein. In in vitro air-liquid interface cultures of airway epithelial cells, there was a dose dependent increase in HMGB1 release with nicotine treatment. Air-liquid cultures exposed to nicotine also resulted in a dose-dependent loss of barrier as measured by transepithelial electrical resistance and a decrease in E-cadherin expression. Nicotine also caused a dose-dependent increase in epithelial cell death and an increase in caspase-3/7 activities. These results show that the nicotine content of electronic cigarettes may have adverse pulmonary and systemic effects.

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“…Almost all (92.5%) of these exposures occurred from ingestion. The consequences of these exposures were so harmful that 35.1% of these children had to be seen for treatment at a healthcare institution 17. Thus, once e-liquids are brought into the household, whether it be through a sibling or even a parent, they pose a threat to the safety of toddlers.…”

Section: Discussionmentioning

confidence: 99%

Violation of US regulations regarding online marketing and sale of e-cigarettes: FDA warnings and retailer responses

2020

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BackgroundThe aim of this study was to characterise all 2018 Food and Drug Administration (FDA) warning letters specific to e-cigarette products and to evaluate whether online retailers complied with FDA requested actions.MethodsAll 2018 FDA e-cigarette warning letters issued by the Center for Tobacco Products to online retailers were reviewed and characterised. Date of issuance, name, type, and location of the retailer, and violation type were recorded. Retailer websites were rechecked a minimum of 30 days after the issuance of the warning letter to assess compliance with enforcement actions.ResultsOne hundred and thirteen of 124 letters met the inclusion criteria; one duplicate letter and 10 letters unrelated to e-cigarettes were excluded. One manufacturer was cited for associating their e-liquid with prescription drugs, and when analysed, the e-liquid was found to contain phosphodiesterase inhibitors. A majority of violations, 98.2% (111/113), pertained to the sales of an e-cigarette product to a minor and/or use of marketing that appeals to children. The majority of websites (63.7%, 72/113) resolved all violations. However, 19.5% (22/113) inactivated their website, and 16.8% (19/113) did not fully correct all violations.ConclusionsSales of e-cigarette products to minors and the purposeful marketing of e-liquids in a manner that appeals to children and adolescents continues to be problematic. While the warning letters were successful in getting a majority of online retailers to correct the stated violation, many sold other products that would be considered a violation of marketing to minors. The appearance of e-liquids that contain prescription medications is also alarming. Comprehensive and continued enforcement of online e-cigarette retailers is urgently needed.

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E-Cigarette and Liquid Nicotine Exposures Among Young Children

Cited by 36 publications

References 29 publications

Nicotine arms race: JUUL and the high-nicotine product market

Nicotine arms race: JUUL and the high-nicotine product market

Acute pulmonary effects of aerosolized nicotine

Violation of US regulations regarding online marketing and sale of e-cigarettes: FDA warnings and retailer responses

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