Children and e-cigarettes: a new threat to health

The widespread availability and use of e-cigarettes in many countries has established the need for an assessment of their effect on children. By the end of 2017 the number published annually on e-cigarettes had increased to 2976 and included 171 papers on e-cigarettes and children. The objective of this commentary is to provide a review and public health perspective on the effects of e-cigarettes on children. There are four public health questions to be answered: 1. Are e-cigarettes and replenishing fluids toxic on accidental ingestion? 2. If children smoke e-cigarettes is this harmful? 3. Does exposure to second hand vapour from e-cigarettes cause harm to children? 4. Are children (adolescents) who use e-cigarettes more likely to begin smoking conventional cigarettes? There were 2229 reported exposures to e-cigarette fluids and liquid nicotine in the USA in 2017 causing cardiovascular symptoms of varying severity. No deaths were reported although the potential is always there. Exposure to e-cigarette vapor is less dangerous than cigarette smoke. However it does damage pulmonary endothelium in experimental models. No long term studies are yet available on chronic diseases although vapor does contain carcinogens. Adolescents who use e-cigarettes are more likely to become tobacco smokers. Because of the accumulating evidence of harm to children great caution should be exercised in widening the public promotion and usage of e-cigarettes. Children should avoid any contact with E-cigarettes or their vapour.