Nicotine addiction during teen years correlates with greater risk of subsequent addictions, such as opioids. It also increases depression, anxiety and hyperactivity. Many adolescents do not understand that e-cigarettes deliver nicotine and do not understand how addictive they are, often much more than traditional cigarettes. Physicians who care for adolescents should be prepared to provide them education on the dangers of smoking, e-cigarette use, and their vulnerability to addiction.
Recommendations for Patients who Smoke or Chew:
E-cigarettes may possibly help adult tobacco users to transition from traditional combustible cigarettes and oral tobacco to less harmful vapor products to satisfy their nicotine addiction. If a physician chooses to recommend e-cigarettes to their patients, they should caution against dual use of conventional tobacco and e-cigarettes as a way of sustaining their nicotine dosage in places where smoking is prohibited. Dual use can deepen nicotine addiction, making quitting less likely.
Policy Recommendations:
When balancing protecting youth from nicotine addiction versus helping adult smokers to transition, policy should first and foremost emphasize protection of our young.
Stronger measures should be enacted to deter underage sales of all tobacco products, including e-cigarettes. Consideration should be given to banning online sales or at least requiring universal adoption of effective age gates. Youth targeted advertising, such as social media, should be eliminated.
In 2009, Congress banned flavors from cigarettes with the exception of tobacco and menthol. Menthol should be prohibited for all tobacco products as its minty taste and anesthetic qualities (which lessen the harshness of smoke) make it a favorite among first-time teen starter smokers. Nicotine containing e-cigarettes should be marketed only with unsweetened tobacco flavor as sweet and fruity flavors have differential appeal to youth.
E-cigarettes containing high levels of nicotine are highly addictive for nicotine naïve teens. Such e-cigarettes are also more likely to satisfy the craving of addicted adult smokers and help them to switch from combustible tobacco. Policies should be enacted which reserve high nicotine e-cigarette products for adult smokers, perhaps by making them available by prescription only. Because of the risk of poisoning, nicotine containing e-liquids should be required to have child resistant packaging.
It is the position of the AAO-HNS that high quality, prospective research should be conducted on the effects of e-cigarettes on adults and children, as well as the efficacy of e-cigarettes as a means of switching patients from harmful tobacco use, with the goal of weaning them altogether from nicotine addiction.
Community Outreach and Advocacy:
Otolaryngology-Head & Neck Surgeons have important roles as educators in their communities and advocates for community health. Participation in youth education concerning the adverse health consequences of tobacco and e-cigarettes, as well as working with parents and teachers to encourage them to be advocates for health lifestyle choices, are encouraged.
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal,