E-cigarettes linked to higher pediatric admissions

1. When comparing children exposed to e-cigarettes to children exposed to regular cigarettes, the former had 5.2 times higher odds of health care facility admissions and 2.6 times higher odds of severe medical outcomes.

2. Exposures to e-cigarettes increased by 1492.9% from January 2012 to April 2015.

Evidence Rating Level: 2 (Good)

Study Rundown: The effects of cigarette smoking is a well-studied topic, with several major studies demonstrating an overall downtrend in cigarette smoking over the past couple of decades. As an alternative to cigarette smoking, many have chosen what they believe to be the “safer” alternative: e-cigarettes. This study aimed to analyze the effects of e-cigarettes on the pediatric population since its introduction to the public in 2007. An analysis of calls to the National Poison Data System (NPDS) over a 40-month period indicated that 60.1% of these calls were for cigarette exposures, 14.2% for e-cigarettes, and 16.4% for other tobacco products (i.e. chewing tobacco, snuff). While 95.5% of overall exposures occurred via ingestion, 1.7% occurred via non-ingestion. Further analysis, in contrast, found that 8.9% of e-cigarette exposure occurred via non-ingestion. In addition, children exposed to e-cigarettes not only had a higher rate of hospital admission but also higher odds of having a severe outcome than children exposed to cigarettes. One limitation was the voluntary reporting of data via phone calls, thus possibly underestimating the frequency of exposures. In addition, being that e-cigarettes are a relatively newer phenomenon, physicians are more likely to report exposure to a newer product, as opposed to reporting cigarette exposure outcomes. Providers should educate parents who utilize the e-cigarette about these detrimental effects on children and help to provide safer alternatives to smoking cessation.

Click to read the study, published today in Pediatrics

 Relevant Reading: American Academy of Pediatrics State Government Affairs. Liquid nicotine poisoning. State advocacy FOCUS.

In-Depth [retrospective cohort]: From January 2012 to April 2015, 29 141 calls were recorded for nicotine and tobacco product exposures in children ≤6 years old. Symptoms from exposures were categorized as (1) minor effects, such as skin/mucosa irritation, (2) moderate effects, such as non-life threatening systemic effects without residual disability, and (3) major effects, including life-threatening events with residual disability. Moderate and major effects were then further labeled as severe outcomes. 79.6% of children exposed were ≤2 years old. Over the study period, the monthly number of nicotine and tobacco exposure increased by 73.2%, from 563 in January 2012 to 975 in April 2015 (p<0.01). This increase was primarily driven by an increase in e-cigarette exposures without a monthly increase in cigarette exposures (p=0.08) or other tobacco products (p=0.18). Exposures to e-cigarettes increased by 1492.9%, from 14 in Jan 2012 to 223 in April 2015. Children exposed to e-cigarettes were 23.4% more often referred a health-care facility (HCF) by a poison control center (PCC). In addition, children exposed also had a higher odds of being admitted to a HCF (OR 5.19, 95% CI 3.60–7.48) and higher odds of suffering a severe outcome (OR 2.60 95% CI 1.96–3.46) than those exposed to cigarettes.

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