Ask Dr. BellCigarette smoking is the leading cause of preventable disease and death in the United States. For most smokers, tobacco use and addiction begin during adolescence. Fortunately, over the last 20 years significant strides have been made to decrease cigarette use in that age group, to the point where only about 9 percent of high school students use cigarettes today.

But this accomplishment has been tempered by the emergence of new tobacco products, particularly electronic cigarettes, or e-cigarettes. These handheld devices produce a vapor created from a solution of nicotine, flavored chemicals, propylene glycol and, often, other ingredients unknown and unadvertised to the consumer. The past five years have seen a significant increase in middle and high school students’ use of e-cigarettes; they are now the most commonly used tobacco product within this demographic.

A recent American Academy of Pediatrics (AAP) policy statement sounded concern over the potential for e-cigarettes to addict a new generation of youth to nicotine, reversing more than 50 years of public health gains in tobacco control. I asked CHOP attending physician, PolicyLab faculty member and tobacco-control expert Brian Jenssen, MD, MSHP, to weigh in on the issue of e-cigarette use among teens. Dr. Jenssen, who serves on the AAP Section on Tobacco Control, says that while most people — even physicians — mistakenly believe that these products are less harmful than conventional cigarettes, the true health risks aren’t known. Early studies suggest that e-cigarette use results in an addiction to nicotine, which has neurotoxic effects on the developing brains of adolescents. And the vapor these devices emit contains heavy metals and carcinogens that pose an unknown risk to both users and non-users.

A gateway

Studies also suggest that e-cigarettes — with their confectionery-flavored solutions and sleek advertising — are attracting youth who might not otherwise have used tobacco products. And there is concern that adolescents who become addicted to the nicotine from e-cigarettes will be more likely to go on to use traditional cigarettes.

The good news is that as of August 2016, the Food and Drug Administration now regulates e-cigarettes, which will affect how these products are manufactured, marketed and sold. The goal now is to expand research and educate parents, teachers and the general public, thereby deterring youth from ever trying the products in the first place.

“What we emphasize for teenagers is, ‘Never even smoke one,’” says Dr. Jenssen. “Because even just one could send you on a pathway toward tobacco use, addiction and early death.”