AHA Urges Immediate Action to Curb Vaping Among Youth

Action is needed now to reduce or prevent adolescents from accessing and using electronic cigarettes, the American Heart Association (AHA) concludes in a new scientific statement.

Since their introduction in the American market in the early 2000s, e-cigarettes have become increasingly popular among adolescents.

Current scientific evidence indicates that use of these vaping products has harmful effects on health that can accrue over time, leading to an increased risk for cardiovascular and pulmonary disease in long-term users, the writing group says.

“Inhaling any foreign substance can have effects on the respiratory and cardiovascular systems,” writing group chair Loren E. Wold, PhD, Ohio State University College of Medicine, Columbus, says in an AHA news release.

“Furthermore, a person’s lung development continues into the early 20s, so adolescents who vape are at risk for stunting or altering their lung development and may not reach full lung function,” Wold adds.

The AHA statement addressing the cardiopulmonary consequences of vaping in adolescents was published online June 21 in Circulation Research.

Multiple Hazards, Lack of Regulation

Previous work has shown that vaping increases the risk for multiple respiratory problems, including wheezing and cough, asthma, increased susceptibility to lung infections, and respiratory disease, the writing group says.

Studies in young adult vapers show acute hemodynamic changes, including higher arterial stiffness, impaired endothelial function, and increased blood pressure, heart rate, and sympathetic tone. Long-term e-cigarette use is also associated with increased arterial stiffness and sympathetic tone.

The writing group acknowledges that most studies on the harmful health effects of vaping have been conducted in adults and animals.

“It is imperative that we determine the short- and long-term adverse consequences of vaping in adolescence because it is likely that health effects will be observed many years in the future,” they write.

For now, however, the evidence is sufficient to prompt the AHA to call for increased regulation of e-cigarettes in adolescents.

The novelty and customizability of e-cigarettes, including power levels, e-liquid content, and the abundance of flavors “appeals to young people, and it also makes regulation of these products difficult,” Wold says.

Although the US Food and Drug Administration (FDA) has banned the mint and fruit flavors of e-liquids that are popular with adolescents, menthol-flavored products remain on the market.

Additionally, in the United States, there are currently no limits on the concentration of nicotine allowed in e-liquids. Some devices have been shown to have nicotine levels of 59 mg/mL, whereas the European Union limits nicotine concentration in e-liquids to no higher than 20 mg/mL, which is on par with nicotine levels in one standard (combustible) cigarette.

Key actions recommended by the AHA to help reduce or prevent youth from using e-cigarettes include:

• Implement better measures to reduce youth access to e-cigarettes, including strict age verification at place of sale and the prohibition of marketing directed at youth.

• Provide more education for youth and their parents regarding the confirmed and potential health risks of e-cigarette use.

• Establish vaping curricula for medical students to inform the next generation of healthcare professionals.

• Ensure hospital-based vaping-cessation programs exist for adolescents and adults.

• Regulate the marketing of e-cigarette products in traditional, online, and social media platforms that are popular among youth.

• Incorporate e-cigarettes into smoke-free air policies.

The scientific statement was prepared by the volunteer writing group on behalf of the AHA Council on Basic Cardiovascular Sciences; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Hypertension; and the Stroke Council.

This research had no commercial funding. Members of the writing group have declared no relevant financial relationships.

Circulation Res. Published online June 21, 2022. Abstract

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