Last Dec. 9, a tragedy took place in upstate New York.
Around 4 p.m., emergency personnel were called to a home in the village of Fort Plain because a child was "unresponsive." The 18-month old boy was rushed to the hospital. A little before 6 p.m., he was pronounced dead. The cause of death? The toddler did what toddlers do; he opened a bottle of liquid -- one without a childproof cap -- and swallowed the contents, which happened to be the highly toxic liquid nicotine made for electronic cigarettes.
The American Academy of Pediatrics says this boy was the first child in the country to die from such an exposure. While that makes this incident a bit of an outlier, it's also fits the skyrocketing number of incidents involving youngsters ingesting liquid nicotine, one that mirrors the rising popularity of e-cigarettes.
Consider this growth in the number of calls to local poison centers for exposure to e-cigarettes and liquid nicotine. According to the American Association of Poison Centers:
- In 2011, there were 271 cases.
- In 2014, there were 3,831 cases; more than half involved children under age 6.
- In January, 387 cases, an early indication that 2015 could see yet another rise.
About three weeks after the death of the toddler in Fort Plain, New York Gov. Andrew Cuomo signed legislation requiring child-resistant packaging on liquid nicotine products sold in the state and banned their sale to anyone under 18. While this new law will help prevent future tragedies in New York, we urgently need national regulations for e-cigarettes, cigars and other tobacco products.
The frustrating part is that the federal government has yet to follow up on action it began taking last April.
The Food and Drug Administration (FDA) put forward a proposed "deeming rule," its plan for federal oversight of these products. Nearly a year later, we're still waiting for regulations to be finalized.
Without this step being taken, Americans have continued using these products without knowing how they're made, what's really in them or, in the case of e-cigarettes, what the long-term health effects might be.
A major concern is their rising popularity among youth. It's easy to see why.
Appealing flavors, alluring ads and easy access to e-cigarettes and cigars have made these products extremely attractive to kids. Almost 13 percent of high school students currently smoke cigars, according to the Centers for Disease Control and Prevention; and from 2011 to 2013, the number of middle and high school students who used e-cigarettes tripled -- even though they had never smoked a traditional cigarette, according to CDC and FDA.
Federal regulations would help reverse, and hopefully end, these disturbing trends in the following areas:
- Flavored e-cigarettes, cigars and other tobacco products
Last summer, the New York Times reported that e-cigarettes come in 7,000 flavors with more than 250 being added every month. The varieties are especially kid-friendly, with names of cereals (Cap'n Crunch and Froot Loops), candies (Tootsie Rolls), cookies (Thin Mints) and even cartoon characters such as Hello Kitty and Curious George. These "fun flavors" are clearly aimed at luring the young into taking their first hit of nicotine from one of these products. For this reason alone, they must be banned.
E-cigarette and cigar manufacturers are taking more than a page from the tobacco industry's handbook when it comes to selling their products. For example, spending on e-cigarette advertising climbed from5.6 million in 2010 to 82.1 million in 2013. The ads are flagrantly similar to tobacco ads of the past in their use of cartoon characters, celebrity spokespersons and sexual themes. This is further proof that the industry is trying to connect with a new generation of young people, encouraging them to light up to fit in and be "cool" like the celebrities they admire. Current advertising and marketing restrictions must be extended to include all tobacco products.
E-cigarette sales to minors are banned in 41 states currently. But minors in North Carolina bought e-cigarettes online in a recent study with no age verification in almost 94 percent of attempts. The research by the UNC Lineberger Comprehensive Cancer Center indicated that none of the teens were required to say how old they were when they placed an order or at delivery. The packages were just left on their doorsteps. Cigarette and smokeless tobacco retailers are required to check the ID of all customers at the time of purchase and again when the order is delivered. This standard also should be applied to all tobacco products.
As the heartbreaking story from Fort Plain reveals, if the liquid nicotine contained in these products is accidentally put within reach of a small child, the results can be devastating. There is currently no limit on how much nicotine e-liquid can contain. Conventional cigarettes include 10 to 15 mg of nicotine. E-cigarette solutions can have as much as 100 mg of nicotine. This high amount combined with no childproof packaging can be a fatal mixture. The FDA must help stop the increase in these exposures and take action immediately to keep these products away from children.
Since last April, when the FDA released their proposed rule, e-cigarettes have garnered the most attention. But there is another product that we feel strongly needs to be on the list for federal regulation -- cigars. Like their cousins e-cigarettes, cigars come in flavors that appeal to the young. They also include contaminants and chemicals that can be equally as toxic and carcinogenic as cigarette smoke, or even worse in some instances. Cigars must be brought under FDA control.
Time has become our enemy when it comes to these tobacco products. With every day that passes, they remain unchecked in the marketplace and grow in popularity among young Americans. Any further delay will mean more teen users with a dangerous addiction, and more children unintentionally exposed to deadly substances.
The FDA has indicated that it will finalize the tobacco rule by June. We strongly urge the agency to meet that target, or better yet, release the regulations even sooner, and put an end to this growing public health threat.
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