Recently, there has been a significant increase in the use of noncombustible nicotine-containing products, including electronic cigarettes (e-cigarettes). Of increasing popularity are e-cigarettes that can deliver high doses of nicotine over short periods of time. These devices have led to a rise in nicotine addiction in adolescent users who were nonsmokers. Use of noncombustible nicotine products by pregnant mothers is also increasing and can expose the developing fetus to nicotine, a known teratogen. In addition, young children are frequently exposed to secondhand and thirdhand nicotine aerosols generated by e-cigarettes, with little understanding of the effects these exposures can have on health. With the advent of these new nicotine-delivery systems, many concerns have arisen regarding the short-and long-term health effects of nicotine on childhood health during all stages of development. Although health studies on nicotine exposure alone are limited, educating policy makers and health care providers on the potential health effects of noncombustible nicotine is needed because public acceptance of these products has become so widespread. Most studies evaluating the effects of nicotine on health have been undertaken in the context of smoke exposure. Nevertheless, in vitro and in vivo preclinical studies strongly indicate that nicotine exposure alone can adversely affect the nervous, respiratory, immune, and cardiovascular systems, particularly when exposure occurs during critical developmental periods. In this review, we have included both preclinical and clinical studies to identify age-related health effects of nicotine exposure alone, examining the mechanisms underlying these effects.

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AIM To determine patterns of participation and levels of enjoyment in young people with spinal cord injuries (SCI) and to assess how informal and formal participation varies across child, injuryrelated, household, and community variables.METHOD One hundred and ninety-four participants (106 males, 88 females; mean age 13y 2mo, SD 3y 8mo, range 6-18y) with SCI and their primary caregivers completed a demographics questionnaire and a standardized measure of participation (the Children's Assessment of Participation and Enjoyment, [CAPE]) at three pediatric SCI centers in a single hospital system in the United States. Their mean age at injury was 7 years 2 months (SD 5y 8mo, range 0-17y); 71% had paraplegia, and 58% had complete injuries.RESULTS Young people participated more often in informal activities (t (174) =29.84, p<0.001) and reported higher enjoyment with these (t (174) =2.01, p=0.046). However, when engaging in formal activities, they participated with a more diverse group (t (174) =)16.26, p<0.001) and further from home (t (174) =)16.08, p<0.001). Aspects of informal participation were related to the child's age, sex, and injury level, and formal participation to the child's age and caregiver education. Caregiver education was more critical to formal participation among young people with tetraplegia than among those with paraplegia (F (4,151) =2.67, p=0.034).INTERPRETATION Points of intervention include providing more participation opportunities for young people with tetraplegia and giving caregivers the resources necessary to enhance their children's formal participation.A spinal cord injury (SCI) is a life-changing event and is particularly devastating when it occurs during childhood. Many unique challenges exist for children with SCI as a result of both the injury and the dynamic growth and development issues that occur during childhood.1 One area of particular concern is that of participation. The World Health Organization 2 defines participation as 'involvement in a life situation' and the result of peer interaction within an individual's social and physical environment. Researchers have found that involvement, particularly in physical recreation and sports, is highly related to overall health, disease prevention, maintenance of functional independence, 3 and life satisfaction. Despite this, rates of participation tend to be lower among young people with disabilities. 5 In the present study, we explored participation among young people with SCI.Participation is essential to the development of children. It is often through participation that children learn about societal expectations, develop communication skills, build friendships, and conquer important milestones while gaining skills and knowledge imperative to success at home and in the community. 6 Children with disabilities are at risk of decreased participation.5 A disability creates a major disruption in children's ability to play and interact with their environment. 7 This disruption may adversely affect the developmental process, as lack of so...

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