Nicotine and the Developing Human

Abstract

The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale.

Tobacco and nicotine delivery product use in a national sample of pregnant women

“…On the one hand, the low and zero prevalence of e-cigarette use among former and never-smokers is encouraging. On the other hand, the fact that nearly one third of current tobacco cigarette smokers also use e-cigarettes, a product for which nicotine levels and nicotine-related impurities have been shown to vary across brands (England et al, 2015), may be of concern if it results in a greater level of nicotine exposure during pregnancy. Alternatively, if e-cigarette use among pregnant smokers signals interest in smoking cessation, this could be leveraged to reduce the risk of nicotine exposure in this group (Chivers et al, 2016).…”

Flavorings and Perceived Harm and Addictiveness of E-cigarettes among Youth

“…Although many have concluded that e-cigarettes are likely less harmful than conventional cigarettes, 36 there is, however, evidence suggesting they are not harmless. 37 For example, although the level of nicotine delivered to users via an e-cigarette is variable and the threshold for addiction to nicotine associated with e-cigarette use in youth is unknown, nicotine itself is still considered a highly addictive substance. In a neuroimaging study, exposure to intravenous nicotine increased neuronal activity in brain regions also shown to produce reinforcing and dependence properties associated with cocaine, amphetamine and opiates.…”

Self-reported reasons for vaping among 8th, 10th, and 12th graders in the US: Nationally-representative results

“…Use of nicotine in vaporizers can harm the developing adolescent brain (Breland et al, 2016), particularly affecting attention and learning. Nicotine also has a high potential for addiction (England et al, 2015; Kandel and Kandel, 2015). Recent studies show that adolescent use of e-cigarettes is associated with intention to use and actual use of regular cigarettes (Bunnell et al, 2015; Dutra and Glantz, 2014; Leventhal et al, 2015) and with progression to regular cigarette smoking (Primack et al, 2015), although additional research is needed.…”