Rising youth e-cigarette use threatens children’s health and human rights

Exposing children to e-cigarettes compromises their human rights. These products should be regulated in a way that puts children's best interests first and protects them from the harms associated with nicotine consumption in all its forms, argue experts in The BMJ today.

Children are now using e-cigarettes at higher rates than adults, write Tom Gatehouse and colleagues. Globally, the World Health Organization (WHO) estimates that 7.2% of children aged 13-15 currently use e-cigarettes. Data indicate use in this group is nine times that of adults, in countries which monitor both groups. 

As their brains are still developing, adolescents are particularly sensitive to nicotine exposure, which may have long term effects on attention, cognition, memory, and mood, they explain. They are also more susceptible to nicotine addiction, which can lead to problems with addiction and substance abuse later in life, and evidence is also growing that e-cigarettes may act as a gateway to tobacco smoking. 

Yet while protecting children's health is legally required under the UN Convention on the Rights of the Child (CRC), they point out that 62 countries still have no e-cigarette regulation.

An explicit link between tobacco control and children's rights was established in 2003 with adoption of the WHO Framework Convention on Tobacco Control, which the authors say is relevant to youth use of e-cigarettes as well as conventional tobacco products, since the framework obliges countries to prevent and reduce both tobacco consumption and nicotine addiction.

This link was reinforced in 2013 with recommendations that parties protect children from unhealthy food and drink, alcohol, solvents, illicit drugs, and "other toxic substances," which should obviously include e-cigarettes, they add.

The tobacco and nicotine industries argue that regulating e-cigarettes in the same way as conventional tobacco products will prevent people who smoke from switching to safer alternatives. For the authors, by stressing potential benefit to this group, these industries have persuaded governments "to downplay potential harms to a much larger group, which includes children."

They note that WHO recommends strong regulation of e-cigarettes to protect public health, with appropriate implementation. Options include bans on e-cigarette sales and, where they are not banned, measures similar to those that have helped reduce youth smoking rates worldwide, including strictly enforced age restrictions; restrictions on e-cigarette advertising, promotion and sponsorship; retail display bans; plain packaging; and bans or restrictions on flavours.

The overarching goal should be to reduce the appeal, availability, and affordability of e-cigarettes to children, as many countries have already done for tobacco, they say. 

Governments will need to be mindful of practical barriers to enforcement, such as social media marketing and transborder e-commerce, they add, but say pre-empting such challenges "will ensure that a child centric approach to e-cigarette regulation has the greatest chance of success."

"E-cigarettes are known to be harmful for those who do not smoke, particularly for children, regardless of any potential role in smoking cessation, or conversely, potential gateway effects," they write. "Governments are therefore legally bound to prevent their use among this demographic under the CRC and the WHO framework convention."

Given the uncertainty around the long term effects of e-cigarette use, they conclude: "The failure to protect children's right to health today could result in harms which span generations."