Send to

Choose Destination
Eur Respir J. 2018 May 30;51(5). pii: 1800278. doi: 10.1183/13993003.00278-2018. Print 2018 May.

Electronic cigarette use in youths: a position statement of the Forum of International Respiratory Societies.

Author information

Depts of Pediatrics, Cell Biology and Physiology, Washington University in St Louis, St Louis, MO, USA.
Dept of Pediatrics, Pulmonary Section, Baylor College of Medicine, Houston, TX, USA.
Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.
Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia.
Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Dept of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
International Union Against Tuberculosis and Lung Disease, Federal Way, WA, USA.
Dept of Clinical Medicine, FACIMED, Universidad Nacional del Comahue, Neuquen, Argentina.
Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA.


Children and adolescents are highly susceptible to nicotine addiction, which affects their brain development, even in those who smoke infrequently. Young people who become addicted to nicotine are at greater risk of becoming lifelong tobacco consumers. The use of nicotine-delivering electronic cigarettes has risen dramatically among youths worldwide. In addition to physical dependence, adolescents are susceptible to social and environmental influences to use electronic cigarettes. The product design, flavours, marketing, and perception of safety and acceptability have increased the appeal of electronic cigarettes to young people, thus leading to new generations addicted to nicotine. Moreover, there is growing evidence that electronic cigarettes in children and adolescents serve as a gateway to cigarette smoking. There can be no argument for harm reduction in children. To protect this vulnerable population from electronic cigarettes and other nicotine delivery devices, we recommend that electronic cigarettes be regulated as tobacco products and included in smoke-free policies. Sale of electronic cigarettes should be barred to youths worldwide. Flavouring should be prohibited in electronic cigarettes, and advertising accessible by youths and young adults be banned. Finally, we recommend greater research on the health effects of electronic cigarettes and surveillance of use across different countries.

Conflict of interest statement

Conflict of interest: H.J. Farber reports nonfinancial support from the American Thoracic Society for service as Chair, Tobacco Action Committee, and salary support from Texas Children's Health Plan for service as Associate Medical Director, outside the submitted work. A. Vanker reports receiving grants from the Bill and Melinda Gates Foundation (OPP1017641), the Discovery Foundation, the National Research Fund, South Africa, and the Medical Research Council, South Africa, and a Clinical Infectious Diseases Research Initiative Clinical Fellowship, outside the submitted work. T.W. Ferkol reports receiving personal fees from the American Thoracic Society for society leadership and the American Board of Pediatrics for service as a sub-board member, research grants from the National Institutes of Health and National Health and Medical Research Council, and has been an investigator on clinical and device trials for Parion Sciences and Circassia Pharmaceuticals, all outside the submitted work.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center