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E-cigarettes don’t have labels that explain what chemicals they contain. Getty Images

Do you know what’s in that e-cigarette? Your kid likely doesn’t.

A new study published this week in the journal Pediatrics highlights a lack of awareness among adolescents about nicotine consumption and vaping.

Researchers found that 40 percent of participants who reported using nicotine-free products still had significant levels of nicotine biomarkers in their blood.

“The study demonstrates that nicotine is often an ingredient found in vape products, even though the user may not be aware of it,” said Patricia Folan, RN, CNP, director of the Center for Tobacco Control at Northwell Health in Great Neck, NY. Folan was not affiliated with the study.

In the study, researchers looked at self-reported data about tobacco, e-cigarette, and marijuana use among over 500 participants ages 12 to 21. Participants also gave urine samples to be tested for metabolites associated with tobacco and marijuana consumption.

It is one of the first to correlate self-reporting of e-cigarette products with biomarker data.

The study’s first author, Dr. Rachel Boykan, associate professor of clinical pediatrics at Renaissance School of Medicine at Stony Brook University, told Healthline that the findings about unintentional nicotine exposure among adolescents are concerning, but their work looking at total nicotine exposure paints a bleak picture for teen e-cig users.

The data shows that teens who vape can be exposed to just as much nicotine as traditional smokers; in some cases more.

Cotinine, the primary metabolite of nicotine, can be measured in the body and is a common indicator of exposure to tobacco. Researchers found that while cotinine levels were significant for e-cigarette users, users of so-called “pod products” — e-cigarette devices with an attachable cartridge, such as JUUL — had some of the highest levels.

The amount of nicotine exposure is concerning because of the potential for addiction.

“The goal of a pediatrician is to make sure that kids don’t start smoking,” said Boykan.

While national data sets from surveys have helped to form a picture of what the FDA has referred to as an epidemic of e-cigarette use among adolescents, the use of biomarker data, sadly, helps to confirm that.

“If you have kids who are using it much more frequently and you have kids who are using much higher content nicotine products, like the pods, like JUUL, they are going to have a lot more cotinine in their urine. It seems obvious but this really hasn’t been measured before,” said Boykan.

Pod products in particular have drawn the ire of the FDA because of their popularity among teens, and their high nicotine content.

According to Boykan, being able to correlate e-cigarette use and nicotine biomarkers in adolescents is an indicator of nicotine addiction, one that is likely fueled by products with deceptively high amounts of nicotine in them.

“The problem is and what a lot of these national studies have shown, we have good data now from the last several years, is that kids who use e-cigarettes are almost four times more likely to become regular smokers. Is that because of the nicotine addiction? I can’t say. It would make sense that there is that connection there,” said Boykan.

According to recent data, the amount of high school seniors who vaped in the past 12 months has jumped to 37 percent, up about 10 percent from 2017. Similarly, nicotine vaping also rose 10 percent.

Former FDA commissioner Dr. Scott Gottlieb made teen e-cigarette use a pillar of his tenure at the agency. However, public health experts and organizations like the American Lung Association have said his proposals have largely fallen flat.

The FDA’s proposed policies include:

  • Limiting the sale of flavored e-cigarettes in brick-and-mortar locations to age-restricted retailers, such as smoke shops, or within areas of stores that can only be accessed by individuals 18 or older.
  • Increasing regulation of e-cigarette products sold online through “heightened age verification processes.”
  • Prioritizing enforcement of the sale of flavored tobacco products and e-cigarettes aimed at minors. The agency has already warned companies with products or marketing that resembles “kid-friendly” foods and products.

The work of Boykan also seems to suggest that when it comes to labeling, nicotine content also needs to be more obvious as a means of preventing unintended consumption.

“This study highlights the fact that e-cigarette and vaping products do not have ingredient labels. Consequently, the user may not be aware of the nicotine content,” said Folan. “Regulation of these products is needed to educate the public, particularly teens who may never have smoked traditional cigarettes, about their contents and potential risks associated with their use.”