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Although serious medical outcomes were not common, authors of previous studies have found that e-cigarette and liquid nicotine exposures more often are serious and result in health care facility admission than exposures to traditional cigarettes.
In this study, the monthly number of reported liquid nicotine exposures climbed until Januaryfollowed by an overall downward trend through April Although the federal law may have contributed to this decline, its impact is uncertain because of a number of potentially confounding factors and the lack of a comparison group.
The frequency of exposures had been decreasing before its enactment. Various factors likely contributed to the observed decrease, including state legislation requiring child-resistant packaging; efforts by public health professionals, clinicians, and child Abstract adhd case study advocates to inform child caregivers of the risk of liquid nicotine exposures; and widespread media attention.
State legislation may have influenced child exposures even in states without liquid nicotine packaging laws because manufacturers may have begun to distribute child-resistant containers throughout the United States rather than produce different products for states with and without these requirements.
We were unable to detect differences in monthly liquid nicotine exposures before and after enactment of individual state legislation requiring child-resistant packaging for liquid nicotine containers because of the small number of exposures in individual states.
In addition, manufacturers and retailers were aware of the impending implementation dates of these state laws and may have begun to distribute child-resistant liquid nicotine containers before these dates. Prevention Although child-resistant packaging requirements for liquid nicotine containers have been established, more comprehensive requirements could further reduce the likelihood of serious poisonings.
Additionally, the Child Nicotine Poisoning Prevention Act only applies to liquid nicotine bottles and does not address the packaging or design of e-cigarette devices themselves.
Chambers in refillable e-cigarette devices in which the liquid nicotine is held are another source of exposure. Child-resistant chambers in e-cigarette devices could help prevent liquid nicotine exposure among young children.
Liquid nicotine comes in a variety of candy, fruit, dessert, and other flavors that may be attractive to young children. Bythere were unique flavors found across all e-cigarette brands.
The FDA passed a final rule on May 10,deeming all tobacco products, including e-cigarettes and liquid nicotine refill containers, under its authority. This required all e-cigarette products that went into market after February 15,to apply for FDA approval and also established several requirements that had to be implemented by varying deadlines.
Study Limitations This study has several limitations. Exposure calls to PCCs are voluntary; therefore, the NPDS underestimates the true incidence of exposures to liquid nicotine nationwide.
NPDS data may not be representative of the entire spectrum of liquid nicotine exposures because of potential reporting bias. Exposures reported to PCCs do not necessarily represent ingestion, poisonings, or overdoses because exposures are not generally confirmed with definitive laboratory testing.
Differentiation of liquid nicotine exposures due to e-cigarette devices versus e-cigarette liquids was uncertain, thus limiting the ability to assess the impact of child-resistant packaging laws that only apply to e-cigarette liquid containers. Although calls to PCCs regarding liquid nicotine exposures have decreased since Januarythe relationship of this decline with child-resistant packaging legislation is only an association; there are many other factors that may have influenced exposures and call rates.
Despite these limitations, the NPDS is a comprehensive data source useful for investigating liquid nicotine exposures in the United States. Conclusions Liquid nicotine can pose a serious poisoning risk for young children. Additional measures, including child-resistant e-cigarette devices, use of flow restrictors on liquid nicotine containers, and regulations on e-cigarette liquid flavoring, labeling, and concentrations, could further reduce the incidence of these exposures and the likelihood of serious medical outcomes when exposures do occur.
Footnotes Accepted February 21, Address correspondence to Gary A. The authors have indicated they have no financial relationships relevant to this article to disclose. The interpretations and conclusions in this article do not necessarily represent those of the funding organizations.
The authors have indicated they have no potential conflicts of interest to disclose.The study was published online February 17 in Pediatrics.. Helpful With or Without Meds. Neurofeedback and CT are 2 forms of computer-based attention training.
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