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Calling the growing popularity of electronic cigarettes “alarming and dangerous,” the American Academy of Pediatrics on Monday called for the federal government to restrict the sale of e-cigarettes to adults age 21 or older. Just one state, Hawaii, currently does that.

The association also urged tough federal regulations on e-cigarettes, including high taxes, a ban on advertising to minors, and a ban on flavored products that make e-cigarettes taste like gummy bears, cotton candy, peanut butter cups, and other kid-friendly treats.


The recommendations, published in Pediatrics, come as the US Food and Drug Administration is considering regulations on the $1.5 billion-a-year e-cigarette industry.

They also coincide with surging use of e-cigarettes, which work by heating tobacco leaves or liquid nicotine, releasing nicotine vapor that is inhaled like cigarette smoke.

More teens report using e-cigarettes than any other tobacco product, according to the Centers for Disease Control and Prevention. Last year, 13.4 percent of high school students said they had used electronic cigarettes in the previous month, up from just 1.5 percent in 2011.


Pediatricians worry that the nicotine in e-cigarettes could damage developing adolescent brains and cause other problems, including nicotine addiction. They point to toxic chemicals in the vapor released by e-cigarettes such as formaldehyde, a known carcinogen, and diacetyl, which can cause respiratory problems. For this reason, the pediatricians’ group recommends that indoor and outdoor smoking bans in place for traditional cigarettes also be applied to e-cigarettes.

Cynthia Cabrera, executive director of the Smoke-Free Alternatives Trade Association, called the proposed regulations unfair.

“Vapor products are not tobacco,” she said. “Vaporizers do not present the same risks as cigarette smoke. Why try to tax these products at the same rate as something that could kill you?”

Nonetheless, some state and local governments are moving forward with restrictions on e-cigarettes.

In September, Massachusetts Attorney General Maura Healey finalized regulations to prohibit the sale of e-cigarettes to those under 18.

Massachusetts joined 47 other states and territories prohibiting sales of electronic cigarettes to minors.

The Campaign for Tobacco-Free Kids is pushing states to extend those bans so that no one under 21 could purchase any tobacco product, including e-cigarettes. “It makes it less likely that 18- or 19-year-olds would pass these products along to younger kids,” said Vince Willmore, a spokesman for the advocacy group.

Cabrera, however, argued that making e-cigarettes harder for older teens to get could bring its own problems.

“They’ll just move to something else,” she said.

Dr. Karen Wilson, chair of the pediatric association’s tobacco control group, said older teens already hooked on e-cigarettes should get access to smoking cessation programs.