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The electronic cigarette consists of a battery on the bottom and a bottom-coiled tank on top. Electronic cigarettes are growing in popularity, but concern still lingers nationwide about their safety.

(Diedra Laird/Charlotte Observer/MCT file photo)

By Mary E. O'Dowd

As part of National Poison Prevention Week (March 15-21), the New Jersey Department of Health (NJDOH) is working to raise awareness of the serious health risk, particularly to young children, of liquid nicotine commonly used in e-cigarettes. With the growing popularity of e-cigarettes, accidental exposure to liquid nicotine by children has become a serious public health concern.

The department's efforts call attention to the potentially deadly toxic properties of nicotine, an active ingredient used at varying levels in e-cigarette liquids, which are unregulated products sold over the counter in convenience stores.

The different flavors and different nicotine strengths that can be tried inside the Smokeless Image store on Washington Street in Hoboken.

Poison centers have seen a dramatic rise in e-cigarette-related calls, from one call a month in September 2010 to 215 calls a month in February 2014, according to the Centers for Disease Control. More than half of the calls involved children age five and under. An 18-month old toddler died in New York State last December after drinking from a container of liquid nicotine. E-cigarette and liquid nicotine-related calls to the New Jersey Poison Information and Education System (NJPIES) rose from nine in 2011 to 45 in 2014.

E-cigarettes, or electronic cigarettes, are battery-operated devices that contain a combination of nicotine, flavor and chemicals in various liquid combinations that are turned into vapor, which is inhaled by the user.

The liquids used to refill these devices are sold in cartridges, vials and small bottles that are not required to be childproof. The American Academy of Pediatrics maintains that some small (15 ml) bottles of e-liquid contain sufficient liquid nicotine to kill four small children. One swallow can be fatal.



Children may be drawn to the colorful liquid available in hundreds of tantalizing candy and fruit flavors with names such as "vivid vanilla," "cherry crush" and "cola."

According to the CDC, there are three routes of exposure that are toxic to children. Even without swallowing, when taken into the mouth, liquid nicotine will be absorbed into the child's mucous membranes, just like nicotine gum. If swallowed, it will be absorbed in the intestinal tract. If it comes into contact with a child's skin - through a spill, for example - the liquid nicotine is absorbed through the skin just like a nicotine patch.

Symptoms of liquid nicotine poisoning include vomiting, difficulty breathing, increased heart rate and a jittery and unsteady appearance.

The goal of NJDOH's liquid nicotine poison prevention effort is to protect the lives of children and prevent tragic and avoidable harm through public awareness and consumer protection. This initiative builds on New Jersey's leadership in addressing the health risks posed by e-cigarettes.

In 2010, New Jersey was the first state to include e-cigarettes as part of a comprehensive Smoke Free Air Act, which states that the use of e-cigarettes may pose a health risk to persons exposed to their smoke or vapor because of substances that may be potentially toxic to inhale. That's why use of e-cigarettes was banned in public places and workplaces and the sale of e-cigarettes was banned to people 19 years and younger.

The department is reaching out to partners across the state to join in alerting healthcare professionals and the public to the dangers of e-cigarettes and liquid nicotine. We are calling on local health departments to help distribute a warning advisory online and in the course of their routine inspections.

Parents, caregivers, other family members and friends who "vape," the popular term for e-cigarette smoking, need to be aware of the potential dangers and keep the e-cigarette devices and liquid nicotine refills stored safely out of reach of small children.

Anyone who suspects that a child has been exposed to liquid nicotine should call the New Jersey Poison Help Hotline at 1-800-222-1222, open 24/7/365.

According to the CDC, the nicotine poisoning problem may be underestimated, because its research reports only calls to poison control centers and doesn't include those whose symptoms were so severe they called 911 or went directly to the emergency room.

To learn more about e-cigarettes and the harmful effects of liquid nicotine, visit the U.S. Food and Drug Administration's website at fda.gov or go to the CDC's Office on Smoking and Health website at cdc.gov and type "e-cigarettes" into the search box.

Mary E. O'Dowd, M.P.H., is New Jersey health commissioner.

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