Approach to Tobacco Use in Children and Adolescents: Diagnosis, Prevention and Treatment
Main Article Content
Abstract
Introduction: The use of ENDS (Electronic Nicotine Delivery Systems) among children and adolescents has become one of the most relevant emerging threats to public health. Their spread, driven by marketing strategies and appealing flavors, has encouraged a mistaken perception of safety. Evidence shows that early exposure to nicotine and toxic aerosols affects lung development, increases vulnerability to infections, alters neural reward circuits and facilitates the transition to conventional smoking. In Latin America, where regulatory frameworks are weak and surveillance limited, this phenomenon poses challenges for pediatrics, public health and health policies.
Methods: A critical analysis of scientific and regulatory evidence was conducted through a structured review of original articles, technical documents and international guidelines, emphasizing recommendations adaptable to the Latin American context.
Results: E-cigarette use among adolescents shows a sustained increase. It is associated with early respiratory symptoms, lower academic performance and a higher risk of nicotine dependence. In clinical settings, a comprehensive approach includes: (1) early detection using validated questionnaires, (2) brief motivational counseling, (3) youth-adapted cognitive behavioral therapy and (4) coordination with schools and families. From a regulatory perspective, evidence supports restricting advertising, limiting points of sale and banning appealing flavors for minors.
Conclusions: The use of ENDS in adolescents is not a safe alternative to tobacco but an emerging addictive phenomenon threatening to reverse progress in tobacco control.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
Organización Mundial de la Salud. Informe OMS sobre la epidemia mundial del tabaquismo. Ginebra: OMS; 2023 [Internet]. [Consultado 3 ago 2025]. Disponible en: https://iris.who.int/bitstream/handle/10665/374809/9789240083318-spa.pdf?sequence=1
The Tobacco Atlas. Prevalence of current smoking – Youth e-cigarette prevalence [Internet]. [Consultado 3 ago 2025]. Disponible en: https://tobaccoatlas.org/challenges/prevalence/
Park-Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA. Tobacco product use among middle and high school students — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71(45):1429–35. https://doi.org/10.15585/mmwr.mm7145a1
Álvarez-Orozco IF, Jurado-Hernández J, Marín-Agudelo H, Salvador-Oscco E, Caira-Chuquineyra B, Fernández-Guzmán D. Proportion of electronic cigarette use in Latin America and the Caribbean: A systematic review and meta-analysis [manuscrito no publicado]. 2025.
Birdsey J, Cornelius M, Jamal A, Park-Lee E, Cooper MR, Wang J et al. Tobacco product use among U.S. middle and high school students — National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–82. https://doi.org/10.15585/mmwr.mm7244a1
Di Cicco C, Sephic M, Beni A, Comberiati P, Peroni DG. How e-cigarettes and vaping can affect asthma in children and adolescents. Curr Opin Allergy Clin Immunol 2022;22(2):86–94. https://doi.org/10.1097/aci.0000000000000807
Farber HJ, Bars MP. Preventing and treating tobacco and nicotine use in pediatrics: considerations for clinicians. A clinical support chart. Itasca, IL: American Academy of Pediatrics; 2023.
Centers for Disease Control and Prevention (CDC). Diccionario visual de productos de cigarrillos electrónicos o vapeo [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/ecigarette-or-vaping-products-visual-dictionary-spanish-508.pdf
Jonas A. Impact of vaping on respiratory health. BMJ 2022;378:e065997. https://doi.org/10.1136/bmj-2021-065997
Albright K, Villandre J, Crotty Alexander LE, Zhang M, Benam KH, Evankovich J et al. The paradox of the safer cigarette: understanding the pulmonary effects of electronic cigarettes. Eur Respir J 2024;63:2301494. https://doi.org/10.1183/13993003.01494-2023
Fenech A, Baatjes N, Gunasuntharam K. Fifteen-minute consultation: What paediatricians need to know about vaping. Arch Dis Child Educ Pract Ed 2024;109:60–65. https://doi.org/10.1136/archdischild-2022-324752
Wills TA, Soneji SS, Choi K, Jaspers I, Tam EK. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur Respir J 2021;57:1901815. https://doi.org/10.1183/13993003.01815-2019
Alnajem A, Redha A, Alroumi D, Alshammasi A, Ali M, Alhussaini M et al. Use of electronic cigarettes and secondhand exposure to their aerosols are associated with asthma symptoms among adolescents: a cross-sectional study. Respir Res 2020;21:300. https://doi.org/10.1186/s12931-020-01569-9
Münzel T, Hahad O, Kuntic M, Keaney JF Jr, Deanfield JE, Daiber A. Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. Eur Heart J 2020;41(41):4057–70. https://doi.org/10.1093/eurheartj/ehaa460
Farber HJ, Sockrider MM. Chapter 26: Tobacco smoke exposure and children. En: Pediatric pulmonology, asthma, and sleep medicine. Itasca, IL: American Academy of Pediatrics; 2018.
Mylocopos G, Wennberg E, Reiter A, Hébert-Losier A, Filion KB, Windle SB, et al. Interventions for preventing e-cigarette use among children and youth: a systematic review. Am J Prev Med 2024;66(2):351–70. https://doi.org/10.1016/j.amepre.2023.09.028
Lorenzo-Blanco EI, Unger JB, Thrasher JF. E-cigarette use susceptibility among youth in Mexico: the roles of remote acculturation, parenting behaviors, and internet use frequency. Addict Behav 2021;113:106688. https://doi.org/10.1016/j.addbeh.2020.106688
Weser UV, Duncan LR, Pendergrass TM, Fernandez C-S, Fiellin LE, Hieftje KD. A quasi-experimental test of a virtual reality game prototype for adolescent e-cigarette prevention. Addict Behav 2021;112:106639. https://doi.org/10.1016/j.addbeh.2020.106639
Chávez C, Rousseau-Pierre C, Bu A, Gonzalez MP. Improving the delivery of e-cigarette screening and counseling services to adolescents. J Adolesc Health 2022;70(4 Suppl):S92–3. https://doi.org/10.1016/j.jadohealth.2022.01.094
Duncan LR, Pearson ES, Maddison R. Smoking prevention in children and adolescents: a systematic review of individualized interventions. Patient Educ Couns 2018;101(3):375–88. https://doi.org/10.1016/j.pec.2017.09.011
Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open 2015;5(3):e006976. https://doi.org/10.1136/bmjopen-2014-006976
Plaisime M, Robertson-James C, Mejia L, Núñez A, Wolf J, Reels S. Social media and teens: a needs assessment exploring the potential role of social media in promoting health. Soc Media Soc 2020;6(1):2056305119886025. https://doi.org/10.1177/2056305119886025
Hair EC, Kreslake JM, Rath JM, Pitzer L, Bennett M, Vallone D. Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults. Tob Control 2021;32(2):179–87. https://doi.org/10.1136/tobaccocontrol-2020-056047
Giustini D, Ali SM, Fraser M, Kamel Boulos MN. Effective uses of social media in public health and medicine: a systematic review of systematic reviews. Online J Public Health Inform 2018;10(2):e215. https://doi.org/10.5210/ojphi.v10i2.8270
Prokhorov AV, Pallonen UE, Fava JL, Ding L, Niaura R. Measuring nicotine dependence among high-risk adolescent smokers. Addict Behav 1996;21(1):117–27. https://doi.org/10.1016/0306-4603(96)00048-2
Wheeler KC, Fletcher KE, Wellman RJ, Difranza JR. Screening adolescents for nicotine dependence: the Hooked on Nicotine Checklist. J Adolesc Health 2004;35(3):225–30. https://doi.org/10.1016/j.jadohealth.2003.10.004
Graham AL, Cha S, Jacobs MA, Amato MS, Funsten AL, Edwards G, Papandonatos GD. A vaping cessation text message program for adolescent e-cigarette users: a randomized clinical trial. JAMA 2024;332(9):713–21. https://doi.org/10.1001/jama.2024.11057
Butler AR, Lindson N, Livingstone-Banks J, Notley C, Turner T, Rigotti NA et al. Interventions for quitting vaping. Cochrane Database Syst Rev 2025;1(1):CD016058. https://doi.org/10.1002/14651858.CD016058.pub2
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Guía SEPAR de práctica clínica de tratamiento farmacológico del tabaquismo. [Internet]. [Consultado 3 ago 2025]. Disponible en: https://drive.google.com/file/d/1AwOBj5n6VxcQWuBAqomVNML-QomKjxFi/view
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Infografía: Efectos del tabaquismo sobre la salud. [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.separ.es/node/418
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Notas de prensa [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.separ.es/enlosmedios
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Revista del área de tabaquismo: Prevención del tabaquismo. [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.separ.es/separcontenidos.es/site/?q=node/32
Jurado J, Álvarez IF, Oscco E, Caira-Chuquineyra B, Marín-Agudelo H, Fernández-Guzmán D. Clinical features, radiological findings, and deaths in patients with e-cigarette or vaping product use-associated lung injury (EVALI): a systematic review and meta-analysis. Datos no publicados; 2025.
Foulds J, Veldheer S, Yingst J, Hrabovsky S, Wilson SJ, Nichols TT et al. Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking e-cigarette users. Nicotine Tob Res 2015;17(2):186–92. https://doi.org/10.1093/ntr/ntu204
Recursos para pacientes:
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Infografías educativas: Nuevas formas de consumo del tabaco [Internet]. [Consultado 3 ago 2025]. Disponible en: https://drive.google.com/file/d/1izSrTs1lqzJqYCZtA_SbzJ89xfJ2Ii1Y/view
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). ¿Qué es el tabaquismo? [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.separ.es/?q=node/882
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Guía para pacientes: Tabaco no me fumes [Internet]. [Consultado 3 ago 2025]. Disponible en: https://drive.google.com/file/d/0B3-GelWPMn4dcmc1STNxaGJ1cEE/view?resourcekey=0-AIjC-_x7a2bV1kJlWh9_rA
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Folleto informativo sobre tabaquismo [Internet]. [Consultado 3 ago 2025]. Disponible en: https://drive.google.com/file/d/0B3-GelWPMn4dekZsc3JSczhkRDA/view?resourcekey=0-iBj-4KgLjofKK54rq6wn8w
Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Póster educativo: Tabaco [Internet]. [Consultado 3 ago 2025]. Disponible en: https://drive.google.com/file/d/0B3-GelWPMn4dQTlKV2cxdkpVeW8/view?resourcekey=0-6lYZPYKpH31Rf5T1BIuiTQ
Centers for Disease Control and Prevention (CDC). Cómo dejar de fumar [Internet]. [Consultado 3 ago 2025]. Disponible en: https://www.cdc.gov/tobacco/campaign/tips/spanish/dejar-fumar/index.html
Langley RJ, Dagli E, Bush A. E-cigarettes: WHO knows best. Arch Dis Child 2025;110(4):316–7. https://doi.org/10.1136/archdischild-2024-327395
Farber HJ, Rábade Castedo C, Jimenez-Ruiz CA, Pacheco MC. The fallacy of electronic cigarettes for tobacco dependence. Ann Am Thorac Soc 2024;21(10):1372–4. https://doi.org/10.1513/AnnalsATS.202405-465VP
Esteban-Lopez M, Perry MD, Garbinski LD, Manevski M, Andre M, Ceyhan Y et al. Health effects and known pathology associated with the use of e-cigarettes. Toxicol Rep 2022;9:1357–68. https://doi.org/10.1016/j.toxrep.2022.06.006
López-Ojeda W, Hurley RA. Vaping and the brain: effects of electronic cigarettes and e-liquid substances. J Neuropsychiatry Clin Neurosci 2024;36(1):A41–5. https://doi.org/10.1176/appi.neuropsych.20230184
Farber HJ. How harmful are electronic cigarettes? Manuscript in preparation. 2025.