Rutgers study finds e-cigarettes surpass cigarettes as top nicotine risk for young children
Electronic cigarettes have overtaken traditional cigarettes as the leading nicotine exposure risk for young children, according to a new Rutgers Health study.
The research, published in JAMA Network Open, found that while exposures to conventional tobacco products among children age 5 and younger declined by 43% between 2016 and 2023, e-cigarette-related incidents surged by 243% during the same period.
Researchers at the New Jersey Poison Control Center analyzed more than 92,000 reported nicotine exposures nationwide to assess how newer products, including disposable e-cigarettes and nicotine pouches, are changing risks for young children.
The study found that e-cigarette exposures often involved children inhaling vapors directly from the devices and were more likely to result in visits to health care facilities compared with cigarette exposures.
“This significant spike in children breathing in these substances tells us the risk has changed: It’s no longer just about a toddler swallowing something they found on the floor,” said Perry Rosen, the study’s lead author. “Many recent cases involve children actively using e-cigarette devices after gaining access to them.”
Researchers said young children may mimic behaviors they observe from adults or older family members.
“When children see caregivers or older family members vaping, they may copy that behavior—bringing the device to their mouth and inhaling—without any understanding they are exposing themselves to a harmful substance,” said Diane Calello, executive and medical director of the New Jersey Poison Control Center.
Unlike traditional cigarettes, e-cigarette devices are often brightly colored, easy to activate and may resemble toys, increasing their appeal to children, according to the study.
Despite federal laws enacted in recent years to raise the minimum age for purchasing tobacco products and restrict certain flavors, researchers said childhood nicotine exposures continue to rise.
New Jersey law requires liquid nicotine to be sold in child-resistant packaging, aligning with federal safety standards. However, researchers said those protections primarily address ingestion and may not prevent children from accessing and using devices.
“Child-resistant packaging may prevent a toddler from swallowing liquid nicotine, but it does nothing to stop a child from copying what they see an adult do,” Rosen said. “That’s why we need safety standards that address the device itself, not just the container.”
“Current laws which focus on child-resistant packaging for nicotine liquids, are no longer enough,” Calello said. “This study underscores the need for safety regulations at the device level. For example, manufacturers should be required to include flow restrictors or designs that make it more difficult for a child to activate a device.”
