Although young children’s exposure to cigarettes is decreasing, electronic nicotine products are exposing young children to new risks of inhalation, Rutgers Health researchers say.
Researchers at the New Jersey Poison Control Center, based at Rutgers New Jersey Medical School, used the National Poison Data System to analyze more than 92,000 nicotine exposures in children under 5 years of age reported between 2016 and 2023 to understand how the rise of new products, particularly disposable e-cigarettes and nicotine pouches, has changed risks to young children.
They found that while exposure to cigarettes from traditional products such as cigarettes has decreased by 43%, e-cigarette-related incidents have increased by 243% over the past eight years, with many involving children directly inhaling vapor from e-cigarettes. They also found that children exposed to e-cigarettes were more likely to require a visit to a health care facility compared to children exposed to cigarettes.
“The huge spike in children inhaling these substances tells us that the risks are changing. It’s no longer just a toddler swallowing something on the floor,” said lead author Perry Rosen, who conducted the study at the New Jersey Poison Control Center before becoming a medical student at New York Institute of Technology’s College of Osteopathic Medicine. “Many of the recent incidents have involved children gaining access to e-cigarettes and then actively using them.”
Young children naturally imitate behaviors they see around them. “When children see their caregivers or older family members vaping, they may imitate that behavior without understanding that they are being exposed to harmful substances,” said Diane Calero, executive and medical director of the New Jersey Poison Control Center. Unlike cigarettes, these devices are often ready to use, brightly colored, require little effort to activate, and look more like toys than harmful products.
Even moderate, sustained exposure among users of e-cigarette products, including adolescents, is associated with lasting health effects on the developing lungs, including increased risk of bronchitis and worsening of asthma, although such effects have not yet been reported in young children.
Despite federal laws passed in 2019 and 2020 raising the minimum purchase age and restricting certain flavors, the upward trend in childhood addiction continues.
In New Jersey, liquid nicotine can only be sold in child-resistant containers that adopt federal safety standards that require packaging that cannot be easily opened by young children under the New Jersey Liquid Nicotine Child-Resistant Containers Act (NJSA 2A:170‑51.9). The state law is in line with the federal Child Nicotine Addiction Prevention Act of 2015, which requires child-safe “special packaging” on all liquid nicotine products nationwide. However, although these may prevent the child from swallowing liquids, the child may still be tempted by the attractive device and imitate the behavior he or she sees, i.e., inhaling nicotine.
He stressed that existing protections primarily focus on liquid nicotine ingestion, not behavioral exposure. “Child-safe packaging may prevent young children from swallowing liquid nicotine, but it does not prevent children from imitating what adults are doing,” Rosen said. That’s why we need safety standards that cover not just the containers, but the devices themselves. ”
“Current legislation focused on child-safe packaging of nicotine e-liquids is no longer sufficient,” Calero said. “This study highlights the need for safety regulations at the equipment level. For example, manufacturers should be required to include flow restriction devices and designs that make it more difficult for children to operate the equipment.”
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DOI: 10.1001/jamanetworkopen.2026.0479. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845878
