By AMERICAN HEART ASSOCIATION NEWS

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Until recently, the sale of e-cigarettes was like the Wild West, with almost no regulations for what ingredients they contained or how old you had to be to buy them.

But new rules from the U.S. Food and Drug Administration are adding some semblance of law and order to e-cigarettes, including the banning of their sales to anyone under 18.

“It’s about time,” said Dr. Jeffrey M. Schussler, medical director of Cardiac Rehabilitation at Baylor University Medical Center in Dallas. “Regulating addictive substances makes common sense, especially when e-cigarettes are appealing to minors and teenagers, who are an especially vulnerable population.”

The new regulations taking effect in August will require e-cigarette makers to register with the FDA and report to the agency all of the ingredients in their products. The new FDA rules also apply to cigars, hookah, pipe tobacco, and dissolvables.

E-cigarette use among high school students has jumped by 900 percent from 2011 to 2015, according to a recent survey by the FDA and Centers for Disease Control and Prevention.

In 2015, about 3 million middle and high school students were current e-cigarette users. 

The 2015 survey released this month by the CDC found that 24 percent of high school students reported using e-cigarettes during the past 30 days.

“As much progress as we have made in reducing cigarette use in teenagers, we have seen the use of e-cigarettes skyrocket, so the total number of young people using nicotine products actually went up last year,” said Matthew Meyers, President of the Campaign for Tobacco-Free Kids. “We’re seriously concerned that the increased use among young people has the potential to re-normalize smoking and make smoking cool and part of the social scene once again.”

The first concept of an electronic cigarette was patented in 1965 and an aerosolized version was patented in China. It entered the marketplace in 2003 and was patented internationally in 2007.

Some manufacturers championed them as a healthier alternative to traditional cigarettes, since they don’t contain smoke, tar or carbon monoxide. Sales have risen rapidly since then, and today, e-cigarettes are a multi-billion dollar business.

Some e-cigarettes resemble traditional cigarettes, while others look like cylindrical pipes or pens. Most contain nicotine, which is delivered by a heating element that turns a liquid “juice” into a smoke-like vapor you can inhale.

And no matter if you’re an adult or a minor, nicotine can be harmful.

“Nicotine is an addictive substance that can cause problems with heart rates and blood pressure and constriction of the heart arteries,” said Dr. Schussler.

“I have a lot of patients who smoke tobacco, and I don’t have a problem with them using e-cigarettes as a mechanism to wean themselves off smoking. But I’m not suggesting anyone pick up e-cigarettes as a new hobby — there’s nothing good about being addicted to nicotine.

“The new FDA rules will place other ingredients in e-cigarettes under increased scrutiny as well and “will help prevent misleading claims by tobacco product manufacturers, evaluate the ingredients of tobacco products and how they are made, as well as communicate their potential risks,” according to the administration.

Studies have shown there are health risks with e-cigarettes. One recent study by the Center for Environmental Health tested nearly 100 e-cigarette products and concluded that “the majority of e-cigarette products tested produce high levels of the cancer-causing chemicals formaldehyde and acetaldehyde.”

There’s also the issue of whether or not e-cigarettes are a stepping stone to traditional cigarettes – especially for teens.

“If you’re getting your nicotine fix from watermelon-flavored vapor, then the concern is that you end up smoking cigarettes which will lead that person to life-threatening problems down the road,” Dr. Schussler said.

According to the Centers for Disease Control and Prevention, smoking is the leading cause of preventable death, and tobacco use causes nearly 6 million deaths per year worldwide.

E-cigarettes are currently sold in hundreds of flavors, including chocolate, pizza and cookies-and-cream. Meyers, of the Campaign for Tobacco-Free Kids, said he’s disappointed the new FDA rules don’t ban flavored e-cigarettes outright.

“The majority of kids who start using e-cigarettes use flavored products, and many of them say they use e-cigarettes because of the flavors.  Our hope is the FDA will set the precedent that flavors that appeal to kids will no longer be permitted,” said Meyers.

“The new rules are a good start, but they’re just a start. This is the first step of what is likely to be a long journey,” he said.