Retrospective review of nicotine exposures in California from 2012 to 2018 and analysis of the impacts of e-cigarette regulations.

Introduction:
This text provides an analysis of the association between US e-cigarette regulations and the number of reported nicotine exposures in California from 2012 to 2018. The study identifies higher-risk products and examines the impact of the Child Nicotine Poisoning Prevention Act of 2015 and the 2017 Food and Drug Administration Compliance Policy.

Key Points:

* The study examined 5277 exposures, of which 3033 involved combustible cigarettes, 1489 involved e-cigarettes, and 818 involved other substances.
* Implementation of the Child Nicotine Poisoning Prevention Act of 2015 was not significantly associated with reduced exposures.
* Exposures for e-cigarettes increased significantly after the 2017 FDA Compliance Policy.
* Total exposures for all tobacco and nicotine products also increased significantly after the policy change.
* Nicotine exposure outcomes classified as being of minor and moderate severity increased significantly after implementation of the 2017 Compliance Policy.
* Ingestion was the most common route of exposure, followed by inhalation, dermal, ocular, and other routes.
* Exposure cases involving e-cigarettes fell into three problem categories: product design, labelling, and the appeal of flavors.

Main Message:
The study concludes that current regulations are insufficient to reduce nicotine toxicities due to e-cigarette use. The analysis found that despite previous studies suggesting that the Child Nicotine Poisoning Prevention Act appeared to have reduced exposures for e-cigarettes, there was no significant change in exposures after its implementation. Instead, there was a 30% increase in California e-cigarette exposures following the 2017 Compliance Policy. Therefore, the study emphasizes the need for more effective regulations to protect public health from the harmful impacts of liquid nicotine and address the rapid rise in poisonings associated with vaping.

Driller G, Plasencia E, Apollonio DE. Retrospective review of nicotine exposures in California from 2012 to 2018 and analysis of the impacts of e-cigarette regulations. BMJ open. 2021;11(3):1. doi:10.1136/bmjopen-2020-043133