The CDC looked at tobacco product use among U.S. youth from 2017 to 2018 and the results are alarming, with e-cigarettes called out as the main culprit for the increase.

Use of any tobacco product grew by 38.3 percent among high school students in the last year and 4.9 million youth became current tobacco product users in 2018.

E-cigarette use increased from 11.7 percent to 20.8 percent among high school students and from 3.3 percent to 4.9 percent among middle school students from 2017 to 2018. No change was found in the use of other tobacco products, including cigarettes, during this time.

“E-Cigarettes are often promoted as safer alternatives to cigarette smoking,” said Don Wilson, M.D., an endocrinologist at Cook Children’s. “But the promotion of any addictive behavior in youth is potentially harmful, and can be translated into other addictive behaviors and may alter social development. Recent scientific evidence suggests that in addition to nicotine, which can be harmful to the cardiovascular system and brain, the ingredients inhaled during vaping are likely harmful and may lead to adverse health consequences, such as cancer.”

Dr. Wilson said e-cigarettes are designed to simulate the act of smoking and delivering nicotine, which is highly addictive.

“Even though exposure to toxic chemicals for a single vaping session may be limited, there is likely a cumulative affect for youth who start vaping at a young age and continue to do so over lifetime,” he said.

Recent research suggests nicotine exposure may also cause the brain to become addicted to other substances. Youth nicotine use can lead to addiction and can harm the developing brain, impacting learning, memory and attention. Vapor from some e-cigarettes has also been shown to contain known cancer producing and toxic chemicals, such as diethylene glycol and nitrosamines, as well as small particles of toxic metals.

Dr. Wilson points out this latest in-depth study from the CDC only adds to the growing concern among other health care experts in recent years.

Vaping “has the potential to create a whole new generation of kids who are addicted to nicotine,” said Vivek Murthy, M.D., then the U.S. surgeon general, said in December 2016.

JUUL is the most commonly sold e-cigarette in the U.S. It’s shaped like a USB flash drive and is easy to conceal. JUUL uses liquid nicotine refills called “pods,” which contain at least as much nicotine as a pack of cigarettes and are available in flavors that appeal to youth. The product is being used by youth in schools, including inside bathrooms and classrooms.

The CDC asks that parents set a positive example by not using tobacco product themselves and learn about different types and risks of tobacco products including e-cigarettes.

Read the full report from the CDC here.

Get to know Don P. Wilson, M.D.

Although most of his professional focus has been in the area of childhood diabetes, Dr. Wilson has expanded his role in the related areas of childhood obesity, insulin resistance and dyslipidemia. He is board certified by the American Board of Lipidology, a Fellow of the National Lipid Association and an Associate Editor for the Journal of Clinical Lipidology. Dr. Wilson is currently a member of the board of directors of the Southwest Lipid Association and the American Board of Clinical Lipidology.

Recognizing that current approaches have proven inadequate to identify and effectively address the growing concern of premature cardiovascular disease, Dr. Wilson has been working with local, regional and national experts to create a better clinical care model that will provide enhanced health care, assessment, research and education for children and adolescents with genetic and acquired forms of dyslipidemia.

When your child looks and acts healthy, it’s hard to understand how they could have a condition that, without proper treatment, could cause them to have a heart attack or stroke before the age of 50. Maria Gutierrez found herself in this situation when she received a life-changing phone call from Don Wilson, M.D., an endocrinologist and medical director of the REACH Clinic at Cook Children’s to discuss her daughter Kate.

When Kate was 4 years old, doctors told Maria that Kate was overweight and might be developing thyroid issues. Maria encouraged Kate to be more active and eat healthier. Her daughter’s change of lifestyle seemed to be the answer and by age 7 Kate was no longer overweight.

“Kate is always very hyper, very active. She eats vegetables! She loves cucumbers, lemons, loves fruits, loves everything,” Maria said. “Why would doctors call now to suggest blood tests when she’s healthy?”

According to the REACH (Risk Evaluation to Achieve Cardiovascular Health) Clinic, ideal total cholesterol levels should be less than 170 mg/dL, or LDL cholesterol levels (sometimes called “bad cholesterol”) less than 130 mg/dL. Kate’s lab work showed her cholesterol levels at 250 mg/dL, and she was diagnosed with hypercholesterolemia.

Hypercholesterolemia is a condition characterized by high levels of cholesterol in the blood. The condition is frequently caused by a genetic condition and kids can be at risk even when they are living a healthy, active lifestyle. The good news is that with early detection made possible by a routine blood test and medication to lower the cholesterol to safe levels, children with high levels of cholesterol can avoid serious health issues such as a heart attack or stroke when they become adults. But for children with genetic causes of high cholesterol, a healthy lifestyle is not enough.

Maria realized that Kate’s levels matched that of her husband’s, Roberto Macedo, who is diabetic. Dr. Wilson decided to test Kate to see if she had a genetic condition that would cause her cholesterol to be high. When she tested positive, Maria brought in her older son Brandon, 10, too. Brandon also tested positive for the gene. Brandon’s Vitamin K levels were also extremely high, putting him at risk of blood clots.

Both Kate and Brandon take medicine daily to treat their high cholesterol. Their schedules for lab work vary depending on how well they respond to their medication. It’s been two years since their diagnoses.

Right now, Brandon is coming in monthly to monitor his Vitamin K levels. If his medicines do not improve his condition, his dosages will have to be changed. Fortunately, with medication both children have achieved a healthy level of blood cholesterol. Like virtually all children treated with cholesterol medication, Dr. Wilson notes that none of the children have experienced side effects, and all have shown normal growth and development.

Everyday decisions, like what’s for dinner, are potential health risks for Brandon and Kate. They’re kids, so of course they want treats every once in a while. Maria says for her family “if they want a burger, they have to eat really healthy during the week and they can have just one hamburger at the end of the week, but with lettuce and tomato. It’s all about the balance.”

What’s hardest for Maria is knowing that there currently isn’t any cure for her children’s conditions. “I feel really bad because there is no way I can help them. The only way I can help is with what they eat, get plenty of exercise and make sure they take their medicine every day,” said Maria.

What’s even more difficult for her is the fact that not everyone believes Maria when she explains her kids have high cholesterol. She hears this a lot, “They aren’t fat, how can they have high cholesterol?” Maria explains that it’s genetic, and there isn’t much they can do other than to make sure her kids take their medicine, eat healthy and stay active.

But Maria’s children aren't alone. Genetic causes of high cholesterol affects 1 out of every 250 children, and it is one of the most frequent health concerns that affect children. For kids with genetic causes of high cholesterol, early treatment with cholesterol lowering medication is readily available, inexpensive, and most importantly, has proven to be safe and effective.

“It’s hard to understand that little kids can have this issue. They look fine, but they could become diabetic if their levels don’t go down. Or be at risk of having a heart attack or stroke when they’re adults” Maria said.

According to Dr. Wilson, left untreated, 50 percent of men and 30 percent of women with this condition will experience a heart attack by age 50.

Hypercholesterolemia is a challenge that Kate and Brandon face every day, yet an outsider could easily never notice. Maria hopes to bring awareness to her children’s conditions; she wants others whose children appear healthy but face health issues to know that they aren’t alone.

View this video  to learn about high cholesterol.

Harper was born with a rare genetic disorder called familial chylomicronemia syndrome (FCS) that causes a build-up of dietary fats, often resulting in pancreatitis, acute inflammation of the pancreas and severe abdominal pain. FCS is so rare estimates vary; but experts believe about one to two per million are likely to have the syndrome.

"It was really crazy at first because I went from breastfeeding to having to get formula, and it wasn't your everyday formula," Harper's mother Kendra Braughton said. "This was our first baby, too, so we didn't even really know what to expect."

Many people who have FCS live with severe pain for years as they receive misdiagnosis after misdiagnosis. Although Harper's condition was diagnosed at nine months, she still encountered a fair share of medical missteps.

"When we first took her to a specialist in Dallas, we actually took her to a cardiologist on the recommendation of our pediatrician," Harper's father Chris Braughton said. "After she put her on flaxseed oil, Harper ended up getting hospitalized with pancreatitis . Unbeknownst to us, it was because her body can't tolerate fat."

It wasn't until her hospitalization that Harper's family knew they had to dig deeper to find an answer that would give them an unfamiliar diagnosis, and would lead them to the Cook Children's Endocrinology Program.

Kendra's mother works for a Dr. Dennis Canon in Canyon, Texas. She spoke to the physician about Harper's condition. He did some research and found information he thought matched Harper's symptoms. Dr. Canon emailed Don P. Wilson, M.D., a Cook Children's endocrinologist, to ask for help.

Despite the rarity of the syndrome, Dr. Wilson is nationally known for treating patients with FCS. Dr. Wilson and his team currently care for 12 patients from around the nation, including six from Texas.

"Receiving such a rare diagnosis was shocking at first, but once Dr. Wilson explained what it was and how to manage it, and that it was really going to change us more than her, we realized we could do this," Chris said.

Normal triglyceride levels in a healthy person are typically less than 150 mg, however patients with FCS can reach levels of 10 times that amount. With a correct diagnosis, Harper could now be treated for her condition.

Dr. Wilson orders a lipid profile and Harper's triglyceride levels are closely monitored every six months to ensure she doesn't fall into another case of pancreatitis. Her triglyceride levels have remained around 700, which may seem high but is within a healthy range for a FCS patient.

"High triglycerides can destroy the pancreas, which would lead to problems absorbing nutrients and could cause her to have diabetes. Particularly in her [Harper] case dietary restrictions are necessary to avoid pancreatitis," Dr. Wilson said.

Patients with FCS are usually diagnosed due to debilitating symptoms such as severe abdominal pain, numbness or tingling, impaired cognition or blood with the consistency of milk, but at nine months old Harper was diagnosed due to her pink blood.

"Harper had high triglycerides and had little fat bubbles under her skin that looked like little pimples almost," Chris said. "One time we took her to get blood tests and her blood came out pink because it was so full of fat. The lab technicians actually thought they had messed up the test so they took her in for a second one and she broke the test again [due to inconclusive results]."

While there is no cure for FCS, patients are encouraged to meet with a dietician to maintain a lifestyle with extremely low levels of fat and the importance of avoiding excess carbohydrates.

"The only thing we have to watch is her fat intake," Chris said. "She eats a very low fat diet, we typically try to keep it between 7 or 8 grams per day. She eats very healthy, but otherwise we don't limit her. We try to keep her day as normal as her friends' would be."

While most 5 year olds are concerned with getting a piece of cake with the most icing, Harper is thankful on her "cheat days" and understands her daily restrictions.

"FCS requires a strict and rigid diet, and that's the problem especially with young children," Dr. Wilson said. "Everyone will grow up and be tempted to eat things that we shouldn't be eating, but when a child cannot always participate in birthday parties and other treats it can ostracize them."

Despite her dietary limitations, Harper has now lived five years with FCS and her healthy lifestyle is her definition of normal.

"Harper doesn't know anything else besides this type of lifestyle," Kendra said. "It seems like her body can tell when she does eat too much fat because she doesn't feel well and needs to eat something different."

Harper's parents quickly realized if she was aware of her diagnosis their daily lives would be easier to manage.

"We're very open with her about limiting her and why we're limiting her," Chris said. "She's very conscious of it. I think that's really the key for parents with kids who have dietary restrictions. That's your kid, and you have to let them have their cheat days and fun with their friends, but you also have to explain why you can only do that every so often. It really does help."

Two new studies emphasize the dangers of teens using e-cigarettes

The studies published in Pediatrics magazine showed teens who only vape have the highest level of cancer causing chemicals in their bodies and the e-cigarettes are associated with future smoking in teens.

The researchers from the University of California, San Francisco challenge the idea that e-cigarette vapor is safe. They found that teens who use e-cigarettes are in danger of inhaling cancer-causing chemicals, especially in fruit flavors.

“The presence of harmful ingredients in e-cigarette vapor has been established; we can now say that these chemicals are found in the body of human adolescents who use these products,” authors wrote.

The UC San Francisco researchers found that adolescents who smoke e-cigarettes expose themselves to a high levels of the potentially cancer-causing chemicals also found in tobacco cigarettes, even when the e-cigarettes do not contain nicotine.

"Teenagers need to be warned that the vapor produced by e-cigarettes is not harmless water vapor, but actually contains some of the same toxic chemicals found in smoke from traditional cigarettes," said lead author Mark L. Rubinstein, MD, a professor of pediatrics at UCSF. "Teenagers should be inhaling air, not products with toxins in them."

This was the first known study to report on the potentially cancer-causing compounds in the bodies of adolescents use e-cigarettes, according to UCSF. The lists of compounds include acrylonitrile, acrolein, propylene oxide, acrylamide and crotonaldehyde.

Another study from the same institution and also published in Pediatrics found that “e-cigarette use is more likely to encourage youth smoking that to divert youth form smoking.”

The team found those who had ever used e-cigarettes were significantly more likely than never users to have smoked at least 100 cigarettes at follow-up, have smoked during the past 30 days or both.

To learn more about e-cigarettes, we talked to Don Wilson, M.D., an endocrinologist and an Endowed Chair of Cardiovascular Health and Risk Prevention at Cook Children’s.

What do e-cigarettes do?

E-cigarettes are designed to simulate the act of smoking and deliver nicotine without the toxic chemicals produced by burning tobacco. The use of nicotine, however, is highly addictive. Recent research suggested nicotine exposure may also cause the brain to become addicted to other substances. Vapor from some e-cigarettes has also been shown to contain known cancer producing and toxic chemicals, such as diethylene glycol and nitrosamines, as well as small particles of toxic metals. Although not well studied, there is the potential for second hand exposure by others in the environment.

How do e-cigarettes work?

E-cigarettes are smokeless, battery operated devices designed to deliver nicotine mixed with a variety of flavorings (fruit, mint, chocolate, etc.) and other chemicals via an inhaled aerosol. They typically resemble regular tobacco cigarettes, cigars, pipes or everyday items like pins or USB memory sticks.

Most e-cigarettes generally contain three components: a cartridge that contains a liquid solution containing various amounts of nicotine, flavoring and other chemicals, a heating device or vaporizer, and a rechargeable battery. Puffing on the e-cigarette activates the battery powered heating device causing the liquid to vaporize. The vapor is inhaled by the user. E-cigarette vapor may include metals, rubber and ceramics which may be aerosolized and have adverse health effects.

Are e-cigarettes safe?

Although a limited number of studies have been conducted, the safety of e-cigarettes has not thoroughly been evaluated in scientific studies.

Here are a few points to consider:

• Nicotine is highly addictive and has negative effects on brain development from infancy to teens.
• Potential consequences of using e-cigarettes among youth include nicotine addiction, withdrawal and the potential for overdose.
• The use of a variety of flavoring in the liquid solution of e-cigarettes has created concern for accidental ingestion by smaller children.
• With the rapid increase in use of electronic nicotine delivery systems (ENDS), users and nonusers are exposed to the aerosol product. While e-cigarette aerosol may contain fewer toxins than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive.

Bottom line: e-cigarettes are often promoted as safer alternatives to cigarette smoking. Although very little is known about their safety, they are increasingly being used by youth and young adults.

What about second hand exposure?

The potential exists for secondhand nicotine and other tobacco-related toxin exposures to others. Studies have shown that e-cigarettes are a source of secondhand exposure to nicotine but not to combustion toxins. Thus, while use of e-cigarettes in indoor environments may involuntarily expose nonsmokers to nicotine, it does not seem to expose them to toxic, tobacco-specific combustion products.

What does the American Academy of Pediatrics recommend?

To protect the health of youth, the American Academy of Pediatrics has made the following recommendations:

• Sales of e-cigarettes to minors (under 18 years of age) should be prohibited.
• Candy and fruit flavored e-cigarettes, which encouraged youth smoking initiation, should be banded.
• To avoid exposing others to potential harm, laws should mandate smoke-free environments which include e-cigarette vapor.
• To prevent poisoning, all e-liquids should be required to be sold in child-proof packaging.

Both girls and boys can be develop Type 1 and Type 2 diabetes, but only females have to be concerned with a type of diabetes that begins during pregnancy. Gestational diabetes, which can cause high blood sugar, is not only a concern for mom, but her baby as well.

Here are four other unique ways that diabetes of all types affects females:

1. Compared with men with T1D, women with T1D are more likely to have a fatal heart attack. In a study of 23,000 men and women, women were 4 times more likely to die from a heart attack. The increased risk for cardiovascular disease that leads to this often starts in the teenage years where teenagers are already starting to show risk factors.
2. Girls are more likely to develop T2D than boys, occurring in both usually after 10 years of age. Along with other important factors we can’t control, such as family history and certain ethnicities, just being a woman increases your risk for Type 2 diabetes. Girls with T2D have a unique risk for polycystic ovary syndrome which can lead to irregular periods, excessive hair growth and acne.
3. Pregnant moms with T1D and T2D must be aware of the effect of pregnancy on their diabetes control and that they are at increased risk for complication because of their diabetes, including death.
4. Pregnant moms with all forms of diabetes must also worry about their baby’s health as diabetes during pregnancy, particularly when poorly controlled, can have a significant impact on the developing fetus.

As you can see, the risk of diabetes and pregnancy is a big part of the unique challenges that women with diabetes face. Diabetes occurs in approximately 5-10 percent of U.S. pregnancies (2 percent have Type 1; 8 percent T2D and 90 percent have gestational diabetes).

Along with the risk of cardiovascular disease, women with diabetes have to contend with the fact that babies born to moms with poor diabetes control have an increased risk of birth defects, such as spina bifida or microcolon. The babies can also have complications at delivery such as low blood sugar, low calcium and increased risk for certain breathing problems.

“I know that all moms would like to be at their ideal health prior to conception, it’s especially important for women with diabetes. However, 50 percent of all pregnancies are unplanned and the majority of those with diabetes have gestational diabetes; therefore, the mother’s glycemic control may be inadequate at time of conception and during the early part of her pregnancy,” said Don Wilson, M.D. an endocrinologist at Cook Children’s.