Adolescents and young adults (AYAs) are modifying e-cigarettes and similar devices, which can make them more dangerous, according to a new study.
“Understanding modifications to ENDS (electronic nicotine delivery systems) is crucial, because these behaviors can expose AYAs to additional harm through increased risk of burns from devices exploding, lung injury because of e-liquid contaminants, and exposure to substances like cannabis,” authors wrote in “Modification of Electronic Nicotine Delivery Systems Among Adolescents and Young Adults” (Kong G, et al. Pediatrics. June 17, 2024).
About 10% of teens and 11% of young adults use ENDS, most commonly disposable pods and prefilled or refillable pods/cartridges. They may modify the devices to save money, change the flavors or nicotine concentration, or to add cannabis, according to the study.
To learn more about these modifications, researchers from Yale School of Medicine conducted a 20-minute survey with 1,018 adolescents and young adults ages 14-29 years who had used ENDS in the past month.
About 40% reported refilling rechargeable pods/cartridges, and 36% said they recharged disposable pods, making these the most common modifications. Rates of trying the other modifications all were at least 20%, including putting cannabis liquid in ENDS (21%).
Youths under 21 years were more likely than older participants to modify rechargeable pods/cartridges and disposable pods, while young adults were more likely to modify e-liquids and put cannabis liquid in ENDS.
Adolescents and young adults most often heard about modifications from friends and social media. However, they appeared to be making modifications after learning how to do so from vape shops and non-social media websites. They were more likely to modify their devices if they perceived doing so was cool or low-harm, the study found.
Even without modifications, e-cigarettes are addictive and harmful to developing brains. In 2019, there was an outbreak of vaping-related lung injuries associated with vitamin E acetate, which sometimes is used as a diluent in cannabis vaping products. Sixty-eight people died and 2,807 were hospitalized.
Authors called for more study on the health consequences of modifying ENDS and said prevention efforts should stress the potential for these harms. Lawmakers also should consider potential modifications when legislating ENDS.
Resources
- AAP policy statement, clinical report and technical report, Protecting Children and Adolescents from Tobacco
- AAP tobacco prevention resources
- Information from the Centers for Disease Control and Prevention on youth tobacco use
- The Food and Drug Administration’s The Real Cost tobacco prevention campaign
