Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Electronic nicotine delivery system (ENDS), a category of smoking devices including disposable pods, rechargeable pods, and customizable devices, have become increasingly popular in adolescents and young adults (AYA). These devices are susceptible to off-label modifications, such as:
- recharging disposable pods
- refilling pods that are not designed to be refilled
- modifying nicotine liquids (such as adding flavor)
- mixing nicotine with cannabis
- switching out nicotine for cannabis
However, it is unknown how frequently youth are engaging in these activities.
The risks of these modifications are not fully understood, but include the potential for burns, lung injury, and increased exposure to cannabis. Off-label modifications may also decrease the effect of laws banning flavored pods to decrease ENDS appeal to younger populations.
It is important for clinicians to understand ENDS modifications to better understand our patients’ risk factors and tailor counseling.
In an article and video abstract being early released in Pediatrics this week entitled, “Modification of Electronic Nicotine Delivery Systems among Adolescents and Young Adults,” Dr. Grace Kong and colleagues from Yale School of Medicine aim to better define the prevalence of ENDS modifications in AYA populations, AYA awareness of modifications, sources of information regarding modifications, and perceptions about the perceived “coolness” of these modifications (10.1542/peds.2023-063984).
The authors surveyed individuals enrolled age 14-29 years old who had used ENDS at least 1 day in the last month.
The authors found that:
- Most participants were aware of modifications.
- The most widely known modifications were refilling pods that were not designed to be refilled (69%) and recharging disposable devices (66%).
- These were also the most commonly performed modifications (40% and 35%, respectively).
- Participants younger than the legal ENDS purchase age of 21 years were more likely to refill or recharge disposable devices.
- Participants ≥21 years old were more likely to modify ENDS liquid (adding flavor, combining or replacing nicotine with cannabis).
- The most common source of information on ENDS modification was from friends, followed by social media.
- More frequent vaping and cannabis use in the last month were associated with increased modifications.
- Perceptions of “coolness” and low harm of modifications were associated with increased modifications.
AYA who use ENDS are frequently aware of and engage in ENDS modifications, increasing the potential for harm associated with ENDS use. Clinicians should incorporate a discussion of ENDS modifications into their social history for this population, especially for patients who endorse frequent vaping or cannabis use. Clinicians should also consider counseling all patients who use ENDS on the risks of modifications, as increasing awareness of potential harms may decrease future ENDS modifications.
