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Modification of Electronic Nicotine Delivery Systems Among Adolescents and Young Adults

June 17, 2024

As many as four out of every 10 teenagers and young adults who vape are modifying their e-cigarettes in ways that could expose them to burns, lung injury, and covert use of marijuana, a team of Yale Department of Psychiatry scientists found.

Their study, published online June 17 in Pediatrics, found that many young vapers are modifying devices in ways not intended by the manufacturers, also known as “hacking.”

The study revealed 40.1% had refilled devices not intended to be refilled, and 35.8% recharged the battery of disposable pods meant to be discarded after one use. Other “hacks” included mixing nicotine and cannabis liquids and adding THC to devices designed to vape only nicotine.

These modifications may expose vapers to additional harm through increased risk of burns from e-cigarette explosion and lung injury due to contaminants added, according to the researchers. Modifications can also violate laws.

“Little is known about what ways and how often adolescents are hacking their e-cigarettes, as well as where they may be learning this information, so we conducted a survey to find out,” said Grace Kong, PhD, associate professor of psychiatry at Yale School of Medicine and the study’s first author.

Kong and her colleagues surveyed 1,018 adolescents and young adults ages 14-29 who reported using e-cigarettes in the past month. The survey was completed online between November 2022 and February 2023. The survey takers were asked about their awareness of different e-cigarette hacks, where they learned about them, and if they made different types of modifications/hacks to their e-cigarettes.

About 64.4% of respondents said they learned how to modify e-cigarettes from their friends. Social media was the source of information for 46.7% of survey takers. Young people who learned about e-cigarette hacking through websites and vape shops were more likely to modify their e-cigarettes, and Kong said the findings suggest that regulations and other types of interventions that target website content and vape shops may be important.

“The findings about vape shops were concerning because many participants were under the age of 21 and should not be allowed to enter vape shops,” Kong said. “This suggests that some vape shops are serving underage customers and potentially teaching them how to modify e-cigarettes. Thus, stricter rules are needed to prevent underage individuals from entering vape shops.”

Many participants reported vaping both marijuana and nicotine, which was expected based on previous studies, according to Kong. “However, about half of our participants were aware of hacking e-cigarettes by combining nicotine and marijuana in the same e-cigarette, and 20% reported actually doing this,” she said. “This suggests that vaping devices intended for nicotine and marijuana use can be used interchangeably, potentially putting young people at risk for exposure to both substances.”

Vaping has become more common in teenagers and young adults, with an estimated 10% of U.S. high school-aged students and adolescents, and 11% of U.S. young adults (18-24 years) vaping.

Kong and her colleagues, including Yale co-authors Meghan Morean, PhD; Rachel Ouellette, PhD; and John Lee, PhD, concluded that as modifying or “hacking” e-cigarettes was associated with more frequent vaping, there is a need for more research to understand this practice and that lawmakers should consider e-cigarette “hacking” when passing laws and regulations on e-cigarettes.

The study was funded by National Institute of Drug Abuse and the Food and Drug Administration’s Center for Tobacco Products.

Submitted by Christopher Gardner on June 17, 2024