Researchers Note Latest Vaping Concern: ‘Hacked’ E-Cigarette Devices

To understand vaping, it’s best to start on broad terms. To vape is to inhale vapor created from a liquid heated up inside a device. From there, things quickly get complicated. The devices have many names—vape pens, pod mods, tanks, electronic nicotine delivery devices (ENDS), e-hookahs and e-cigarettes.

The liquid they contain also has many monikers—it might be called e-juice, e-liquid, cartridges, pods, or oil. Most vape liquids contain a combination of propylene glycol or glycerol—also called glycerin—as a base, and nicotine, THC, or flavoring chemicals to produce common or outlandish flavors, from mint to “unicorn puke.” The devices rely on batteries to power heating elements made of various materials that aerosolize the liquid.

Since e-cigarettes arrived in the U.S. in 2007, they have been investigated by addiction researchers as possible cessation devices for adults trying to quit combustible, or regular, cigarettes. The FDA lists 93 harmful or potentially harmful chemicals found in regular cigarettes, and the National Cancer Institute (NCI) describes cigarettes as having more than 7,000 chemicals in them. Because e-cigarettes contain fewer chemicals the industry has presented them as a healthier alternative to regular cigarettes. But vape liquids can still contain nicotine, a highly addictive drug.

And on one point, Yale health researchers who study the health effects of vaping and e-cigarettes agree: Vape devices have not been proven to help adult smokers quit smoking. Moreover, vaping increases the risk a teen will smoke regular cigarettes later.

“The addiction to nicotine and later conversion to (or dual use with) regular cigarettes are the greatest concerns,” says Roy S. Herbst, MD, Yale Medicine’s chief of medical oncology at Yale Cancer Center. He points to two heavyweight organizations, the American Society of Clinical Oncology (ASCO) and the American Association for Cancer Research (AACR), that have issued statements that vaping could be harmful to youth. (Dr. Herbst chairs the AACR Tobacco & Cancer Subcommittee that led the development of the statement.)

When potentially risky behaviors experience an uptick in popularity, health researchers are never far behind—gathering data. A Yale study in 2019 found that, among students at three Connecticut public schools, those who used e-cigarettes were more likely to smoke regular cigarettes in the future.

Krishnan-Sarin points to progress that has been made—finally—in recent years to reduce regular cigarette smoking rates among young adults. In her opinion, the significant decline is due to the success of large-scale public health campaigns and a general awareness among youth that cigarettes are harmful to health.

She is concerned that most teens who vape with nicotine don’t know the drug can be damaging to their development. “We have a lot of evidence showing that the adolescent brain is extremely sensitive to the effects of nicotine,” she says, adding that the brain doesn’t stop growing until around age 25. “Studies have shown us that nicotine can interfere with memory and attention processing.”

In his imaging studies of adults who use e-cigarettes, Stephen Baldassarri, MD, an internist at Yale Medicine, has begun to gather information on the factors that influence nicotine delivery from e-cigarettes and whether vaping promotes cessation from conventional cigarette smoking. Teens cannot participate in such studies, but “we all agree that e-cigs are not a good thing for youth and nonsmokers,” Dr. Baldassarri says.