bar graph showing use of tobacco by teens, e-cigarettes have the highst usage for both middle and high school students
2017 North Carolina Youth Tobacco Survey Results. Graph courtesy, NC DHHS

By Sarah Ovaska-Few

Crème brûlée, mango, pumpkin spice.

Those aren’t ice cream options, but flavors commonly added to a combination of liquidized nicotine, flavor additives and solvents that e-cigarette users pull into their lungs through devices that heat and vaporize the mixture.

graphic showing growth of e-cigarette use by teens from 2011-2017
Data, graphic courtesy: NC Dept. of Health and Human Services

Public health and governmental groups, concerned about the rapid rise in the use of vaping devices by teenagers, point to the hundreds and thousands of flavor options as a lure for youth that potentially will leave them with hard-to-overcome addictions to nicotine.

But there’s more to worry about than just the appeal of flavors according to new findings from researchers at Duke and Yale universities.

A study published Thursday in Nicotine & Tobacco Research by Duke and Yale researchers found that the flavor additives create chemical compounds that in turn irritate and inflame the lungs when inhaled.

“Our findings show that even in the absence of heating and combustion, chemical reactions are occurring in e-cigarette liquids and the resulting compounds could be harmful to the user’s airways,” said Hanno Erythropel, a Yale postdoctoral associate and co-author of the study, in a news release.

The study comes on the heels of growing questions and pressure from governmental regulators regarding the still-fledgling e-cigarette industry.  More North Carolina teens are using the products, with nearly 17 percent of high-schoolers found to be e-cigarette users in a biennial survey on tobacco use conducted by the state’s health department in conjunction with the federal Centers for Disease Control and Prevention.

graphic titled "reasons for e-cigarette use, 2017" including one in four students admitting they used e-cigs becaus they come in flavors
*Current use is defined as using tobacco products on one or more of the past 30 days. Data, graphic courtesy: NC Dept. of Health and Human Services

The Food and Drug Administration has called the escalating use of e-cigarettes in teenagers an “epidemic” and launched an investigation into whether Juul, a wildly popular device resembling a computer memory drive that has cornered more than 70 percent of the market, has improperly steered its products toward youth. Juul, which can have nicotine levels in a single pod that equate to a pack of cigarettes, has said it’s primarily targeted not youth but existing tobacco users looking for a safer alternative to smoking cigarettes. The FDA is also looking at the practices of other e-cigarette device makers.

Meanwhile, N.C. Attorney General Josh Stein launched his own probe into Juul this week, sending questions to the company via a civil demand letter about Juul’s marketing practices, contacts with resellers and the numbers of North Carolinians the company thinks are using the device.


“I am extremely concerned about the way Juul has marketed its product to young people, who face increased risk for addiction and exposure to health problems,” said Stein, according to a written statement.

pictures the Juul nicotine delivery system. The next generation in e-cigarettes
The Juul nicotine delivery device with it’s USB charger and “pods” filled with nicotine liquid. The devices have proven hugely popular with teens. Photo credit: Rose Hoban

Among the many concerns public health officials have is that the recently popularity of e-cigarettes is undoing decades of work to decrease the overall numbers of youth tobacco use. Nearly all, or 90 percent, of regular adult tobacco users started before they were 18, and efforts to dissuade youth from staring has been a major aim of tobacco prevention work.

The Duke and Yale researchers offer insight into a question many have had about e-cigarettes and how the vaporized nicotine mixtures pose health issues of their own.

The scientists looked at the chemical composition of Juul pods and found that the flavor additives can create acetals when mixed with e-liquids. When inhaled, those acetals irritate the lungs in ways similar to how asthma and inhaling smoke or fumes can bother the lungs. Researchers at the University of North Carolina at Chapel Hill previously documented similar concerns about the effects on lungs from vaping.

Children and teenagers may be even more susceptible to the irritation and inflammation because of their still-developing bodies and the high rates of asthma.

“Individuals who use e-cigarettes frequently should know they are exposing themselves to these chemicals, and that the long-term effects of these chemicals on the airways are unknown,” Erythropel said, according to a news release about the study.

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Sarah Ovaska is a freelance writer based in Orange County, who has called North Carolina home for well over a decade. She’s reported on criminal justice, education, health and government issues at publications...