Risks of flavored nicotine and nicotine-free substances on adolescents : IJS Global Health

Secondary Logo

Journal Logo


Risks of flavored nicotine and nicotine-free substances on adolescents

Zahoor, Tayyab MBBS; Azeem Syed, Areeb MBBS; Rizwan, Dua MBBS; Mustafa, Muhammad MBBS

Author Information
International Journal of Surgery: Global Health 6(3):e0153, May 2023. | DOI: 10.1097/GH9.0000000000000153
  • Open

Nicotinic substances, tobacco, and vape pods have been widely used in electronic cigarettes that have been increasing in global popularity among adolescents. Global rise in electronic cigarettes and vaping devices are mainly being promoted through social media platforms such as Instagram advertisements and TikTok commercials1,2. Particularly, the inhalation (vaping) of electronic cigarettes contains toxic particles such as nicotine combined with various flavors that are delivered to the lungs and brain. Chronic vaping of toxic particles can cause addiction, dyspnea, cough, chest pain, and increased risks of hypoxemia3,4. Recent commercials promote non-nicotine (0 mg) vape pods consisting of harmful particles that target adolescents to smoke electronic cigarettes and to keep up with current societal norms1,4.

Ultrafine particles found in vaping products can harm vital organs such as the lungs, and gastrointestinal tract, and cause neurological dependence on flavored nicotinic substances3,4. A recent study by Smith and colleagues includes computed tomography images of the lungs when exposed to 90 days of smoking electronic cigarette particles to cause acute lung injury. The computed tomography images show ground-glass opacities associated with consolidation in the lungs that can clinically manifest as hypersensitivity pneumonitis, alveolar hemorrhage, and/or respiratory bronchiolitis interstitial lung disease3. Flavored inhalation of nicotine or nicotine-free substances increases the risks of lung injury and can cause oxidative stress in the body. A similar study by Caporale and colleagues emphasizes the toxicity of non-nicotine electronic cigarettes to impact the endothelial function of a healthy nonsmoker. Specifically, the study highlights when nonsmokers went through magnetic resonance imaging before and after inhaling nicotine-free cigarette aerosol, there was vascular resistance in the arterioles which resulted in lowering venous hemoglobin saturation that may be a result of hypoxemia. Regardless of smoking, nicotine or nicotine-free substances some microparticles can penetrate the blood-brain barrier, which can cause adverse reactions such as neuroinflammation and neurotoxicity4. Therefore, limiting electronic cigarettes in the market should be implemented to promote the healthy development of adolescents.

Should the government implement school classes to educate adolescents about the dangers of electronic cigarettes? The benefits of public awareness about the toxicity of vaping outweigh the potential government spending that may be required. Educating the youth about the dangers of vaping can limit its usage and can promote normal adolescent development. However, there is a rise in non-nicotine vape pods, which were originally introduced to assist chronic smokers in quitting conventional cigarettes. Now nicotine-free vape pods are being used as a stepping stone for young individuals to start vaping and potentially use products with nicotine. Some suggestions to counter the rise of vaping can be to increase the prices of electronic cigarettes, raise taxes on each purchase, increase the minimum age to buy vaping devices, and monitor social media advertisements. Another way to curb and limit the usage of nicotine vaping devices in the community is to dispense electronic cigarettes with medical prescriptions. Moreover, a common problem that educational institutions may face is the rise in social media trends that use vaping as a way for students to bond with one another. To counter this trend, institutions should ensure healthier social groups by introducing clubs such as sports, gaming, drama, art, and cooking, or promoting any gathering of students’ interest that avoids inhalation or ingestion of toxic microparticles. Therefore, electronic cigarettes should be difficult to purchase for adolescents and further research is necessary on non-nicotine vaping devices and the potential pathologic problems that could cause chronic diseases or halt normal development.

Ethical approval


Sources of funding


Author contributions

T.Z.: conceptualization, literature review, writing—original draft, writing—reviewing and editing of the manuscript. A.A.S.: literature review, writing—original draft. D.R.: literature review, revising, and editing of the manuscript. M.M.: literature review and revising the manuscript.

Conflicts of interest disclosure

The authors declare that they have no financial conflict of interest with regard to the content of this report.


Tayyab Zahoor.




1. Silver NA, Bertrand A, Kucherlapaty P, et al. Examining influencer compliance with advertising regulations in branded vaping content on Instagram. Front Public Health 2023;10:1001115.
2. Dinardo P, Rome ES. Vaping: the new wave of nicotine addiction. Cleve Clin J Med 2019;86:789–798.
3. Smith ML, Gotway MB, Crotty Alexander LE, et al. Vaping-related lung injury. Virchows Arch 2020;478:81–88.
4. Caporale A, Langham MC, Guo W, et al. Acute effects of electronic cigarette aerosol inhalation on vascular function detected at quantitative MRI. Radiology 2019;293:97–106.
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of IJS Publishing Group Ltd.