Valerie Pavilonis

Mint. Mango. Creme. 

While these may be welcome components of a tropical dessert, they were also the harmful flavor additions in Juul cartridges that enticed much of the nation’s youth to partake in vape culture. As this behavior spread, Yale scientists raced to understand and communicate the health risks associated with the use of e-cigarettes. 

A 2018 study conducted by the Yale Tobacco Center of Regulatory Science was the first to identify that advertisements for flavored e-cigarettes may override negative perceptions of tobacco products, even when health warnings are printed on the packaging. 

At the time when the study was published, the U.S. government imposed few rules for e-cigarette advertisements. Meanwhile, campaigns championing tobacco cigarettes were subject to strict regulation, including the Family Smoking Prevention and Tobacco Control Act, which was passed in 2009 and banned the promotion of cigarette flavors other than menthol. 

“Overall, we think [the study’s] findings indicate that one way to reduce the appeal of e-cigarettes to youth and educate youth about e-cigarette health risks is to regulate advertising for flavors,” said Kathleen Garrison, an assistant professor of psychiatry and the first author of the paper. 

Due in part to Garrison’s study as well as similar research, the Trump administration imposed a nationwide ban on Juul cartridges with flavors other than tobacco or menthol. However, researchers continued to investigate the issue, focusing on prevention, intervention and the dangers of vaping among teens. 

In September 2019, a Yale study that surveyed 3,170 high school students in Connecticut demonstrated that most teens do not understand caution labels printed on Juul products, nor what constitutes a high concentration of nicotine. 

“It’s the first study that shows directly that most adolescents aren’t aware of the fact that Juuls — at least at the 5 percent level — contain a high nicotine concentration,” said first author of the study and assistant professor of psychology at Oberlin College Meghan Morean. 

Grace Kong, an assistant professor of psychiatry at Yale, added that even scientists who are researching e-cigarettes struggle to understand Juul’s vague labeling. 

Last year, the Yale play4REAL Lab received funding to develop smokeSCREEN VR, a virtual reality game intended to dispel misperceptions about the safety of Juuls and prevent teens from using e-cigarettes. This technology came after the launch of the lab’s online game, Invite Only VR, where players could use virtual reality to stand up to peer pressure surrounding vaping. 

“It’s not cool to smoke anymore, but it is cool to Juul, which is a problem,” said Kimberly Hieftje, the lab’s founder. She explained that these tools will provide a safe space for children to practice crucial social skills. 

Other scientists at the Yale Tobacco Center for Regulatory Science studied the similarities between cigarettes and e-cigarettes to gauge the potential health risks of vaping. Suchitra Krishnan-Sarin, co-leader of the center, described that the nicotine in both products can damage the developing brain when ingested in high doses. 

“The teen brain is very sensitive to the effects of nicotine,” she said. “During adolescence, the brain is growing and maturing and developing connectivity. Nicotinic receptors are one of the primary regulators of many of these pathways. If you use nicotine, you are altering your pathways and processes related to cognition and memory, your response to rewards and also your anxiety and depression pathways.” 

Krishnan-Sarin described the need for further research on the topic, but her advice was straightforward: children and teens should not start vaping.  

The Yale Zimmerman Lab echoed Krishnan-Sarin’s message, as researchers here examined how components of e-liquid react once inhaled into the lungs. Within these inhaled vapors, scientists came across acetones — chemicals that can pose a serious threat to people with asthma or other respiratory problems. In the flavor creme brulee, for example, much of the compound vanillin — an extract of vanilla bean — turns into acetones once puffed. The scientists also discovered other compounds in these vapors that are banned in traditional cigarettes. 

Hanno Erythropel, a postdoctoral associate at the Zimmerman Lab, explained that even in healthy lungs, these altered products are potentially more irritating than the chemicals found in the Juul pods themselves. He said that it was irresponsible for corporations like Juul to market cartridges to consumers when so much is still unknown about their physiological effects.     

“We can’t just go and sell these products that might form something new inside of [the lungs],” Erythropel said. “That seems crazy to me.” 

The findings of this study came just months before the Centers for Disease Control and Prevention announced on Sept. 11 that approximately 400 lung illness cases in e-cigarette smokers across the United States had been reported, including one in Connecticut. Six deaths were also recorded, and the following day, Director of Yale Health Paul Genecin warned community members in a University-wide email about the dangers of vaping. 

With much still unknown about the chemicals involved in vaping, he advised against the use of e-cigarettes, as smokers could be exposed to toxins including benzene, metals or harmful bacteria. 

“The cause of vaping-related lung injury is unknown,” he wrote. “While some patients have improved with high dose steroids, others have developed progressive lung injury resembling severe infection.” 

The announcement had special relevance to Yale students. At the beginning of the 2019 fall semester, the News distributed a survey to members of the class of 2023 to learn more about their vaping history. Though the survey results were not adjusted for selection bias, over fifteen percent of first years reported having vaped at least once, marking Yale’s campus as just one more locus of the nationwide vaping epidemic.  

As of February 2020, 21 percent of high school and middle school students in the United States were reported to have vaped. 

Sydney Gray |