Some smell like candy. Others, like strawberries, mango, cool mint or coffee. And you can find them everywhere: smoke shops, supermarkets, gas stations and, of course, online.
They’re vape pens, also known as e-cigs, mods, tanks or, in the world of scientific research, “ENDS,” short for electronic nicotine delivery systems. But no matter the name, shape or flavor, the products can do harm ― especially to a young person’s lungs, developing brain and future health.
Just ask Josie Shapiro, a George Washington University student from Seattle who began vaping when she was a 14-year-old high school freshman.
“School was online that year because of COVID and I started hanging around a peer group blowing super sweet candy-flavored vape,” she said. “It seemed harmless because it was blue raspberry; it smelled like gum. I knew there was nicotine in it, but I saw my friends doing it and didn’t really see the harm of it in that moment.”
Shapiro quickly became addicted and her life soon began to revolve around her vaping habit which she called “intense and scary.” She turned to the nonprofit Campaign for Tobacco-Free Kids for help and began sharing her story with others, even testifying before Congress. Her passion eventually led her to become part of a Community Advisory Board helping Fred Hutch Cancer Center’s Jonathan Bricker, PhD, design a new intervention to help teens quit vaping.
“The latest national survey estimates show that about 1.4 million middle and high school students still vape,” said Bricker, who holds the Endowed Chair in Cancer Prevention. “And most vapes contain nicotine, which can produce a very powerful addiction.”
In addition to hooking the uninitiated on a drug as addictive as heroin, vaping can lead to severe asthma attacks and EVALI, e-cigarette or vaping product use-associated lung injury, a serious and potentially fatal respiratory illness. Vapes contain multiple lung irritants, including formaldehyde and volatile organic compounds, and do lasting harm to a developing brain.
Vaping can even change your voice, according to a recent Instagram post by singer Selena Gomez.
Now teens and young adults looking for a way to kick the vaping habit can take advantage of two Fred Hutch studies funded through the National Institutes of Health, testing out a pair of digital interventions that promote cessation.
The health risks of smoking are well-documented, but vaping’s risks have been consistently downplayed by e-cigarette manufacturers, resulting in both millions in fines for deceptive marketing practices and a false belief among the public that vaping is much safer than smoking.
But “safer than smoking” doesn’t mean harmless.
Studies on vaping point to the inhalation of cancer-causing chemicals; the impact of nicotine on adolescent brain development and increased likelihood of addiction (not just to nicotine but other drugs).
Young kids don’t necessarily realize this, though. Research by the American Lung Association, in fact, shows two thirds of teens don’t even realize e-cigs contain nicotine, much less propylene glycol, formaldehyde, vegetable glycerin and flavoring chemicals.
“These aerosols have little particles that can travel really deep into the lungs,” Bricker said. “There’s propylene glycol and also nickel and lead ― these are all chemicals that can cause cancer. We’re still trying to see how big the risk is for cancer from vapes, but we do know that these chemicals are in vapes.”
By adding fruit flavorings, though, vapes come across as safe and harmless.
“When you add flavorings, you get something that feels like candy, but it’s not,” he said. “The flavoring masks these other chemicals that are actually not safe to inhale.”
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‘Vapes often contain nicotine salts, which pack a much more powerful dose of nicotine. They can make these very high concentrations of nicotine easier to inhale without the same harshness in your throat. So a vape can feel very smooth and still deliver a very powerful dose of nicotine.’
― Fred Hutch smoking cessation expert Dr. Jonathan Bricker
Learn more about our targeted approach to the diagnosis and treatment of lung cancer.
Even more worrisome is the amount of nicotine vaping devices contain.
“Vapes often contain nicotine salts, which pack a much more powerful dose of nicotine,” Bricker said. “They can make these very high concentrations of nicotine easier to inhale without the same harshness in your throat. So a vape can feel very smooth and still deliver a very powerful dose of nicotine.”
It’s a formidable double whammy.
“The harm is one thing,” Bricker said. “But it’s also how it hooks. Kids don’t know about nicotine, they don’t know about nickel or lead, but they do know fruits and they know candy and that’s what attracts them. It’s really a marketing ploy to get them hooked.”
It’s a ploy that works, too.
“E-cigarettes pose numerous risks, particularly to youth and young adults,” said Fred Hutch clinical psychologist and public health researcher Jaimee Heffner, PhD, who just launched another vaping-cessation trial for young adults ages 18 to 30. “Contemporary e-cigarette devices like Juul and pod-based e-cigs employ nicotine salt formulations that expose users to high levels of nicotine and are more likely to lead to dependence.”
Heffner said her research shows many young vapers desperately want to quit but can’t.
“Some of the more common reasons they give are health concerns and financial savings,” Heffner said. “But many also don’t like waking up in the middle of the night and needing to vape, needing more and more nicotine over time, or feeling anxious in situations where they can’t vape. Some have young children and want to be good role models and be healthy for them ― and keep them healthy. Some are absolutely desperate to quit and just can’t figure out how to do it.”
Unfortunately, there’s little rigorous evidence about which approaches help teens and young adults stop vaping.
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Both Bricker’s Health and Behavioral Innovations in Technology or HABIT Lab and Heffner’s Tobacco-Related Health Disparities (TREHD) Research Group create digital tools to help various populations handle behavioral change.
Bricker’s vaping cessation trial ― designed exclusively for teens ― is called QuitQuest. Launching in 2027 in collaboration with co-principal investigator Sean David, MD, PhD, of the University of Chicago, Bricker plans to recruit just over 1,000 participants to see if QuitQuest improves vaping abstinence better than the National Cancer Institute’s Smokefree Teen Quit Vaping app.
Like many of his digital interventions, QuitQuest uses ACT, or acceptance and commitment therapy, as a way to help teens recognize and acknowledge cravings without necessarily giving in to them.
“ACT basically teaches people how to notice urges without acting on them and to choose actions committed to their values and what matters to them,” Bricker said.
Bricker adapted his smoking cessation app for adults (ICanQuit) for a teen vaping audience, working with a Community Advisory Board or CAB to create an approach that would appeal to a younger audience: gaming.
“We worked with teens to shape the app,” he said. “They’re fighting a monster, and over time, they learn that the monster is actually the cravings they feel in their body. They learn to live with their cravings, to make peace with them. They learn the acceptance skills to deal with these craving monsters but not act on them. Eventually, they’re able to stop vaping.”
Shapiro, now 20, joined the CAB and worked with Bricker and other community members to create and nuance the intervention.
It was the first time she’d experienced public health science up close. It made such an impression, she’s now thinking of going into the field.
“I think this app is going to be super beneficial,” she said. “Especially since it’s online and there is so much marketing of vaping online. There are so many people struggling with this in so many ways.”
When the QuitQuest trial is complete, the app will be available to the public for free.
Heffner’s trial ― called ACT on Vaping ― focuses on young adults aged 18 to 30. Much like Bricker, she based the new tool on an app originally developed for tobacco smokers. Her trial began recruiting in May.
“We’re recruiting a total of 1,178 young adults from all over the U.S.,” she said. “They don’t have to be ready to quit to enroll; the program is designed for all levels of quit readiness.”
Heffner’s randomized controlled trial will feature two versions of the ACT on Vaping program; participants will download one or the other. The program includes an avatar that guides participants through the program.
“When we developed the first iteration of this program for young adults, we heard very early that people want to be able to see themselves in the avatar,” Heffner said. “And that just isn’t possible when there is a single avatar, or even a small group of avatars.”
Over time, though, new funding became available and the tools became more adept; they were eventually able to evolve the avatar into a fully customizable program guide.
“The addition of an avatar that is fully customizable in both appearance and voice is a major upgrade to enhance engagement,” Heffner said.
And engagement in this age group is key ― many of them do not consider themselves smokers.
“’Smoker’ is definitely not a term used by people who exclusively vape,” she said. “They also may or may not relate to the idea of being addicted to nicotine.”
Once they attempt to quit, she said, they may discover they’re addicted and “how uncomfortable and distressing nicotine withdrawal can be.”
It’s not all bad news, though.
“Nicotine withdrawal is generally short-lived and manageable with behavioral strategies and medications,” Heffner said, “which participants are encouraged to consider using.”
Young adults who vape cannabis as well as tobacco are welcome to join Heffner’s trial, too.
“We do include people in the study who use other tobacco products and/or cannabis,” she said. “The same ACT principles that apply to quitting vaping also apply to quitting other tobacco products, and to quitting cannabis.”
But the trial is primarily for young adults who are vaping nicotine.
“If they vape nicotine and also want to quit vaping cannabis, then yes, they would potentially be eligible to participate,” she said. “But someone who only vapes cannabis, and not nicotine, would not be eligible.”
Future trials, however, may focus on how to quit co-use of nicotine and cannabis.
Bricker pointed to longtime Fred Hutch public health researcher and mentor Art Peterson, PhD, as the reason for his focus on tobacco cessation in teens.
“NCI-funded teen tobacco control research is in Fred Hutch's DNA,” he said. “It goes back 40 years to the 1980s. My mentor, Art Peterson, taught me that focusing on teens is important and how to work with them.”
This project, he said, brings that same commitment into the modern era.
“We’ve got a newer treatment approach, ACT. And a newer technology, digital apps,” he said. “And we’re working to help teens control a newer form of nicotine delivery, vaping. It’s a continuation of that legacy.”
What does Shapiro think of the work?
“I never considered that a cancer research center would do something like this,” she said. “People should care about this problem, it’s growing. I feel lucky I can use my story to make things happen.”
The Act on Vaping study is funded by the National Institute on Drug Abuse (NIDA). The QuitQuest study is funded by the National Cancer Institute (NCI).
Diane Mapes is a senior editor and writer at Fred Hutch Cancer Center, who's written for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor and patient advocate, you can reach her at dmapes@fredhutch.org or doublewhammied.com / @double_whammied / @doublewhammied.bsky.social. Just diagnosed and need information and resources? Visit our Patient Care page.
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