{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:17:08Z","timestamp":1788430628167,"version":"build-2803163510"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009210","name":"Food and Drug Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009210","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010628","name":"Center for Tobacco Products","doi-asserted-by":"publisher","award":["R01DA047397"],"award-info":[{"award-number":["R01DA047397"]}],"id":[{"id":"10.13039\/100010628","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Youth in the United States are using electronic nicotine delivery systems (ENDS) at a high rate. Modifications to ENDS by youth can introduce additional health hazards which have not been previously considered. To better understand these risks, we need more information on what these modifications are, the motivations behind them, and the sources of information on modifications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims and Methods<\/jats:title><jats:p>Utilizing a trained moderator, in 2020\u20132021, we conducted one-on-one interviews with 19 youth ENDS users aged 16\u201317 living in the United States and analyzed their responses using a qualitative description approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The most prominent modification was to the e-liquid; youth indicated they mixed e-juices to create new flavors and added substances not intended for vaping, including illicit drugs such as cannabis and cocaine. Few youths from our sample were interested in achieving a specific nicotine level to vape, and modifications to the battery, coil and wick were less frequently mentioned. Some of these modifications were motivated by a desire to achieve specific experiences with their device. At other times, modifications were made due to necessity because of limited access to ENDS devices and supplies. YouTube and peers were the main sources of information about modifying.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Youth are making modifications that are both intended and unintended by the manufacturer. Adding illicit drugs and other substances not made for vaping is of particular concern. Understanding how youth modify ENDS and how that changes their use is important to guide regulatory policy intended to reduce harm to youth from ENDS use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p>Youth from our study indicated that they make modifications to the ENDS devices, specifically to the e-liquid. These modifications are both intended by the manufacturer, such as changing the e-liquid and replacing coils, and unintended, such as adding substances not meant for vaping. Future policies aimed at reducing youth ENDS use should consider mandating better safeguards against modifications that appeal to youth.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ntr\/ntad104","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T17:46:45Z","timestamp":1687628805000},"page":"1791-1797","source":"Crossref","is-referenced-by-count":12,"title":["\u201cI Get the Flavors and It Makes Me Love Vaping More\u201d: How and Why Youth Users Modify Electronic Nicotine Delivery Systems"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0393-3212","authenticated-orcid":false,"given":"Victoria","family":"Churchill","sequence":"first","affiliation":[{"name":"Morehouse School of Medicine, Cancer Health Equity Institute , Atlanta , GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9157-4576","authenticated-orcid":false,"given":"Robert T","family":"Fairman","sequence":"additional","affiliation":[{"name":"Georgia State University School of Public Health , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon","family":"Brown","sequence":"additional","affiliation":[{"name":"JSI Research & Training Institute, Inc. , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary B","family":"Massey","sequence":"additional","affiliation":[{"name":"University of Missouri School of Journalism , Columbia, MO , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1060-5893","authenticated-orcid":false,"given":"David L","family":"Ashley","sequence":"additional","affiliation":[{"name":"Georgia State University School of Public Health , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3450-4579","authenticated-orcid":false,"given":"Lucy","family":"Popova","sequence":"additional","affiliation":[{"name":"Georgia State University School of Public Health , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"2023090404200338800_CIT0001","author":"National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health","year":"2012"},{"issue":"50","key":"2023090404200338800_CIT0002","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.15585\/mmwr.mm6950a1","article-title":"Tobacco product use among middle and high school students \u2014 United States, 2020","volume":"69","author":"Gentzke","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"14","key":"2023090404200338800_CIT0003","doi-asserted-by":"crossref","first-page":"361","DOI":"10.15585\/mmwr.mm6514a1","article-title":"Tobacco use among middle and high school students \u2014 United States, 2011\u20132015","volume":"65","author":"Singh","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"21","key":"2023090404200338800_CIT0004","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1001\/jama.2019.18387","article-title":"E-cigarette use among youth in the United States, 2019","volume":"322","author":"Cullen","year":"2019","journal-title":"JAMA."},{"issue":"1","key":"2023090404200338800_CIT0005","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s00213-006-0499-8","article-title":"Smoking impacts on prefrontal attentional network function in young adult brains","volume":"191","author":"Musso","year":"2007","journal-title":"Psychopharmacology (Berl)."},{"issue":"1","key":"2023090404200338800_CIT0006","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.biopsych.2004.10.022","article-title":"Effects of smoking and smoking abstinence on cognition in adolescent tobacco smokers","volume":"57","author":"Jacobsen","year":"2005","journal-title":"Biol Psychiatry."},{"issue":"3","key":"2023090404200338800_CIT0007","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/tc.9.3.313","article-title":"Initial symptoms of nicotine dependence in adolescents","volume":"9","author":"DiFranza","year":"2000","journal-title":"Tob Control."},{"issue":"16","key":"2023090404200338800_CIT0008","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.1113\/JP270492","article-title":"Nicotine and the adolescent brain","volume":"593","author":"Yuan","year":"2015","journal-title":"J Physiol."},{"key":"2023090404200338800_CIT0009","first-page":"295","volume-title":"Department of Health and Human Services. 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