Vaping

To the Editor Dr Winickoff and colleagues’ Insights article notes that “discreet, easily concealed vaping devices, with concentrated nicotine and youth-friendly features and flavors, present new clinical challenges.”¹ We add that so-called smart vapes present additional challenges. At prices similar to other e-cigarettes, these e-cigarettes with digital displays can include animations that display when puffing, built-in games, reward systems for vaping such as points and rankings, touchscreens, photo wallpapers, and Bluetooth connectivity.²

Multiple e-cigarette brands with smart vape features are currently illegally marketed in the US without US Food and Drug Administration (FDA) authorization. These products are rapidly gaining market share, according to retail scanner data. Specifically, the smart vape brands Geek Bar Pulse and Raz, which debuted in October 2023, emerged as the third and sixth top-selling e-cigarettes as of June 2024.³

Smart vapes are gaining popularity among youth. Among US middle and high school students reporting past-month e-cigarette use in 2024, 5.8%–an estimated 90 000 youth–wrote in that they use Geek Bar.⁴ As a write-in response, this is likely an underestimate; Geek Bar Pulse became popular in the brief span between survey finalization and the January to May survey fielding period.

E-cigarette use among US youth reached a 10-year low in 2024,⁴ likely owing to concerted multisector public health efforts. Young people also deserve credit for resisting or quitting vaping. But high-tech e-cigarettes that gamify use of an addictive substance could undermine recent progress. These inexpensive, appealingly flavored products intersect nicotine addiction with 2 potentially addicting behaviors–screen use and gaming.^2,5

Smart vapes, and all other illegally marketed e-cigarettes, warrant urgent attention. Clinicians can ask all patients about any tobacco product use, including smart vapes, educate patients about the risks of use, and provide prevention messages and cessation support. Public health practitioners can monitor use of these products and educate the public, including parents and educators, about their risks. Illegal importation of e-cigarettes could be addressed through importation licenses for e-cigarettes, as is currently required for cigarettes. Although continued enforcement of existing regulations against unauthorized tobacco products is important, retailers and distributors can refrain from selling or distributing unauthorized e-cigarettes. Researchers can study marketing tactics, consumer perceptions, sales, use patterns, and adverse events such as nicotine poisoning associated with smart vape use. Continued actions are critical to prevent and reduce youth tobacco product use and thwart e-cigarette manufacturers’ latest offerings with potential to addict yet another generation of young people to nicotine.