HHS Warns of Youth Vaping Harms, Illicit Chinese Products, Gamified Vapes, and Aggressive Marketing

HHS released a guide on teen vaping to combat the epidemic that peaked in 2019 when nearly one-third of high school students were vaping. The document calls out gamified vaping, colorful marketing materials and products, and the illegality of up to 85% of vaping products, with a large amount of those illicit products coming from China.

Fruit and bubble gum flavors can be appealing to teens, and a single vape cartridge can contain the nicotine equivalent of up to 30 packs of cigarettes. The number of high school students vaping in 2011 was 220,000, but that number increased by a multiple of 12 by 2019, with over three million high school students vaping. That number has since decreased to 1.6 million in 2024.  

“Vaping directly threatens children’s brain development, mental health, and long-term well-being,” Secretary Kennedy said. “We’re acting now to protect the next generation—giving families, schools, and communities the clear warnings they need to keep kids safe from nicotine addiction and illegal products.”

The CDC notes that nicotine use during adolescence can impact the portions of the brain that control attention, learning, mood, and impulse control. The most common reason middle school and high school students give for vaping is to deal with stress, anxiety, and depression. The CDC also references a 2014 study that concluded cessation of smoking results in lower rates of depression, anxiety, and stress. Quitting smoking also improves mood and quality of life.

In July, FDA Commissioner Marty Makary warned about the illicit products coming in from China that are not approved by the FDA and also aim to help children discreetly hide their vaping habit from parents. This includes vapes disguised as smart phone cases, video games, or backpacks.

“There is no approved vaping product in the United States that has a video game,” Makary said while holding an illicit vape. “There is not an approved vaping product in the United States that has one of these cutie fruity flavors.”

One of these vaping products is called URSA Pocket, which includes a gaming interface and certain gamified competitions. One is a virtual pet, similar to the Tamagotchi pet of the 90s, in which children would have to check in to “feed” the virtual pet. The URSA Pocket requires puffs of the e-cigarette to virtually feed the pet. The device also features a “slot machine” and a “puff count competition,” allowing users to share their results on social media for a chance to win prizes.

Earlier this year, the Supreme Court upheld the FDA’s effective ban on flavored e-cigarettes aside from tobacco and menthol flavors. This has opened the door to the illicit market, including products from China. Since the products are not regulated, they often contain higher concentrations of nicotine, the addictive element of smoking, and include these gamified features to encourage teen use of the product.

More than one-third of middle school and high school students who use vaping products reported using other tobacco products, such as cigarettes and cigars. 67.4% of students who used vaping products in 2020 said they tried to quit, according to HHS statistics.

“Youth vaping is not a harmless trend,” said Dr. Stephanie Haridopolos, Acting Chief of Staff and Senior Advisor in the Office of the Surgeon General. “It’s a serious threat to the health and development of our children. This guide is a call to action for all of us, including families, schools, health professionals, and communities, to come together and protect our youth from the dangers of nicotine addiction and toxic exposure.”

A February report from the Washington Reporter described the way illicit e-cigarettes travel from China to the Mexican drug cartels and across the U.S. border. The trade is similar to the way fentanyl makes its way to the U.S. whereby the Sinaloa cartel brings in Chinese e-cigarettes and mandates local business owners to sell these devices by use of threats and force. Illegal e-cigarettes are becoming a larger part of the Mexican drug cartel portfolio.

The illicit vape market was estimated to be worth over $8 billion last year. Shipments of illegal Chinese e-cigarettes and vaping products are frequently disguised as other products, like toys and shoes. In June, Reuters reported that the FDA sent letters to 24 middlemen in the vape trade, including U.S. importers and customs brokers. In May, there was a seizure of $34 million worth of illegal vapes in Chicago.

“The FDA and our federal partners are taking swift action to seize millions of illegal vapes at ports, distributors and retailers,” said Commissioner Makary. “American kids should not be getting hooked on addictive vaping devices — especially ones that have been imported illegally from our adversaries.”

The HHS press release states “Vaping products often contain high concentrations of nicotine, the same highly addictive chemical found in cigarettes, which can disrupt brain development, worsen anxiety or depression, and increase the risk of chronic disease. Studies have also linked nicotine consumption to blood vessel damage.”

The newly released guide is intended to help parents and educators to understand the risks of vaping and to facilitate discussions with their children. The guide also suggests healthcare providers should screen adolescents for vaping use and inform them of the dangers. Researchers should continue studying the long-term effects of vaping.

There is a hotline for adolescents and young people who are trying to quit vaping. They can text DITCHVAPE to 88709 or call 1-800-QUIT-NOW.