Use of electronic cigarette (vaping) devices, whether to inhale nicotine, cannabis, or other substances, may pose health risks to adolescents. Those risks could be heightened when a vaping device is "fake," a term we use to include inauthentic, knockoff, counterfeit, and/or adulterated devices, an issue exemplified by the Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) outbreak of 2019-2020.

Methods

Investigators completed in-depth, semi-structured interviews in 2020-2021 with 47 California adolescents (ages 13-17) who used nicotine products. Investigators used thematic analysis to examine participants' perceptions and reactions to fake vaping products, including devices to inhale nicotine or cannabis.

Results

Participants were familiar with fake vaping devices, which they considered to be low-quality and potentially dangerous, learning about them from peers, their own experience, seeing other young people affected by them, social media, and occasionally from classes in school. Some had heard about health emergencies after using a fake product, but few were specifically familiar with EVALI. Some adolescents were confident that they could detect fake products, although others perceived encountering and using fake devices to be unavoidable. Participants believed that profit motives drove the existence of fake products, especially from informal sellers, and assumed that large companies and government agencies were actively protecting consumers.

Conclusions

Adolescents are aware of and may encounter fake vaping devices, potentially exposing them to elevated health risks. Effective public messaging and stronger actions to curb the fake product supply would better protect this population.