Despite often being considered a healthy alternative to smoking, electronic nicotine delivery systems (ENDS) are increasingly being connected to health hazards. Now, a study published Sept. 15 in Tobacco Control of the British Medical Journal reports newly identified health hazards for "vaping."

Noel J. Leigh and colleagues from the Department of Health Behavior of the Roswell Park Cancer Institute in Buffalo, New York, found that the delivery systems themselves may be a health hazard. They reported that the battery output voltage was related to poor cell health, because one of the chemicals in the compartments and batteries of ENDS products is copper. A previous study had found the rate of copper is six times greater in ENDS products compared to traditional cigarettes, and copper is toxic to cells.

The battery system in ENDS products have also been shown to damage more than just cells. There have been reports of the systems exploding and causing injuries to the hand and face.

In January 2015, the American Society of Clinical Oncology in a policy statement in collaboration with the American Association for Cancer Research determined a need for further research before concluding that ENDS were a safer alternative to traditional tobacco products, and the findings about the battery systems supports the need for more research.

The group from Buffalo also reported that flavorings in the ENDS products were a major contributor to poor cell health. This is not a new finding. Other groups have identified the product flavorings of popcorn and cherry in ENDS products to be toxic to cells. The popcorn flavoring ingredient diacetyl was found to be hazardous, and the cherry ingredient benzaldehyde is detrimental to health.

The new report tested the flavors tobacco, piña colada, menthol, coffee and strawberry. The strawberry flavor used in ENDS was found to be the most toxic to cells.

The Buffalo study utilized gas chromatography/mass spectrometry to identify the flavoring chemicals used in ENDS. They tested how human bronchial epithelial cells were impacted when exposed to 55 puffs of either ENDS product in aerosol form, tobacco smoke or air. They used a system of air and liquid interface. As an outcome they studied the cell viability, cell metabolic activity and the presence of inflammatory markers.

Flavorings of ENDS products are attractive to youth, and adolescents, teenagers and young adults are using ENDS products at an increasing rate. Even using the ENDS products without flavoring has been demonstrated to be harmful.

The flavor additives to make the product more appealing are harming the cells in their developing lungs. Whether strawberry, popcorn or cherry, the flavors are setting up youth for long-term health consequences.