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The results of the recent cross-sectional survey by Krishnan-Sarin et al.1 should not be interpreted as evidence that youth are "dripping" in high numbers. The concept is inadequately defined and it's likely that many or most respondents misunderstood a poorly constructed questionnaire item.
“Dripping” is conceptualized as "directly dripping e-liquids onto heated coils" and "vaporizing... e-liquid at high temperatures and then immediately inhaling the vapor that is produced."1 This is wholly inconsistent with what “dripping” refers to in e-cigarette use. Dripping onto a hot coil would result in an unpleasant experience and certainly preclude producing thicker clouds of vapor or better flavour. Specifically, “dripping” means applying drops of liquid onto an atomizer to saturate its wick prior to the coil heating. If the wick isn't saturated, the coil will burn the wick instead of vaporizing liquid, rendering any device unusable. It's obvious that “dripping” prevents (rather than increases, as the Authors imply) the risk of exposing users to high levels of toxic thermal degradation by-products.
The Authors wrongly assume “dripping” is new. The practice is nearly as old as e-cigarettes themselves. Many early devices (circa 2008-2011) required users to drip frequently to keep atomizers saturated. Since 2014, “dripping” is required by specialized "rebuildable dripping atomizers” (RDAs). Therefore, dripping behavio...
The Authors wrongly assume “dripping” is new. The practice is nearly as old as e-cigarettes themselves. Many early devices (circa 2008-2011) required users to drip frequently to keep atomizers saturated. Since 2014, “dripping” is required by specialized "rebuildable dripping atomizers” (RDAs). Therefore, dripping behaviour is device specific. E-cigarettes aren’t “used for” dripping. They're either made for dripping or not. Measuring the practice would entail separating RDA use from far more popular refillable tanks that keep the wick saturated without manual dripping to an atomizer.2
Refilling” was highlighted in the survey's definition of e-cigarettes, yet “dripping method” seems left to interpretation. It’s unlikely that the question "Have you ever used the dripping method to add e-liquid to your e-cigarette?” isolated device-specific dripping: first, “dripping” not “the dripping method” is the typical way to refer to adding droplets of liquid to early atomizers or RDAs; second, all refillable devices are filled by adding e-liquid with a “dripping method”.
We believe students counted as “dripping” had instead refilled a device or tried one they’d seen refilled. And given the obviousness of a "dripping method" in a refilling context, we believe the question likely confused many respondents. This could explain why 25.2% of the sample reported, "I don't know." This study's original 26.6% rate of ever-users was similar to the 2015 NYTS average of 26.4%.3 The authors excluded a huge group from the final sample for inconsistencies (31.8% n=596) or failing to answer (10.6% n=198) the “dripping” question. Using the original number of ever-users, (n=1874), 15% answered yes to the dripping question, 28% answered no, and 57% were too confused to answer sensibly. Given the study’s weak translation of the specific dripping practice, and substantial oversight of the ubiquitous practice of refilling with dropper bottles, results don't indicate youth are "dripping" in the specific sense. Though we'd emphasize that if they were, there's no reason to assume this is any more or less risky than using other types of e-cigarettes.
1. Krishnan-Sarin S, Morean M, Kong G, et al. E-Cigarettes and “Dripping” Among High-School Youth. Pediatrics. 2017;139(3):e20163224.
2. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Saf. 2014;5(2):67–86.
3. US Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.
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