The off-Broadway musical discusses vaping in a satirical way but e-cigarettes can be harmful
Jeremy Daniel
When I first saw Grease on the big screen decades ago, little did I know that I would one day be watching an off-Broadway parody with vaping as the backdrop. Even less expected—that I would find key medical lessons throughout the musical, particularly involving the use of e-cigarettes or vaping, which is a growing public health concern.
As a fan of musicals, I enjoyed the modern-day references to technology and social media embedded into the songs and dialogue. For example, when Sandy talks about love, Danny says “I heart you,” a popular reaction across social media platforms. Unlike the 1978 performance, the 2025 parody references “TikTok University” and a student group called YCTA, the Youth Conspiracy Theorists of America.
The Canadian in me certainly appreciated the many satirical elements sprinkled throughout the show. The cast belts out that “We’re all on our cell phones” and “We all have ADHD!” Instead of a 1949 Ford De Luxe convertible, the famous race car scene in the Vape! parody uses low-emission Priuses. And in one of many references to gender bias, after a transgression by Danny (one of several), Sandy responds “Lucky for you, society tells me to give unlimited chances to undeserving men.”
‘Danny’ (L), played by Scott Silagy, and his friends try to convince ‘Sandy,’ played by Lara Strong, that all the cool kids vape.
Jeremy Daniel
Addiction-Related References
As a physician who specializes in substance use disorders and behavioral addictions, I was struck by various moments in the musical parody. A telling scene occurred when the school principal, sitting at a desk next to an assistant, downed several Percocet pills then uttered, “My husband left me.” People typically take opioids to relieve pain—physical and emotional. In another scene, after drinking one White Claw, Sandy asks, “Now that I’m hammered, what other bad decisions should I make?” The implication here is spot-on: addictive substances such as alcohol in fact impair parts of the brain that control decision-making. On a lighter—though not unrealistic—note, near the end of the musical, Kenickie exclaims, “I’m gonna spill my guts on Celebrity Rehab!”, a reference to the 2008 reality show hosted by Dr. Drew Pinsky.
What is Vaping?
Audiences were greeted by a cloud of strawberry-scented vapor in this lighthearted musical as well as multiple references to this “chilled-out” activity. But what exactly is vaping, and why should we be concerned? I asked two addiction medicine experts about this pastime that’s rising in popularity.
“The term vaping first became common as a way to describe the use of battery-operated e-cigarette devices to inhale liquids containing nicotine,” explains Yngvild Olsen, MD, MPH, the former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA).
Originally, these e-cigarette devices or vapes primarily contained nicotine, the addictive substance in tobacco products. But now they can deliver multiple substances. “They have evolved to contain THC (the psychoactive substance in the marijuana plant), CBD (a non-psychoactive substance from the marijuana plant) and other substances,” describes Dr. Olsen. The devices go by different names including vape pens, vapes, mods, tanks or electronic nicotine delivery systems (ENDS).
Colorful e-cigarette cartridges containing sweet and fruity flavors are part of aggressive marketing strategies used by vape manufacturers to entice teenagers.
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How Does Vaping Compare to Traditional Cigarette Smoking?
While the aerosol from vaping typically contains fewer harmful chemicals like carbon monoxide compared to the smoke from cigarettes, vapes aren’t necessarily safer—particularly for certain groups like adolescents, young adults and people who’ve never smoked cigarettes. Significant health risks are associated with long-term daily vaping.
“E-cigarette users can be exposed to a variety of chemicals added for flavor and aroma, pollen or nitrosamines (carcinogens) with the nicotine from tobacco and by-products of vaporization such as formaldehyde and acetaldehyde,” explains Michael Weaver, MD, professor of psychiatry and director of the Center for Neurobehavioral Research on Addictions at UTHealth Houston. Vape-associated pulmonary lipidosis—a rare lung inflammation caused by fat accumulation—has been published in case reports. “Although e-cigarettes are less harmful than tobacco cigarettes, they are still not as safe as plain air,” cautions Dr. Weaver.
Health Harms
A critical point that can’t be over-emphasized is that nicotine, whether delivered through vaping or cigarettes, has a high addictive potential. 22% or 61.6 million people in the U.S. 12 years or older reported using a tobacco product or vaped nicotine; among them, 8.5% (23.6 million) had nicotine dependence. Once addicted, it’s hard to quit: the average person who smokes needs six to 30 attempts before successfully quitting. In contrast, many of my patients found it much easier to quit heroin than cigarettes.
Health injury can start as early as in utero. Nicotine has toxic effects on the developing fetus leading to potential birth defects, low birth weight and premature birth. “In adolescents and young adults, nicotine can impair parts of the brain that are involved in impulse control, learning, mood and attention,” warns Dr. Olsen. Aerosols can also impair lung function, increase cancer risk, burns and oral disease.
Vaping: The Next Epidemic?
A third of adolescents have tried e-cigarettes, and they are likely to go on to use tobacco cigarettes which are less expensive.
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It’s definitely a concern among health experts, especially among children and youth.
“A third of adolescents have tried e-cigarettes, and they are likely to go on to use tobacco cigarettes which are less expensive,” worries Dr. Weaver.
Why the rise among young folks? Creative and aggressive marketing by manufacturers, for one. “E-cigarettes are marketed to young people with sweet and fruity flavors that are not available in tobacco cigarettes,” says Dr. Weaver. To complicate matters, no country currently regulates e-cigarettes as drug delivery devices, so there are no manufacturing standards and no monitoring of impurities or toxic compounds. Dr. Olsen shares this concern.
“Between February 2020 and June 2024, the percentage of e-cigarette unit sales increased by almost 35%,” states Dr. Olsen. Vaping is now more common than cigarette smoking among youth: over 1.6 million middle and high school-age adolescents used e-cigarettes in 2024, exposing youth to both short-term negative health consequences such as impaired brain development and long-term problems like addiction to nicotine and other substances. Adults are also vaping: roughly a third who use e-cigarettes develop a nicotine addiction. Dr. Olsen believes that we need to “really pay attention” to these groups as we learn more about the negative health impacts of vaping.
Advantages to Vaping?
The students of Rydell High certainly want to give the impression that e-cigarettes are cool. But vaping may in fact have some health benefits, the primary one being harm reduction. While not risk-free, vaping is considerably less harmful than cigarette smoking. Vaping is also associated with much less second-hand smoke exposure to bystanders compared to cigarettes because it doesn’t involve the combustion of tobacco. Some studies also suggest that nicotine vapes, combined with psychosocial support, can be effective in helping people quit smoking tobacco. First-line treatment for nicotine addiction, however, remains nicotine replacement therapy, prescription medicines and counseling.
Nicotine in e-cigarettes can be harmful to the fetus and the woman. Harms include potential birth defects, low birth weight and premature birth.
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Final Curtain Call
As a fan of musicals, comedy and satire, I truly enjoyed this unique homage to the 1978 classic. The doctor in me also enjoyed dissecting different health angles. In addition to vaping, the musical also briefly touches on CTE or chronic traumatic encephalopathy, encountered by the character, Tom, a football player who acts forgetful and almost dopey. It’s important to remember that CTE is a serious brain injury likely related to repeated head injury that warrants evaluation and treatment. While vaping may have some health benefits by reducing harm from cigarette smoking, it is not risk-free, and can in fact worsen health through nicotine addiction, lung and brain damage, and pregnancy risks. Vape! The Grease Parody is a reminder that the arts aren’t just entertainment but also a vehicle for health education. Music and satire can help the medicine go down!
