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Tillery A, Aherrera A, Chen R, Lin JJY, Tehrani M, Moustafa D, Mihalic J, Navas-Acien A, Rule AM. Characterization of e-cigarette users according to device type, use behaviors, and self-reported health outcomes: Findings from the EMIT study. Tob Induc Dis 2023; 21:159. [PMID: 38059181 PMCID: PMC10696923 DOI: 10.18332/tid/174710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) rapidly evolved from large modifiable (MOD) devices, to small and affordable 'POD' devices. Detailed information on user demographics and preferences according to device type, which can inform potential chemical exposure and policy recommendations, is currently limited. The goal of this study is to describe user demographics, use behaviors and preferences, as well as self-reported health outcomes according to the e-cigarette device type used. METHODS From April 2019 to March 2020, 91 participants from Maryland (18 MOD users, 26 POD users, 16 dual users (use of both combustible and e-cigarettes), and 31 non-users (never e-cigarette users and never smokers or >6 months former use) were recruited. A comprehensive questionnaire collected sociodemographic characteristics, e-cigarette/tobacco use behaviors, self-reported health outcomes, device characteristics and preferences. Chi-squared tests for categorical variables, ANOVA for continuous variables, qualitative thematic analysis, linear and logistic regressions were used to assess relationships between variables and groups. RESULTS POD users were younger (average 22.5 years) than MOD users (30.8 years) or dual users (34.3 years) (p<0.001). MOD users reported more puffs per day (mean ± SD: 373 ± 125 puffs) compared to POD users (123.0 ± 172.5). E-cigarette users who were former smokers used 1.16 mg/mL lower nicotine concentrations compared to lifetime exclusive e-cigarette users (p=0.03) in linear models. Exclusive POD users self-reported more coughing than exclusive MOD or dual users (p=0.02). E-cigarette users reported more shortness of breath, headaches, and fatigue from their e-cigarette use compared to non-users. CONCLUSIONS We found significant differences between user demographics, e-cigarette preferences, device characteristics, and use behaviors by user group. This information can help explain exposure to chemicals from e-cigarettes, including compounds with known toxic effects (e.g. metals, formaldehyde), and help inform the design of prevention and intervention strategies and policy decisions.
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Affiliation(s)
- Anna Tillery
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Angela Aherrera
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Rui Chen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Joyce J. Y. Lin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Mina Tehrani
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Donia Moustafa
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Jana Mihalic
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Ana Navas-Acien
- Mailman School of Public Health, Columbia University, New York, United States
| | - Ana M. Rule
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Commodore S, Sharma S, Ekpruke CD, Pepin R, Hansen AM, Rousselle D, Babayev M, Ndeke JM, Alford R, Parker E, Dickinson S, Sharma S, Silveyra P. Thirdhand vaping exposures are associated with pulmonary and systemic inflammation in a mouse model. JOURNAL OF ENVIRONMENTAL EXPOSURE ASSESSMENT 2023; 2:22. [PMID: 38741701 PMCID: PMC11090496 DOI: 10.20517/jeea.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Thirdhand smoke (THS) is the accumulation of secondhand smoke on surfaces that ages with time. THS exposure is a potential health threat to children, partners of smokers, and workers in environments with current or past smoking, and needs further investigation. In this study, we hypothesized that thirdhand Electronic Nicotine Delivery Systems (ENDS) exposures elicit lung and systemic inflammation due to resuspended particulate matter (PM) and inorganic compounds that remain after active vaping has ceased. To test our hypothesis, we exposed C57BL/6J mice to cotton towels contaminated with ENDS aerosols from unflavored vape fluid (6 mg nicotine in 50/50 propylene glycol/vegetable glycerin) for 1h/day, five days/week, for three weeks. We assessed protein levels in serum and bronchoalveolar lavage fluid (BALF) using a multiplex protein assay. The mean ± sd for PM10 and PM2.5 measurements in exposed mouse cages were 8.3 ± 14.0 and 4.6 ± 7.5 μg/m3, compared to 6.1 ± 11.2 and 3.7 ± 6.6 μg/m3 in control cages respectively. Two compounds, 4-methyl-1, 2-dioxolane and 4-methyl-cyclohexanol, were detected in vape fluid and on ENDS-contaminated towels, but not on control towels. Mice exposed to ENDS-contaminated towels had lower levels of serum Il-7 (P = 0.022, n = 7), and higher levels of Il-13 in the BALF (P = 0.006, n = 7) than those exposed to control towels (n = 6). After adjusting for sex and age, Il-7 and Il-13 levels were still associated with thirdhand vaping exposure (P = 0.010 and P = 0.017, respectively). This study provides further evidence that thirdhand ENDS aerosols can contaminate surfaces, and subsequently influence lung and systemic health upon exposure.
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Affiliation(s)
- Sarah Commodore
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Shikha Sharma
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Carolyn Damilola Ekpruke
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Robert Pepin
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Angela M. Hansen
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Dustin Rousselle
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Maksat Babayev
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Jonas M. Ndeke
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Rachel Alford
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
| | - Erik Parker
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Stephanie Dickinson
- Biostatistics Consulting Center, Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health Bloomington, Indiana University, Bloomington, IN 47408, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Hua M, Luo W, Khachatoorian C, McWhirter KJ, Leung S, Martinez T, Talbot P. Exposure, Retention, Exhalation, Symptoms, and Environmental Accumulation of Chemicals During JUUL Vaping. Chem Res Toxicol 2023; 36:492-507. [PMID: 36867872 DOI: 10.1021/acs.chemrestox.2c00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Little is known about the chemical exposures that electronic cigarette (EC) users receive and emit during JUUL vaping and if exposures produce symptoms dose dependently. This study examined chemical exposure (dose), retention, symptoms during vaping, and the environmental accumulation of exhaled propylene glycol (PG), glycerol (G), nicotine, and menthol in a cohort of human participants who vaped JUUL "Menthol" ECs. We refer to this environmental accumulation as "EC exhaled aerosol residue" (ECEAR). Chemicals were quantified using gas chromatography/mass spectrometry in JUUL pods before and after use, lab-generated aerosols, human exhaled aerosols, and in ECEAR. Unvaped JUUL "Menthol" pods contained ∼621.3 mg/mL of G, ∼264.9 mg/mL of PG, ∼59.3 mg/mL of nicotine, ∼13.3 mg/mL of menthol, and ∼0.1 mg/mL of the coolant WS-23. Eleven experienced male EC users (aged 21-26) provided exhaled aerosol and residue samples before and after vaping JUUL pods. Participants vaped ad libitum for 20 min, while their average puff count (22 ± 6.4) and puff duration (4.4 ± 2.0) were recorded. The transfer efficiency of nicotine, menthol, and WS-23 from the pod fluid into the aerosol varied with each chemical and was generally similar across flow rates (9-47 mL/s). At 21 mL/s, the average mass of each chemical retained by the participants who vaped 20 min was 53.2 ± 40.3 mg for G, 18.9 ± 14.3 mg for PG, 3.3 ± 2.7 mg for nicotine, and 0.5 ± 0.4 mg for menthol, with retention deduced to be ∼90-100% for each chemical. There was a significant positive relationship between the number of symptoms during vaping and total chemical mass retained. ECEAR accumulated on enclosed surfaces where it could contribute to passive exposure. These data will be valuable to researchers studying human exposure to EC aerosols and agencies that regulate EC products.
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Affiliation(s)
- My Hua
- Environmental Toxicology Graduate Program, University of California, Riverside, Riverside, California 92521, United States
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, Riverside, California 92521, United States
| | - Wentai Luo
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97201, United States
| | - Careen Khachatoorian
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, Riverside, California 92521, United States
| | - Kevin J McWhirter
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97201, United States
| | - Sara Leung
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, Riverside, California 92521, United States
| | - Teresa Martinez
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, Riverside, California 92521, United States
| | - Prue Talbot
- Environmental Toxicology Graduate Program, University of California, Riverside, Riverside, California 92521, United States
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, Riverside, California 92521, United States
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Ranpara A, Stefaniak AB, Fernandez E, Bowers LN, Arnold ED, LeBouf RF. Influence of puff topographies on e-liquid heating temperature, emission characteristics and modeled lung deposition of Puff Bar ™. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:450-466. [PMID: 37969359 PMCID: PMC10641718 DOI: 10.1080/02786826.2023.2190786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 11/17/2023]
Abstract
Puff Bar™, one of the latest designs of e-cigarettes, heats a mixture of liquid using a battery-powered coil at certain temperatures to emit aerosol. This study presents a mass-based characterization of emissions from seven flavors of Puff Bar™ devices by aerosolizing with three puff topographies [(puff volume: 55 < 65 < 75-mL) within 4-seconds at 30-seconds interval]. We evaluated the effects of puff topographies on heating temperatures; characterized particles using a cascade impactor; and measured volatile carbonyl compounds (VCCs). Modeled dosimetry and calculated mass median aerodynamic diameters (MMADs) were used to estimate regional, total respiratory deposition of the inhaled aerosol and exhaled fractions that could pose secondhand exposure risk. Temperatures of Puff Bar™ e-liquids increased with increasing puff volumes: 55mL (116.6 °C), 65 mL (128.3 °C), and 75mL (168.9 °C). Flavor types significantly influenced MMADs, total mass of particles, and VCCs (μg/puff: 2.15-2.30) in Puff Bar™ emissions (p < 0.05). Increasing puff volume (mL:55 < 65 < 75) significantly increased total mass (mg/puff: 4.6 < 5.6 < 6.2) of particles without substantially changing MMADs (~1μm:1.02~0.99~0.98). Aerosol emissions were estimated to deposit in the pulmonary region of e-cigarette user (41-44%), which could have toxicological importance. More than 2/3 (67-77%) of inhaled particles were estimated to be exhaled by users, which could affect bystanders. The VCCs measured contained carcinogens-formaldehyde (29.6%) and acetaldehyde (16.4%)-as well as respiratory irritants: acetone (23.9%), isovaleraldehyde (14.5%), and acrolein (4.9%). As Puff Bar™ emissions contain respirable particles and harmful chemicals, efforts should be made to minimize exposures, especially in indoor settings where people (including vulnerable populations) spend most of their life-time.
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Affiliation(s)
- Anand Ranpara
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Health Science Center, Morgantown, West Virginia, USA
| | - Aleksandr B. Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Elizabeth Fernandez
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Lauren N. Bowers
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Elizabeth D. Arnold
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Lamb T, Muthumalage T, Meehan-Atrash J, Rahman I. Nose-Only Exposure to Cherry- and Tobacco-Flavored E-Cigarettes Induced Lung Inflammation in Mice in a Sex-Dependent Manner. TOXICS 2022; 10:471. [PMID: 36006150 PMCID: PMC9413458 DOI: 10.3390/toxics10080471] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/01/2023]
Abstract
Flavoring chemicals in electronic nicotine delivery systems have been shown to cause cellular inflammation; meanwhile, the effects of fruit and tobacco flavors on lung inflammation by nose-only exposures to mice are relatively unknown. We hypothesized that exposure to flavored e-cigarettes would cause lung inflammation in C57BL/6 J mice. The mice were exposed to air, propylene glycol/vegetable glycerin, and flavored e-liquids: Apple, Cherry, Strawberry, Wintergreen, and Smooth & Mild Tobacco, one hour per day for three days. Quantification of flavoring chemicals by proton nuclear magnetic resonance spectroscopy (1H NMR), differential cell counts by flow cytometry, pro-inflammatory cytokines/chemokines by ELISA, and matrix metalloproteinase levels by western blot were performed. Exposure to PG/VG increased neutrophil cell count in lung bronchoalveolar lavage fluid (BALF). KC and IL6 levels were increased by PG/VG exposure and female mice exposed to Cherry flavored e-cigarettes, in lung homogenate. Mice exposed to PG/VG, Apple, Cherry, and Wintergreen increased MMP2 levels. Our results revealed flavor- and sex-based e-cigarette effects in female mice exposed to cherry-flavored e-liquids and male mice exposed to tobacco-flavored e-liquids, namely, increased lung inflammation.
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Affiliation(s)
| | | | | | - Irfan Rahman
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14620, USA
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Pozuelos GL, Kagda M, Rubin MA, Goniewicz ML, Girke T, Talbot P. Transcriptomic Evidence That Switching from Tobacco to Electronic Cigarettes Does Not Reverse Damage to the Respiratory Epithelium. TOXICS 2022; 10:370. [PMID: 35878275 PMCID: PMC9321508 DOI: 10.3390/toxics10070370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022]
Abstract
The health benefits of switching from tobacco to electronic cigarettes (ECs) are neither confirmed nor well characterized. To address this problem, we used RNA-seq analysis to compare the nasal epithelium transcriptome from the following groups (n = 3 for each group): (1) former smokers who completely switched to second generation ECs for at least 6 months, (2) current tobacco cigarette smokers (CS), and (3) non-smokers (NS). Group three included one former cigarette smoker. The nasal epithelial biopsies from the EC users vs. NS had a higher number of differentially expressed genes (DEGs) than biopsies from the CS vs. NS and CS vs. EC sets (1817 DEGs total for the EC vs. NS, 407 DEGs for the CS vs. NS, and 116 DEGs for the CS vs. EC comparison). In the EC vs. NS comparison, enriched gene ontology terms for the downregulated DEGs included cilium assembly and organization, whereas gene ontologies for upregulated DEGs included immune response, keratinization, and NADPH oxidase. Similarly, ontologies for cilium movement were enriched in the downregulated DEGs for the CS vs. NS group. Reactome pathway analysis gave similar results and also identified keratinization and cornified envelope in the upregulated DEGs in the EC vs. NS comparison. In the CS vs. NS comparison, the enriched Reactome pathways for upregulated DEGs included biological oxidations and several metabolic processes. Regulator effects identified for the EC vs. NS comparison were inflammatory response, cell movement of phagocytes and degranulation of phagocytes. Disease Ontology Sematic Enrichment analysis identified lung disease, mouth disease, periodontal disease and pulmonary fibrosis in the EC vs. NS comparison. Squamous metaplasia associated markers, keratin 10, keratin 13 and involucrin, were increased in the EC vs. NS comparison. Our transcriptomic analysis showed that gene expression profiles associated with EC use are not equivalent to those from non-smokers. EC use may interfere with airway epithelium recovery by promoting increased oxidative stress, inhibition of ciliogenesis, and maintaining an inflammatory response. These transcriptomic alterations may contribute to the progression of diseases with chronic EC use.
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Affiliation(s)
- Giovanna L. Pozuelos
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA 92521, USA; (G.L.P.); (M.K.); (M.A.R.)
| | - Meenakshi Kagda
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA 92521, USA; (G.L.P.); (M.K.); (M.A.R.)
| | - Matine A. Rubin
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA 92521, USA; (G.L.P.); (M.K.); (M.A.R.)
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Thomas Girke
- Institute for Integrative Genome Biology, University of California, Riverside, CA 92521, USA;
| | - Prue Talbot
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA 92521, USA; (G.L.P.); (M.K.); (M.A.R.)
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Collaco JM, McGrath-Morrow SA. Developmental Effects of Electronic Cigarette Use. Compr Physiol 2022; 12:3337-3346. [PMID: 35578965 DOI: 10.1002/cphy.c210018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Electronic cigarettes have gained widespread acceptance among adolescents and young adults. As a result of this popularity, there are concerns regarding the potential harm of primary, secondhand and thirdhand electronic cigarette exposures on fetal and postnatal development. In vitro studies have shown that constituents in electronic cigarette liquids, including nicotine, flavorings, and carrier agents can alter cellular processes and growth. Additionally, aerosolized electronic cigarette emissions have been shown to disrupt organ development and immune responses in preclinical studies. In clinical studies, an association between electronic cigarette use and frequent respiratory symptoms, greater asthma severity and impaired mucociliary clearance has been demonstrated with adolescent and young adult users of electronic cigarettes having twice the frequency of cough, mucus production, or bronchitis compared to nonusers. Along with the popularity of electronic cigarette use, secondhand electronic cigarette exposure has increased substantially; with almost one-fourth of middle and high school children reporting exposure to secondhand vapors. The health consequences of secondhand electronic cigarette exposure on children and other vulnerable populations are poorly understood but detectable levels of cotinine have been measured in nonusers. Pregnant women and their offspring are another vulnerable group at increased risk for health consequences from electronic cigarette exposure. Nicotine crosses the placenta and can disrupt brain and lung development in preclinical studies. This article will focus on the physiological and health effects associated with primary or secondhand exposure to electronic cigarettes. It is expected that with ongoing availability of electronic cigarettes as well as the accumulation of additional follow-up time for long-term outcomes, the risks associated with exposure will become better clarified. © 2022 American Physiological Society. Compr Physiol 12:3337-3346, 2022.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Sharon A McGrath-Morrow
- Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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