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Qazi SU, Ansari MHUH, Ghazanfar S, Ghazanfar SS, Farooq M. Comparison of Acute Effects of E-cigarettes With and Without Nicotine and Tobacco Cigarettes on Hemodynamic and Endothelial Parameters: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev 2024; 31:225-237. [PMID: 38668958 DOI: 10.1007/s40292-024-00643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/11/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently. AIMS This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC-) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC). METHODS Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC- and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC-. However, EC+ was observed to cause less detrimental effect on SBP (WMD = - 4.72 mmHg, 95% CI [- 6.58, - 2.86], p < 0.01), and HR (WMD = - 3.11 BPM, 95% CI [- 4.54, - 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = - 1.14 mmHg, 95% CI [- 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC- but to a lesser degree as compared to TC. CONCLUSION EC+ shows greater impairment in hemodynamic and endothelial parameters than EC- but less than TC. Additional studies are needed to evaluate prolonged effects of EC use.
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Affiliation(s)
- Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Shamas Ghazanfar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Minaam Farooq
- Department of Neurological Surgery, King Edward Medical University, Lahore, Pakistan
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Aherrera A, Lin JJ, Chen R, Tehrani M, Schultze A, Borole A, Tanda S, Goessler W, Rule AM. Metal Concentrations in E-Cigarette Aerosol Samples: A Comparison by Device Type and Flavor. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127004. [PMID: 38048100 PMCID: PMC10695266 DOI: 10.1289/ehp11921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The rapid evolution of electronic cigarette (e-cigarette) products warrants surveillance of the differences in exposure across device types-modifiable devices (MODs), cartridge ("pod")-containing devices (PODs), disposable PODs (d-PODs)-and flavors of the products available on the market. OBJECTIVE This study aimed to measure and compare metal aerosol concentrations by device type and common flavors. METHODS We collected aerosol from 104 MODs, 67 PODs (four brands: JUUL, Bo, Suorin, PHIX), and 23 d-PODs (three brands: ZPOD, Bidi, Stig) via droplet deposition in a series of conical pipette tips. Metals and metalloids [aluminum (Al), arsenic (As), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb), tin (Sn), and zinc (Zn)] were measured using inductively coupled plasma mass spectrometry (ICP-MS), results were log-transformed for statistical analysis, and concentrations are reported in aerosol units (mg / m 3 ). RESULTS Of the 12 elements analyzed, concentrations were statistically significantly higher in MOD devices, except for Co and Ni, which were higher in PODs and d-PODs. Of the POD brands analyzed, PHIX had the highest median concentrations among four metals (Al, Ni, Pb, and Sn) compared to the rest of the POD brands. According to POD flavor, seven metals were three to seven orders of magnitude higher in tobacco-flavored aerosol compared to those in mint and mango flavors. Among the d-POD brands, concentrations of four metals (Al, Cu, Ni, and Pb) were higher in the ZPOD brand than in Bidi Stick and Stig devices. According to d-POD flavor, only Cr concentrations were found to be statistically significantly higher in mint than tobacco-flavored d-PODs. DISCUSSION We observed wide variability in aerosol metal concentrations within and between the different e-cigarette device types, brands, and flavors. Overall, MOD devices generated aerosols with higher metal concentrations than PODs and d-PODs, and tobacco-flavored aerosols contained the highest metal concentrations. Continued research is needed to evaluate additional factors (i.e., nicotine type) that contribute to metal exposure from new and emerging e-cigarette devices in order to inform policy. https://doi.org/10.1289/EHP11921.
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Affiliation(s)
- Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Pediatric Pulmonary Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joyce Jy Lin
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mina Tehrani
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Schultze
- Department of Biochemistry, Ithaca College School of Humanities and Sciences, Ithaca, New York, USA
| | - Aryan Borole
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Tanda
- Institute of Chemistry, University of Graz, Graz, Austria
| | | | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Siddiqi TJ, Rashid AM, Siddiqi AK, Anwer A, Usman MS, Sakhi H, Bhatnagar A, Hamburg NM, Hirsch GA, Rodriguez CJ, Blaha MJ, DeFilippis AP, Benjamin EJ, Hall ME. Association of Electronic Cigarette Exposure on Cardiovascular Health: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101748. [PMID: 37088177 DOI: 10.1016/j.cpcardiol.2023.101748] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Despite the growing use of electronic cigarettes (EC) in the Unites States, particularly among young people, and their perceived safety, current evidence suggests that EC usage may cause adverse clinical cardiovascular effects. Therefore, we aim to pool all studies evaluating the association of EC exposure with cardiovascular health. Medline, Cochrane CENTRAL, and Scopus were searched for studies from January 1, 2006 until December 31, 2022. Randomized and observational studies reporting cardiovascular outcomes, hemodynamic parameters, and biomarkers of platelet physiology, before and after acute or chronic EC exposure were pooled using a random-effects model. Overall, 27 studies (n = 863) were included. Heart rate increased significantly after acute EC exposure (weighted mean difference [WMD]: 0.76 bpm; 95% confidence interval [CI], 0.48, 1.03; P < 0.00001; I2 = 92%). Significant increases in systolic blood pressure (WMD: 0.28 mmHg; 95% CI, 0.06, 0.51; P = 0.01; I2 = 94%), diastolic blood pressure (WMD: 0.38 mmHg; 95% CI, 0.16, 0.60; P = 0.0006; I2 = 90%), and PWV (WMD: 0.38; 95% CI, 0.13, 0.63; P = 0.003; I2 = 100%) were also observed. Augmentation index increased significantly (SMD: 0.39; 95% CI, 0.11, 0.67; P = 0.007; I2 = 90%), whereas reduction in flow-mediated dilation (WMD: -1.48; 95% CI, -2.49, -0.47; P = 0.004; I2 = 45%) was observed. Moreover, significant rise in both soluble P-selectin (WMD: 4.73; 95% CI, 0.80, 8.66; P = 0.02; I2 = 98%) and CD40L (WMD: 1.14; 95% CI, 0.41, 1.87; P = 0.002; I2 = 79%) was observed. Our results demonstrate that smoking EC is associated with a significant increase in cardiovascular hemodynamic measures and biomarkers. Our findings can aid policymakers in making informed decisions regarding the regulation of EC to ensure public safety.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
| | | | | | - Anusha Anwer
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Hifza Sakhi
- Philadelphia College of Osteopathic Medicine, Suwanee, GA
| | - Aruni Bhatnagar
- Division of Cardiovascular Medicine, Department of Medicine, Diabetes and Obesity Center, Institute of Molecular Cardiology, University of Louisville, Louisville, KY
| | - Naomi M Hamburg
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Glenn A Hirsch
- Department of Medicine, Division of Cardiology, National Jewish Health | St. Joseph Hospital and The Rocky Mountain Heart Institute part of Intermountain Health, Denver, CO
| | - Carlos J Rodriguez
- Division of Cardiovascular Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center and Boston University Department of Medicine, Chobanian and Avedisian School of Medicine, and Department of Epidemiology, School of Public Health, Boston, MA
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Lee JW, Kim S. Comparison of a Tobacco-Specific Carcinogen in Tobacco Cigarette, Electronic Cigarette, and Dual Users. J Korean Med Sci 2023; 38:e140. [PMID: 37191844 DOI: 10.3346/jkms.2023.38.e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is known as a lung carcinogen. The objective of this study was to investigate associations of urine NNAL concentrations and smoking status. METHODS This was a cross-sectionally designed study based on data from the 2016-2018 Korean National Health and Nutrition Examination Survey. A total of 2,845 participants were classified into past-smoker, electronic cigarette (e-cigar) only, dual-user, and cigarette only smoker groups. All sampling and weight variables were stratified and analysis was conducted accounting for the complex sampling design. Analysis of covariance was used to compare the geometric mean of urine NNAL concentrations and log-transformed urine NNAL level among smoking status with weighted survey design. Post hoc paired comparisons with Bonferroni adjustment was performed according to smoking status. RESULTS The estimated geometric mean concentrations of urine NNAL were 1.974 ± 0.091, 14.349 ± 5.218, 89.002 ± 11.444, and 117.597 ± 5.459 pg/mL in past-smoker, e-cigar only, dual-user, and cigarette only smoker groups, respectively. After fully adjusting, log-transformed urine NNAL level was significantly different among groups (P < 0.001). Compared with the past-smoker group, e-cigar only, dual-user, and cigarette only smoker groups showed significantly higher log-transformed urine NNAL concentrations in post hoc test (all P < 0.05). CONCLUSION E-cigar only, dual-user, and cigarette only smoker groups showed significantly higher geometric mean concentrations of urine NNAL than the past-smoker group. Conventional cigarette, dual users, and e-cigar users can potentially show harmful health effects from NNAL.
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Affiliation(s)
- Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Department of Preventive Medicine, Graduate School of the Catholic University of Korea, Seoul, Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Alcantara C, Chaparro L, Zagury GJ. Occurrence of metals in e-cigarette liquids: Influence of coils on metal leaching and exposure assessment. Heliyon 2023; 9:e14495. [PMID: 36950607 PMCID: PMC10025154 DOI: 10.1016/j.heliyon.2023.e14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Electronic cigarettes are generally recognized as a safer alternative than conventional cigarettes. Nevertheless, previous research suggests metal (loid) leaching due to coil contact, potentially transferring to the e-liquid and its aerosolized form. In this study, Cr, Cd, Ni, and Pb levels were measured by inductively coupled plasma mass spectrometry (ICP-MS) on 17 samples of e-liquids with different chemical properties (e.g., pH, nicotine content, flavoring, free-base, and nicotine salts). Twelve e-liquids were then put in contact with 36-gauge Kanthal A-1, Nichrome 80, Stainless steel 317 L and disposable coils such as Juul, and Aspire BVC for three days at 200-250 °C for 1 h each day. Metal levels expressed as mean (standard deviation) metal concentration, were below detection (Cd) to very low in bottle samples (Ni ≤ 76 (18); Pb ≤ 16 (1.5); and Cr ≤ 386 (15.6) μg/kg). In the coil extracts, varying concentrations of the same metal (loid) were found, indicating that metal leaching capacity may differ per sample. All samples contained Ni and Cr, followed by Pb to a much lesser extent. Cd levels were mostly below detection limits. Coil + e-liquid combinations with the highest Ni, Cr, and Pb concentrations were: Aspire BVC + Melon 0 mg/mL: Ni = 1.22 E+04 (281); Aspire BVC + Hit Nicotine 40 mg/mL: Cr = 864 (116); and Nichrome 80 + Melon 0 mg/mL: Pb = 56 (5) μg/kg. Overall, results suggest that nicotine salts at 40 mg/mL enhance Cr and Ni transfer. Stainless steel 317 L released very low metal concentrations. A conservative screening level risk characterization showed that 10.5% and 3.5% of the coil extracts may exceed Ni and Cr (III) safe concentrations, respectively. In the aerosol phase, 8.8% of samples might be above Ni equivalent daily dose for chronic exposure and 1.8% for intermediate exposure. Further studies on coil metal leaching could aid in establishing coil manufacturing regulations.
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Affiliation(s)
- Claudia Alcantara
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
| | - Laura Chaparro
- Les Laboratoires Vaporus Inc., 9704 Trans Canada Route, Saint-Laurent (QC), H4S 1V9, Canada
| | - Gerald J. Zagury
- Department of Civil, Geological and Mining Engineering, Polytechnique Montréal (QC), H3C 3A7, Canada
- Corresponding author. Department of Civil, Geological and Mining Engineering Polytechnique Montréal P.O. Box 6079, Station Centre-Ville Montréal, (QC), Canada, H3C 3A7 .
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Giovacchini CX, Crotty Alexander LE, Que LG. Electronic Cigarettes: A Pro-Con Review of the Current Literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2843-2851. [PMID: 35872217 DOI: 10.1016/j.jaip.2022.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Electronic cigarettes (e-cigarettes, e-cigs, or electronic nicotine delivery systems) are battery-operated devices typically containing glycerol and/or propylene glycol-based solutions with varying nicotine content, known as e-liquids. Although e-cigarettes were originally developed as a potentially less harmful alternative to traditional combustible tobacco cigarette smokers, several factors have driven their popularity among smokers and nonsmokers alike, including their sleek product designs, innumerable appealing flavors, lack of combustible smoke and odor, and high potential nicotine concentrations. Furthermore, many advocates have promoted the idea that e-cigarettes are safe to use, or at least safer than conventional tobacco, despite limited longitudinal data to support these claims. Here, we examine what is known about the impacts of e-cigarette use on traditional cigarette smoking cessation, lung health, and youth and young adult tobacco product exposure. Upon review of the currently available literature, the negative effects of e-cigarette use seem to outweigh any potential benefit, because the available evidence does not confirm the use of e-cigarettes as an effective strategy for supporting traditional combustible tobacco cigarette smoking cessation, particularly given the emerging adverse effects on lung health and the potential future public health effects of e-cigarette adoption among a burgeoning new generation of tobacco product users.
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Affiliation(s)
- Coral X Giovacchini
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section, VA San Diego Healthcare System, San Diego, Calif; Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, San Diego, Calif.
| | - Loretta G Que
- Division of Pulmonary, Allergy, and Critical Care, Duke University Health System, Durham, NC.
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7
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Song M, Lee WS, Moon J. Antecedents and consequences of healthiness in café service: Moderating effect of health concern. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.913291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aims to examine the antecedents of consequences of healthiness in the café business context. Additionally, this study attests to the moderating effect of one's concern for health (health concern) between healthiness and attitude. To attain a more vivid response, this research selected Starbucks coffeehouse as a case study. Hygiene, healthiness, and nutritional disclosure are the determinants of healthiness in the café business area. The consequences of healthiness are attitude and purchase intention for café products. Health concern is the moderating variable between healthiness and attitude in the context of café businesses. In order to test the association between attributes, a survey was used. Amazon Mechanical Turk was chosen to recruit survey participants. The valid observation for data analysis was 455 participants. For hypothesis testing, a structural equation model was implemented. Regarding the results, health concern is positively influenced by hygiene and organicness, but healthiness is negatively affected by nutritional disclosure. Moreover, it was found that health concern significantly moderates the relationship between healthiness and attitude, and attitude exerts a positive effect on purchase intention.
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Soulet S, Sussman RA. A Critical Review of Recent Literature on Metal Contents in E-Cigarette Aerosol. TOXICS 2022; 10:toxics10090510. [PMID: 36136475 PMCID: PMC9506048 DOI: 10.3390/toxics10090510] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 05/23/2023]
Abstract
The inhalation of metallic compounds in e-cigarette (EC) aerosol emissions presents legitimate concerns of potential harms for users. We provide a critical review of laboratory studies published after 2017 on metal contents in EC aerosol, focusing on the consistency between their experimental design, real life device usage and appropriate evaluation of exposure risks. All experiments reporting levels above toxicological markers for some metals (e.g., nickel, lead, copper, manganese) exhibited the following experimental flaws: (i) high powered sub-ohm tank devices tested by means of puffing protocols whose airflows and puff volumes are conceived and appropriate for low powered devices; this testing necessarily involves overheating conditions that favor the production of toxicants and generate aerosols that are likely repellent to human users; (ii) miscalculation of exposure levels from experimental outcomes; (iii) pods and tank devices acquired months and years before the experiments, so that corrosion effects cannot be ruled out; (iv) failure to disclose important information on the characteristics of pods and tank devices, on the experimental methodology and on the resulting outcomes, thus hindering the interpretation of results and the possibility of replication. In general, low powered devices tested without these shortcomings produced metal exposure levels well below strict reference toxicological markers. We believe this review provides useful guidelines for a more objective risk assessment of EC aerosol emissions and signals the necessity to upgrade current laboratory testing standards.
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Affiliation(s)
| | - Roberto A. Sussman
- Institute of Nuclear Sciences, National Autonomous University of Mexico, Mexico City 04510, Mexico
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9
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Rastian B, Wilbur C, Curtis DB. Transfer of Metals to the Aerosol Generated by an Electronic Cigarette: Influence of Number of Puffs and Power. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159334. [PMID: 35954690 PMCID: PMC9368615 DOI: 10.3390/ijerph19159334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023]
Abstract
Electronic cigarettes (e-cigarettes) are increasing in popularity despite uncertainties about their health hazards. Literature studies have shown that e-cigarettes may be a source of toxic heavy metal exposure to the user, but the mechanism by which metals are transferred from the e-cigarette parts into the aerosol plume that is inhaled by the user is poorly understood. The goal of this study was to quantify the potentially harmful heavy metals chromium, nickel, copper, and lead systematically during the simulated use of a mod-type e-cigarette in order to better understand the mechanism of metal transfer from the e-cigarette parts into the aerosol plume and into the liquid in the storage tank. Aerosol was collected and aliquots of the remaining liquid in the storage tank were collected from 0 to 40 puffs in 10 puff increments and analyzed with atomic absorption spectroscopy. It was found that the concentration of metals increased in both the aerosol and tank liquid the more times the e-cigarette was puffed, but at varying rates for each element and depending on the power applied to the heating coil. For copper, lead, and nickel, the concentrations of metals in the aerosol and tank increased with increasing power but for chromium, the concentration varied with power. Additionally, it was observed that chromium and nickel concentrations were greater in the aerosol than in tank liquid, consistent with the direct transfer of those metals to the aerosol from heating of the nichrome coil element used in this study. For copper and lead, the concentrations were similar or greater in the tank compared to the aerosol, consistent with transfer first into the storage tank liquid, followed by vaporization into the aerosol.
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10
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Jităreanu A, Cara IG, Sava A, Mârțu I, Caba IC, Agoroaei L. The Impact of the Storage Conditions and Type of Clearomizers on the Increase of Heavy Metal Levels in Electronic Cigarette Liquids Retailed in Romania. TOXICS 2022; 10:toxics10030126. [PMID: 35324751 PMCID: PMC8950552 DOI: 10.3390/toxics10030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
The growing popularity of electronic cigarettes has raised several public health concerns, including the risks associated with heavy metals exposure via e-liquids and vapors. The purpose of this study was to determine, using atomic absorption spectrometry, the concentrations of Pb, Ni, Zn, and Co in some commercially available e-liquid samples from Romania immediately after purchase and after storage in clearomizers. Lead and zinc were found in all investigated samples before storage. The initial concentrations of Pb ranged from 0.13 to 0.26 mg L−1, while Zn concentrations were between 0.04 and 0.07 mg L−1. Traces of nickel appeared in all investigated e-liquids before storage but in very small amounts (0.01–0.02 mg L−1). Co was below the detection limits. We investigated the influence of the storage period (1, 3, and 5 days), storage temperature (22 °C and 40 °C), and type of clearomizer. In most cases, the temperature rise and storage period increase were associated with higher concentrations of heavy metals. This confirms that storage conditions can affect metal transfer and suggests that the temperature of storage is another parameter that can influence this phenomenon.
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Affiliation(s)
- Alexandra Jităreanu
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania; (A.J.); (I.-C.C.); (L.A.)
| | - Irina Gabriela Cara
- Research Institute for Agriculture and Environment, “Ion Ionescu de la Brad” University of Life Sciences, 700115 Iasi, Romania
- Correspondence:
| | - Alexandru Sava
- Department of Analytical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania;
| | - Ioana Mârțu
- Department of Dental Technology, Faculty of Dental Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania;
| | - Ioana-Cezara Caba
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania; (A.J.); (I.-C.C.); (L.A.)
| | - Luminița Agoroaei
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania; (A.J.); (I.-C.C.); (L.A.)
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Effect of Heating on Physicochemical Property of Aerosols during Vaping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031892. [PMID: 35162914 PMCID: PMC8835267 DOI: 10.3390/ijerph19031892] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Many electronic cigarette manufacturers have offered different types of “high-end mods” that allow for controlled heating of the e-liquid. However, the controlled heating condition can drastically alter the inhaled aerosols’ physical properties and chemical substances, causing potential health risks. To investigate the contribution of heating on aerosol properties, we used four common power settings in the mods to conduct a physicochemical analysis. Our data showed that the aerosol mass and nicotine content in the aerosols increased at high power. Additionally, high power led to aerosolization of a viscous component in the e-liquid, increasing the viscosity of aerosol. However, the pH of the aerosol was constant regardless of the applied power. In addition, high-power operation made nicotine prone to oxidation, resulting in the color of the aerosol turning yellow. Lastly, we demonstrated that e-cigarette aerosol could contain various metals, including aluminum, arsenic, cadmium, chromium, copper, iron, magnesium, nickel, lead, and zinc. Even though these metal contents proportionally increased with the power setting, they remained far below the recommended exposure limits. Our finding demonstrates that the heating conditions of the e-cigarette change the physicochemical properties of the aerosols and their metal contents, thereby possibly affecting users’ oral and respiratory systems.
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Kubachka KM, Wilson RA. Elemental Analysis of Tetrahydrocannabinol and Nicotine E-Liquids Related to EVALI. ACS OMEGA 2021; 6:32090-32100. [PMID: 34870030 PMCID: PMC8638013 DOI: 10.1021/acsomega.1c04868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
During the e-cigarette, or vaping, product use-associated lung injury (EVALI) investigation, the U.S. FDA's Forensic Chemistry Center (FCC) received numerous sample submissions from various states and other sources. Many of these products were linked directly to patients, while others were not; both categories included used and unused products. Elemental analysis using inductively coupled plasma mass spectrometry (ICP-MS) preceded by microwave-assisted decomposition was carried out on the cartridge contents of 65 of these submitted samples. Challenges encountered included limited sample, high sample viscosity, and adhesion, which necessitated sample preparation techniques not commonly used during routine elemental analysis. The elemental concentrations of contaminants including Pb, As, Cd, Cr, Ni, Cu, and Sn in tetrahydrocannabinol (THC) e-liquids associated with EVALI were determined. Nicotine e-liquid samples collected alongside the THC e-liquid samples were analyzed in tandem during method development. Several THC e-liquid samples contained Pb greater than 0.5 μg/g, while others had part per million levels of Ni, Cu, and/or Cr. This study presents the first detailed report of elemental concentrations in multiple THC e-liquid samples including those from informal/illicit sources and also delves into the method considerations needed for testing a viscous, hydrophobic sample matrix in limited quantity.
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Goenka S, Simon SR. Effects of E-Cigarette Refill Liquid Flavorings with and without Nicotine on Human Retinal Pigment Epithelial Cells: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11655. [PMID: 34770169 PMCID: PMC8582700 DOI: 10.3390/ijerph182111655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
Smoking is an etiologic factor for age-related macular degeneration (AMD). Although cigarette smoke has been extensively researched for retinal pigment epithelial (RPE) cell degeneration, the potential for adverse effects on the retinal epithelium following exposure to flavored e-cigarette refill liquid has never been explored. In this preliminary study, we have examined the effects of 20 e-liquids (10 different flavored nicotine-free and 10 nicotine-rich e-liquids) used in e-cigarettes on the metabolic activity, membrane integrity, and mitochondrial membrane potential of RPE cells. Our results showed that of the flavors studied over the concentration range: 0.5, 1, and 2% v/v for a duration of 48 h, cinnamon was the most toxic and menthol was the second most toxic, while other flavors showed lesser or no cytotoxicity. The presence of nicotine augmented cytotoxicity for cinnamon, menthol, strawberry, vanilla, and banana while for other flavors there was no synergism. Together, our results demonstrate that exposure of RPE to flavored e-cigarette refill liquids caused significant cytotoxicity and may be a risk factor for the development of retinal pathogenesis, although further in-depth studies are necessary.
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Affiliation(s)
- Shilpi Goenka
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA;
- Department of Biochemistry and Cellular Biology, Stony Brook University, Stony Brook, NY 11794-5215, USA
| | - Sanford R. Simon
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA;
- Department of Biochemistry and Cellular Biology, Stony Brook University, Stony Brook, NY 11794-5215, USA
- Department of Pathology, Stony Brook University, Stony Brook, NY 11794, USA
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14
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Bonner E, Chang Y, Christie E, Colvin V, Cunningham B, Elson D, Ghetu C, Huizenga J, Hutton SJ, Kolluri SK, Maggio S, Moran I, Parker B, Rericha Y, Rivera BN, Samon S, Schwichtenberg T, Shankar P, Simonich MT, Wilson LB, Tanguay RL. The chemistry and toxicology of vaping. Pharmacol Ther 2021; 225:107837. [PMID: 33753133 PMCID: PMC8263470 DOI: 10.1016/j.pharmthera.2021.107837] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
Vaping is the process of inhaling and exhaling an aerosol produced by an e-cigarette, vape pen, or personal aerosolizer. When the device contains nicotine, the Food and Drug Administration (FDA) lists the product as an electronic nicotine delivery system or ENDS device. Similar electronic devices can be used to vape cannabis extracts. Over the past decade, the vaping market has increased exponentially, raising health concerns over the number of people exposed and a nationwide outbreak of cases of severe, sometimes fatal, lung dysfunction that arose suddenly in otherwise healthy individuals. In this review, we discuss the various vaping technologies, which are remarkably diverse, and summarize the use prevalence in the U.S. over time by youths and adults. We examine the complex chemistry of vape carrier solvents, flavoring chemicals, and transformation products. We review the health effects from epidemiological and laboratory studies and, finally, discuss the proposed mechanisms underlying some of these health effects. We conclude that since much of the research in this area is recent and vaping technologies are dynamic, our understanding of the health effects is insufficient. With the rapid growth of ENDS use, consumers and regulatory bodies need a better understanding of constituent-dependent toxicity to guide product use and regulatory decisions.
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Affiliation(s)
- Emily Bonner
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Yvonne Chang
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Emerson Christie
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Victoria Colvin
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Brittany Cunningham
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Daniel Elson
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Christine Ghetu
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Juliana Huizenga
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Sara J Hutton
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Siva K Kolluri
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Stephanie Maggio
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Ian Moran
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Bethany Parker
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Yvonne Rericha
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Brianna N Rivera
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Samantha Samon
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Trever Schwichtenberg
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Prarthana Shankar
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Michael T Simonich
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Lindsay B Wilson
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA
| | - Robyn L Tanguay
- Department of Environmental and Molecular Toxicology, Sinnhuber Aquatic Research Laboratory, Environmental Health Sciences Center, Oregon State University, Corvallis, OR, USA.
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15
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Khachatoorian C, Luo W, McWhirter KJ, Pankow JF, Talbot P. E-cigarette fluids and aerosol residues cause oxidative stress and an inflammatory response in human keratinocytes and 3D skin models. Toxicol In Vitro 2021; 77:105234. [PMID: 34416289 DOI: 10.1016/j.tiv.2021.105234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
Our goal was to evaluate the effects of EC refill fluids and EC exhaled aerosol residue (ECEAR) on cultured human keratinocytes and MatTek EpiDerm™, a 3D air liquid interface human skin model. Quantification of flavor chemicals and nicotine in Dewberry Cream and Churrios refill fluids was done using GC-MS. The dominant flavor chemicals were maltol, ethyl maltol, vanillin, ethyl vanillin, benzyl alcohol, and furaneol. Cytotoxicity was determined with the MTT and LDH assays, and inflammatory markers were quantified with ELISAs. Churrios was cytotoxic to keratinocytes in the MTT assay, and both fluids induced ROS production in the medium (ROS-Glo™) and in cells (CellROX). Exposure of EpiDerm™ to relevant concentrations of Dewberry Cream and Churrios for 4 or 24 h caused secretion of inflammatory markers (IL-1α, IL-6, and MMP-9), without altering EpiDerm™ histology. Lab made fluids with propylene glycol (PG) or PG plus a flavor chemical did not produce cytotoxic effects, but increased secretion of IL-1α and MMP-9, which was attributed to PG. ECEAR derived from Dewberry Cream and Churrios did not produce cytotoxicity with Epiderm™, but Churrios ECEAR induced IL-1α secretion. These data support the conclusion that EC chemicals can cause oxidative damage and inflammation to human skin.
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Affiliation(s)
- Careen Khachatoorian
- Department of Molecular, Cell & Systems Biology, University of California, Riverside, Riverside, CA, United States
| | - Wentai Luo
- Department of Civil and Environmental Engineering, Portland State University, Portland, OR, United States
| | - Kevin J McWhirter
- Department of Civil and Environmental Engineering, Portland State University, Portland, OR, United States
| | - James F Pankow
- Department of Civil and Environmental Engineering, Portland State University, Portland, OR, United States
| | - Prue Talbot
- Department of Molecular, Cell & Systems Biology, University of California, Riverside, Riverside, CA, United States.
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16
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Paul S, Joseph D, Majumdar M. Health risk assessment of Macro, Trace-elements and heavy metal in various Indian Antidiabetic Polyherbal formulations. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:40929-40937. [PMID: 33774788 DOI: 10.1007/s11356-021-13615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Diabetes mellitus, a global pandemic, can be holistically managed with the use of polyherbal formulations which is an accessible form of treatment in developing countries due to fewer side effects, economical and easily available. Commercial polyherbal formulation lacks systemic based scientific study, thus it is suspected to be associated with many contaminations and related toxicities, one of which is considered to be elemental health hazards. Therefore, the present study is designed to assess six selected antidiabetic polyherbal formulations from the Indian market for their element contents, quality, and health risk assessment. Concentrations of 35 essential and non-essential trace-elements were quantified by Handheld X-ray spectrophotometer and health risk assessment was calculated by estimated daily intake (EDI) and Total hazard quotient (THQ). Elements were found to be in a vast range of concentration in the tested APH. Among the 35 elements analyzed, Ca (23100±0.033ppm) and K (14800±0.021 ppm) in "MH" and Zn (15600±0.025 ppm) in "DB" were found to be the highest. The lowest concentrations of Rb and Nb (3±2 ppm) were observed in the formulation "MH" and "SN" respectively. THQ of all the elements was calculated to be less than unity except for Rb in the formulation "MA". Rb is rarely associated with toxicities as it is rapidly excreted in sweat and urine. V, Co, Ni, Cu, As, Se, Y, Ag, Sn, Sb, Ba, W, and Hg were absent in all the APH. Therefore the present study indicated the presence of essential elements some of which are important for the management of diabetes and hence can be considered safe for use.
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Affiliation(s)
- Saptadipa Paul
- Department of Biotechnology, JAIN (deemed-to-be University), Bengaluru, 560069, India
| | - Daisy Joseph
- Nuclear Physics Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Mala Majumdar
- Department of Biotechnology, JAIN (deemed-to-be University), Bengaluru, 560069, India.
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17
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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18
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Pappas RS, Gray N, Halstead M, Valentin-Blasini L, Watson C. Toxic Metal-Containing Particles in Aerosols from Pod-Type Electronic Cigarettes. J Anal Toxicol 2021; 45:337-347. [PMID: 32672822 DOI: 10.1093/jat/bkaa088] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 12/23/2022] Open
Abstract
The popularity of electronic cigarettes (electronic nicotine delivery systems or ENDS) has grown rapidly over the past decade. With the continued evolution of ENDS, and the arrival of newer replaceable pod devices on the market, it is prudent to examine their emissions to help determine potential health risks to the user. Metal-containing particles were examined in aerosol from several pod-based devices from three manufacturers that offer flavored liquids in their respective products. Previous ENDS metal emissions studies focused on the total toxic metal concentrations in aerosols and have suggested that the principal sources are oxidized internal metal components that are in contact with the liquid. Most metal oxides have limited solubility, and it is likely that some metal content in ENDS aerosol may present as particles rather than dissolved forms. Examining the composition and number of particles in the ENDS aerosols is important because inhaled metal oxide particles cause pulmonary inflammation. Chronic inhalation of ENDS aerosol may lead to inflammatory cell activation in the lungs. Therefore, this study was designed to measure metal oxide particle concentrations and sizes in ENDS aerosols from select pod-based systems. Aerosol samples were generated with pod liquids (tobacco, mint or menthol) from devices produced by three manufacturers using CORESTA Recommended Method 81 parameters with a high-purity fluoropolymer aerosol trap. Particle sizes for chromium, iron, nickel, copper, zinc, tin and lead oxides were measured in triplicate using single particle inductively coupled plasma-mass spectrometry and dynamic light scattering. A novel aspect of these measurements included using dual element particle analysis to infer particle source component material. Particle concentrations in aerosols from the devices were variable between devices and from pod to pod, ranging from no detectable chromium- and zinc-containing particles in aerosol from some pods to 222,000 lead containing particles per 10 puffs from individual pods.
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Affiliation(s)
- R Steven Pappas
- Centers for Disease Control and Prevention, Tobacco and Volatiles Branch, 4770 Buford Hwy, M.S. S110-4, Atlanta, GA 30341, USA
| | - Naudia Gray
- Centers for Disease Control and Prevention, Tobacco and Volatiles Branch, 4770 Buford Hwy, M.S. S110-4, Atlanta, GA 30341, USA
| | - Mary Halstead
- Battelle Analytical Services, 2987 Clairmont Road, Suite 450, Atlanta, GA 30329, USA
| | - Liza Valentin-Blasini
- Centers for Disease Control and Prevention, Tobacco and Volatiles Branch, 4770 Buford Hwy, M.S. S110-4, Atlanta, GA 30341, USA
| | - Clifford Watson
- Centers for Disease Control and Prevention, Tobacco and Volatiles Branch, 4770 Buford Hwy, M.S. S110-4, Atlanta, GA 30341, USA
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19
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Saleh QM, Hensel EC, Eddingsaas NC, Robinson RJ. Effects of Manufacturing Variation in Electronic Cigarette Coil Resistance and Initial Pod Mass on Coil Lifetime and Aerosol Generation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4380. [PMID: 33924226 PMCID: PMC8074776 DOI: 10.3390/ijerph18084380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/14/2022]
Abstract
This work investigated the effects of manufacturing variations, including coil resistance and initial pod mass, on coil lifetime and aerosol generation of Vuse ALTO pods. Random samples of pods were used until failure (where e-liquid was consumed, and coil resistance increased to high value indicating a coil break). Initial coil resistance, initial pod mass, and e-liquid net mass ranged between 0.89 to 1.14 [Ω], 6.48 to 6.61 [g], and 1.88 to 2.00 [g] respectively. Coil lifetime was µ (mean) = 158, σ (standard deviation) = 21.5 puffs. Total mass of e-liquid consumed until coil failure was µ = 1.93, σ = 0.035 [g]. TPM yield per puff of all test pods for the first session (brand new pods) was µ = 0.0123, σ = 0.0003 [g]. Coil lifetime and TPM yield per puff were not correlated with either variation in initial coil resistance or variation in initial pod mass. The absence of e-liquid in the pod is an important factor in causing coil failure. Small bits of the degraded coil could be potentially introduced to the aerosol. This work suggests that further work is required to investigate the effect of e-liquid composition on coil lifetime and TPM yield per puff.
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Affiliation(s)
- Qutaiba M. Saleh
- Department of Computer Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA;
| | - Edward C. Hensel
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA;
| | - Nathan C. Eddingsaas
- School of Chemistry and Materials Science, Rochester Institute of Technology, Rochester, NY 14623, USA;
| | - Risa J. Robinson
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA;
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Khadka S, Awasthi M, Lamichhane RR, Ojha C, Mamudu HM, Lavie CJ, Daggubati R, Paul TK. The Cardiovascular Effects of Electronic Cigarettes. Curr Cardiol Rep 2021; 23:40. [PMID: 33694009 DOI: 10.1007/s11886-021-01469-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Electronic cigarettes (e-cigarettes) are gaining rapid popularity among all age groups, especially among youth. They have evolved into technologically advanced devices capable of delivering nicotine concentration and other substances. In addition to nicotine, e-cigarettes' constituents possess variety of toxic chemicals that have adverse effects on human body. RECENT FINDINGS In recent years, steady downward trend in tobacco usage has been observed; however, e-cigarette use is on upward trend. E-cigarettes are advertised as "safer" alternatives to conventional smoking and as an aid to smoking cessation. Emerging studies have, however, shown that e-cigarettes have harmful effects on the cardiovascular system and that most of the e-cigarette users are dual users, concurrently using e-cigarettes and smoking conventional cigarettes. Despite a gap in clinical studies and randomized trials analyzing adverse cardiovascular effects of e-cigarette use, the existing literature supports that different constituents of e-cigarettes such as nicotine, carbonyls, and particulate matters carry potential risk for cardiovascular diseases (CVD) on its users.
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Affiliation(s)
- Saroj Khadka
- Department of Medicine, Division of Cardiology, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN, 37604, USA
| | - Manul Awasthi
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | | | - Chandra Ojha
- Texas Tech University of Health Sciences, El Paso, TX, USA
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Clinic, New Orleans, LA, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Timir K Paul
- Department of Medicine, Division of Cardiology, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN, 37604, USA.
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21
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Cunningham A, McAdam K, Thissen J, Digard H. The Evolving E-cigarette: Comparative Chemical Analyses of E-cigarette Vapor and Cigarette Smoke. FRONTIERS IN TOXICOLOGY 2020; 2:586674. [PMID: 35296117 PMCID: PMC8915913 DOI: 10.3389/ftox.2020.586674] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background: E-cigarette designs, materials, and ingredients are continually evolving, with cotton wicks and diverse coil materials emerging as the popular components of atomisers. Another recent development is the use of nicotine salts in e-liquids to replicate the form of nicotine found in cigarette smoke, which may help cigarette smokers to transition to e-cigarettes. However, scientific understanding of the impact of such innovations on e-cigarette aerosol chemistry is limited. Methods: To address these knowledge gaps, we have conducted a comparative study analyzing relevant toxicant emissions from five e-cigarettes varying in wick, atomiser coil, and benzoic acid content and two tobacco cigarettes, quantifying 97 aerosol constituents and 84 smoke compounds, respectively. Our focus was the potential for benzoic acid in e-liquids and cotton wicks to form aerosol toxicants through thermal degradation reactions, and the potential for nickel–iron alloy coils to catalyze degradation of aerosol formers. In addition, we analyzed e-cigarette emissions for 19 flavor compounds, thermal decomposition products, and e-liquid contaminants that the FDA has recently proposed adding to the established list of Harmful and Potentially Harmful Constituents (HPHCs) in tobacco products. Results: Analyses for benzene and phenol showed no evidence of the thermal decomposition of benzoic acid in the e-cigarettes tested. Measurements of cotton decomposition products, such as carbonyls, hydrocarbons, aromatics, and PAHs, further indicated that cotton wicks can be used without thermal degradation in suitable e-cigarette designs. No evidence was found for enhanced thermal decomposition of propylene glycol or glycerol by the nickel–iron coil. Sixteen of the 19 FDA-proposed compounds were not detected in the e-cigarettes. Comparing toxicant emissions from e-cigarettes and tobacco cigarettes showed that levels of the nine WHO TobReg priority cigarette smoke toxicants were more than 99% lower in the aerosols from each of five e-cigarettes as compared with the commercial and reference cigarettes. Conclusions: Despite continuing evolution in design, components and ingredients, e-cigarettes continue to offer significantly lower toxicant exposure alternatives to cigarette smoking.
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Affiliation(s)
- Anthony Cunningham
- British American Tobacco (Investments) Limited, Research and Development, Southampton, United Kingdom
| | - Kevin McAdam
- McAdam Scientific Ltd., Eastleigh, United Kingdom
- *Correspondence: Kevin McAdam
| | - Jesse Thissen
- British American Tobacco (Investments) Limited, Research and Development, Southampton, United Kingdom
| | - Helena Digard
- British American Tobacco (Investments) Limited, Research and Development, Southampton, United Kingdom
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22
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Kalayci M, Cetinkaya E, Suren E, Yigit K, Duman F, Erol MK. The effect of electronic cigarette smoking on retinal microcirculation: Enlargement of the foveal avascular zone. Photodiagnosis Photodyn Ther 2020; 32:102068. [DOI: 10.1016/j.pdpdt.2020.102068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
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Wiener RC, Bhandari R. Association of electronic cigarette use with lead, cadmium, barium, and antimony body burden: NHANES 2015-2016. J Trace Elem Med Biol 2020; 62:126602. [PMID: 32650063 PMCID: PMC7655515 DOI: 10.1016/j.jtemb.2020.126602] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/04/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exposure of toxic metals from e-cigarette use is a cause for public health concern because youth, young adults, and non-smokers are the target population rapidly adopting e-cigarette use. The purpose of this research is to determine the association of the body burden of heavy metals with e-cigarette use using NHANES (U.S.) 2015-2016 data. METHODS Blood lead (N = 1899) and urinary cadmium, barium, and antimony (N = 1302) data were extracted from NHANES, 2015-2016; geometric means were calculated and bivariate and multivariable linear regression analyses were conducted. Participants were categorized as having neither e-cigarette nor cigarette use; smoking history (including dual use with e-cigarettes); and only e-cigarette (current or former). RESULTS In multivariable analyses adjusted for sex, race/ethnicity, age, and poverty levels, current or former e-cigarette use failed to reach a statistical significance in the association with metals. However, participants with a smoking history were more likely to have higher blood lead and urinary cadmium than participants who neither used e-cigarettes nor cigarettes. CONCLUSION Blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who used e-cigarettes and participants who did not.
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Affiliation(s)
- R Constance Wiener
- West Virginia University, Department of Dental Practice and Rural Health, School of Dentistry, 104a Health Sciences Addition, PO Box 9415, Morgantown, WV, 26506, United States.
| | - Ruchi Bhandari
- West Virginia University, Department of Epidemiology, School of Public Health, Robert C Byrd Health Sciences Center North, Room G104C, Morgantown, WV, 26506, United States.
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24
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Bennie A, Suessman A, Beaty T, Warrier R. Hemoptysis in a Healthy Teenager. Clin Pediatr (Phila) 2020; 59:943-946. [PMID: 32425069 DOI: 10.1177/0009922820922533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Bennie
- The University of Queensland, Herston, Queensland, Australia.,Ochsner Medical Center, New Orleans, LA, USA
| | | | | | - Raj Warrier
- Ochsner Medical Center, New Orleans, LA, USA
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25
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Buchanan ND, Grimmer JA, Tanwar V, Schwieterman N, Mohler PJ, Wold LE. Cardiovascular risk of electronic cigarettes: a review of preclinical and clinical studies. Cardiovasc Res 2020; 116:40-50. [PMID: 31696222 DOI: 10.1093/cvr/cvz256] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/08/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022] Open
Abstract
Cigarette smoking is the most preventable risk factor related to cardiovascular morbidity and mortality. Tobacco usage has declined in recent years; however, the use of alternative nicotine delivery methods, particularly e-cigarettes, has increased exponentially despite limited data on their short- and long-term safety and efficacy. Due to their unique properties, the impact of e-cigarettes on cardiovascular physiology is not fully known. Here, we summarize both preclinical and clinical data extracted from short- and long-term studies on the cardiovascular effects of e-cigarette use. Current findings support that e-cigarettes are not a harm-free alternative to tobacco smoke. However, the data are primarily derived from acute studies. The impact of chronic e-cigarette exposure is essentially unstudied. To explore the uniqueness of e-cigarettes, we contemplate the cardiovascular effects of individual e-cigarette constituents. Overall, data suggest that exposure to e-cigarettes could be a potential cardiovascular health concern. Further preclinical research and randomized trials are needed to expand basic and clinical investigations before considering e-cigarettes safe alternatives to conventional cigarettes.
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Affiliation(s)
- Nicholas D Buchanan
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Jacob A Grimmer
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Vineeta Tanwar
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Neill Schwieterman
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Loren E Wold
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.,College of Nursing, The Ohio State University, Columbus, OH, USA.,Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
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26
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Neu HM, Lee A, Brandis JEP, Patel V, Schneider A, Kane MA, Dalby RN, Michel SLJ. Cigalike electronic nicotine delivery systems e-liquids contain variable levels of metals. Sci Rep 2020; 10:11907. [PMID: 32681061 PMCID: PMC7368082 DOI: 10.1038/s41598-020-67789-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Electronic nicotine delivery systems (ENDS) are prefilled, battery-operated products intended to deliver nicotine to the user via an inhaled complex aerosol formed by heating a liquid composed of propylene glycol and glycerol, also referred to as vegetable glycerin and collectively called e-liquid, that contains nicotine and various flavor ingredients. Since their introduction in 2006, the number of ENDS on the market has increased exponentially. Despite their growing ubiquity, the possible health risks associated with ENDS use remain poorly understood. One potential concern is the presence of toxic metals in the e-liquid and aerosol. Herein, we report the evaluation of the metal content in the e-liquids from a series of commercially available cigalike ENDS brands (various flavors) determined using inductively coupled plasma mass spectrometry (ICP-MS) following e-liquid extraction. Each brand of cigalike ENDS was purchased at least three times at retail outlets in the Baltimore, Maryland metropolitan region over a period of six months (September 2017 to February 2018). This allowed for comparison of batch-to-batch variability. Several potentially toxic metals, including lead, chromium, copper, and nickel were detected in the e-liquids. In addition, high variability in metal concentrations within and between brands and flavors was observed . The internal assembled parts of each cartridge were analyzed by X-ray imaging, before dissembling so that the materials used to manufacture each cartridge could be evaluated to determine the metals they contained. Following washing to remove traces of e-liquid, lead, chromium, copper and nickel were all detected in the cigalike ENDS prefilled cartridges, suggesting one potential source for the metals found in the e-liquids. Collectively, these findings can inform further evaluation of product design and manufacturing processes, including quantification of metal concentrations in e-liquids over foreseeable storage times, safeguards against high concentrations of metals in the e-liquid before and after aerosolization (by contact with a metal heating coil), and control over batch-to-batch variability.
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Affiliation(s)
- Heather M Neu
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Angela Lee
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Joel E P Brandis
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Vyomesh Patel
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Maureen A Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Richard N Dalby
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Sarah L J Michel
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA.
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27
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Prokopowicz A, Sobczak A, Szuła-Chraplewska M, Ochota P, Kośmider L. Exposure to Cadmium and Lead in Cigarette Smokers Who Switched to Electronic Cigarettes. Nicotine Tob Res 2020; 21:1198-1205. [PMID: 30107446 DOI: 10.1093/ntr/nty161] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/08/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECs) seem to be a less harmful alternative for conventional cigarettes. This study aimed to assess whether the generated aerosols from ECs contain lower amount of cadmium (Cd) and lead (Pb) than cigarette smoke and to detect any changes in exposure to Cd and Pb among cigarette smokers who switched completely or partially to EC. METHODS EC aerosols and cigarette smoke were generated, and the determination of Cd and Pb in trapped samples and e-liquids was performed by the electrothermal atomic absorption spectrometry method. A cross-sectional, group-based survey was carried out using 156 volunteers classified into groups of nonsmokers, EC-only users, dual EC users-cigarette smokers, and cigarette-only smokers. Using electrothermal atomic absorption spectrometry, blood Cd and Pb levels were measured, and the results were compared by analysis of covariance. RESULTS Transfer of Cd and Pb to EC aerosol was found to be minimal, although the metals were present in the remaining e-liquid from tanks used for vapor generation. The geometric mean blood Cd concentration adjusted for age and sex was 0.44 (95% confidence interval = 0.37 to 0.52) µg/L in the EC-only users, which was significantly lower than those in the smokers of 1.44 (1.16 to 1.78) and dual users of 1.38 (1.11 to 1.72). The blood Pb geometric mean differed significantly only between nonsmokers of 11.9 (10.6 to 13.3) and smokers of 15.9 (13.6 to 18.6). CONCLUSION The study revealed that smokers who completely switched to ECs and quit smoking conventional cigarettes may significantly reduce their exposure to Cd and probably Pb. IMPLICATIONS Switching to EC use is associated with a rapid and substantial decrease in the exposure to carcinogenic Cd. Exposure to Pb is probably also decreased but may be overshadowed by other factors. The study provides empirical data based not only on the analysis of generated aerosol but also on biological indicators of recent exposure-that is, the concentrations of Cd and Pb in blood, indicating EC as a potential harm-reduction device, especially regarding Cd exposure. However, in this case, dual EC use-cigarette smoking provides doubtful benefits.
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Affiliation(s)
- Adam Prokopowicz
- Chemical Hazards and Genetic Toxicology Department, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
| | - Andrzej Sobczak
- Department of General and Analytical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jagiellonska Sosnowiec, Poland
| | - Magdalena Szuła-Chraplewska
- Chemical Hazards and Genetic Toxicology Department, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
| | - Patryk Ochota
- Chemical Hazards and Genetic Toxicology Department, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
| | - Leon Kośmider
- Chemical Hazards and Genetic Toxicology Department, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland.,Department of General and Analytical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Jagiellonska Sosnowiec, Poland
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28
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Ruszkiewicz JA, Zhang Z, Gonçalves FM, Tizabi Y, Zelikoff JT, Aschner M. Neurotoxicity of e-cigarettes. Food Chem Toxicol 2020; 138:111245. [PMID: 32145355 PMCID: PMC7089837 DOI: 10.1016/j.fct.2020.111245] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.
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Affiliation(s)
- Joanna A Ruszkiewicz
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Ziyan Zhang
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Filipe Marques Gonçalves
- Biochemistry Graduate Program, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington DC, United States
| | - Judith T Zelikoff
- Department of Environmental Medicine, New York University School of Medicine, Manhattan, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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29
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Metal Concentration Assessment in the Urine of Cigarette Smokers Who Switched to Electronic Cigarettes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061877. [PMID: 32183183 PMCID: PMC7143212 DOI: 10.3390/ijerph17061877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/30/2022]
Abstract
Background: E-cigarettes (ECs) seem to be a less harmful alternative for conventional cigarettes, however, very little is still known about the exposure to some elements, which are the components of this device and may contaminate the nicotine liquid. The aim of this study is to assess whether e-cigarette users are more exposed to 12 elements detected in aerosol than non-smokers and conventional cigarette smokers, using their concentrations in urine as exposure biomarkers. Methods: A cross-sectional, group-based survey was carried out using 90 volunteers classified into groups of non-smokers, EC-only users, dual EC users-cigarette smokers and cigarette-only smokers. Using inductively coupled plasma mass spectrometry (ICP-MS) and electrothermal atomic absorption spectrometry (ETAAS), Cr, Ni, Co, Ag, In, Mn, Ba, Sr, V, Sb, Cd and Pb levels were measured in spot urine samples. Among the selected groups, a comparison was made using the analysis of covariance and correlations with EC usage pattern were assessed by multiple linear regression. Results: Element concentrations in urine of EC-users were not significantly different from the levels found in non-smokers and smokers. Only in the case of Ba, Ni and Sb was a significant correlation found in relation to some e-cigarette usage patterns. Conclusion: Transfer of the investigated elements to the EC aerosol was not found to be a substantial source of exposure in EC users who quitted smoking.
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30
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Nicol J, Fraser R, Walker L, Liu C, Murphy J, Proctor CJ. Comprehensive Chemical Characterization of the Aerosol Emissions of a Vaping Product Based on a New Technology. Chem Res Toxicol 2020; 33:789-799. [PMID: 32122129 PMCID: PMC7308067 DOI: 10.1021/acs.chemrestox.9b00442] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
![]()
Around 10 million people in the United
States and 3 million people
in the United Kingdom are estimated to use vaping category products.
There are some estimates that there will be 75–80 million vapers
worldwide by 2020. Most of these products are based on coil-and-wick
technology. Because the heating and aerosol formation are separate
processes, the system can lead to dry-wicking and elevated emission
of carbonyls if designed and/or manufactured poorly. Low-nicotine
and low-power coil-and-wick devices have also been linked to increased
exposure to formaldehyde due to compensatory behavior by users. We
characterized the emissions of a vaping product which uses a fabric-free
stainless-steel mesh distiller plate technology that heats and aerosolizes
the e-liquid in a single process. The plate has a microporous structure
for capillary-induced liquid transformation (wicking) and aerosolization
that is optimized to avoid fluid starvation and overheating and improved
control. Compared with emissions previously reported for a coil-and-wick
nicotine vaping product (e-cigarette), most classes of harmful and
potentially harmful constituents (HPHCs) from this vaping product
were below the level of detection or quantification. For those that
were quantifiable, this vaping product generally had lower levels
of emissions than the e-cigarette, including carbonyls. Formaldehyde
and methyl glyoxal levels did not differ significantly between vaping
products. In this system, the single mode of liquid transfer and vapor
formation permits high aerosol mass delivery but further reduces emissions
of HPHCs that may be present in conventional e-cigarette aerosol,
by lessening the risk of thermal breakdown of the aerosol-generating
solvent mixture.
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Affiliation(s)
- James Nicol
- JTN Consulting Limited, 272 Bath Street, Glasgow, Scotland G2 4JR
| | - Rory Fraser
- British American Tobacco R&D Centre, Reagents Park Road, Southampton SO15 8TL, United Kingdom
| | - Liam Walker
- British American Tobacco R&D Centre, Reagents Park Road, Southampton SO15 8TL, United Kingdom
| | - Chuan Liu
- British American Tobacco R&D Centre, Reagents Park Road, Southampton SO15 8TL, United Kingdom
| | - James Murphy
- British American Tobacco R&D Centre, Reagents Park Road, Southampton SO15 8TL, United Kingdom
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31
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Zhao D, Aravindakshan A, Hilpert M, Olmedo P, Rule AM, Navas-Acien A, Aherrera A. Metal/Metalloid Levels in Electronic Cigarette Liquids, Aerosols, and Human Biosamples: A Systematic Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:36001. [PMID: 32186411 PMCID: PMC7137911 DOI: 10.1289/ehp5686] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 02/09/2020] [Accepted: 02/27/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have become popular, in part because they are perceived as a safer alternative to tobacco cigarettes. An increasing number of studies, however, have found toxic metals/metalloids in e-cigarette emissions. OBJECTIVE We summarized the evidence on metal/metalloid levels in e-cigarette liquid (e-liquid), aerosols, and biosamples of e-cigarette users across e-cigarette device systems to evaluate metal/metalloid exposure levels for e-cigarette users and the potential implications on health outcomes. METHODS We searched PubMed/TOXLINE, Embase®, and Web of Science for studies on metals/metalloids in e-liquid, e-cigarette aerosols, and biosamples of e-cigarette users. For metal/metalloid levels in e-liquid and aerosol samples, we collected the mean and standard deviation (SD) if these values were reported, derived mean and SD by using automated software to infer them if data were reported in a figure, or calculated the overall mean (mean ± SD) if data were reported only for separate groups. Metal/metalloid levels in e-liquids and aerosols were converted and reported in micrograms per kilogram and nanograms per puff, respectively, for easy comparison. RESULTS We identified 24 studies on metals/metalloids in e-liquid, e-cigarette aerosols, and human biosamples of e-cigarette users. Metal/metalloid levels, including aluminum, antimony, arsenic, cadmium, cobalt, chromium, copper, iron, lead, manganese, nickel, selenium, tin, and zinc, were present in e-cigarette samples in the studies reviewed. Twelve studies reported metal/metalloid levels in e-liquids (bottles, cartridges, open wick, and tank), 12 studies reported metal/metalloid levels in e-cigarette aerosols (from cig-a-like and tank devices), and 4 studies reported metal/metalloid levels in human biosamples (urine, saliva, serum, and blood) of e-cigarette users. Metal/metalloid levels showed substantial heterogeneity depending on sample type, source of e-liquid, and device type. Metal/metalloid levels in e-liquid from cartridges or tank/open wicks were higher than those from bottles, possibly due to coil contact. Most metal/metalloid levels found in biosamples of e-cigarette users were similar or higher than levels found in biosamples of conventional cigarette users, and even higher than those found in biosamples of cigar users. CONCLUSION E-cigarettes are a potential source of exposure to metals/metalloids. Differences in collection methods and puffing regimes likely contribute to the variability in metal/metalloid levels across studies, making comparison across studies difficult. Standardized protocols for the quantification of metal/metalloid levels from e-cigarette samples are needed. https://doi.org/10.1289/EHP5686.
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Affiliation(s)
- Di Zhao
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Atul Aravindakshan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Markus Hilpert
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Pablo Olmedo
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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32
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Lee JW, Kim Y, Kim Y, Yoo H, Kang HT. Cigarette Smoking in Men and Women and Electronic Cigarette Smoking in Men are Associated with Higher Risk of Elevated Cadmium Level in the Blood. J Korean Med Sci 2020; 35:e15. [PMID: 31920018 PMCID: PMC6955437 DOI: 10.3346/jkms.2020.35.e15] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/19/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We investigated the association between blood concentration of cadmium and smoking status including use of electronic cigarettes (E-cigars). METHODS We used data from the Korea National Health and Nutritional Survey 2013 and 2016. A total of 4,744 participants (2,162 men and 2,582 women) were included and were categorized into five groups (Non-smokers, E-cigar non-users in past-smokers, E-cigar users in past-smokers, E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers). Cadmium blood concentration was categorized into tertiles. All sampling and weight variables were stratified, and analysis to account for the complex sampling design was conducted. RESULTS In both genders, the geometric cadmium concentration was significantly different according to smoking status (both genders, analysis of variance P value < 0.001). In men, E-cigar users were significantly higher than the non-smokers (P value = past-smokers, 0.017; cigarette-smokers, < 0.001) when fully adjusted. Compared with non-smokers, fully-adjusted odds ratios (95% confidence intervals) for the highest cadmium tertiles of E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers were 6.56 (3.55-12.11) and 5.68 (1.96-16.50) in men and 2.74 (1.42-5.29) and 1.29 (0.10-17.44) in women. CONCLUSION Conventional cigarette smoking in men and women and E-cigar use in men are associated with higher risk of elevated blood cadmium level. Preventive management of cadmium exposure monitoring in conventional cigarette-smokers and E-cigar users may be needed.
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Affiliation(s)
- Jae Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yeseul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - HyoSun Yoo
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hee Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
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Belushkin M, Tafin Djoko D, Esposito M, Korneliou A, Jeannet C, Lazzerini M, Jaccard G. Selected Harmful and Potentially Harmful Constituents Levels in Commercial e-Cigarettes. Chem Res Toxicol 2019; 33:657-668. [PMID: 31859484 DOI: 10.1021/acs.chemrestox.9b00470] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A broad range of commercially available electronic cigarette (e-cigarette) systems were tested for levels of emissions of harmful and potentially harmful constituents (HPHC), with a particular focus on the carbonyls: acetaldehyde, acrolein, and formaldehyde. The tobacco-specific nitrosamines N'-nitrosonornicotine and 4-(methylnitrosamino)-1-(3-bipyridyl)-1-butanone; the elements arsenic, cadmium, chromium, lead, and nickel; benzene; 1,3-butadiene; and benzo(a)pyrene were also quantified. The results show that except for the levels of carbonyls, all types of e-cigarettes performed in a similar manner, and emission levels for HPHCs were generally not quantifiable. However, levels of carbonyls, especially formaldehyde, were highly variable. Overall, the lowest levels of formaldehyde were observed in cartridge systems, which generally achieved substantial reductions in yields in comparison with cigarette smoke. Formaldehyde levels in open tank systems were variable; however, the median formaldehyde levels across different brands were substantially lower than the formaldehyde levels in cigarette smoke. The results for variable-power devices operated at the highest voltage confirmed existing literature data regardless of orientation and differences in puffing regimes. Furthermore, our results show that many products deliver consistent HPHC yields over a broad range of testing conditions (with minimal variability from one device to another, under a range of puffing conditions). However, some products exhibit high variability in emissions of HPHCs. The use of air blanks is further highlighted to assess nonproduct-related contributions to HPHC levels to avoid misrepresentation of the data. Overall, our results highlight that some but not all electronic cigarettes deliver low levels of carbonyls consistently across the full e-liquid depletion cycle under different test conditions. The need for further research and standardization work on assessment of variable-voltage electronic cigarettes is emphasized.
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Affiliation(s)
- Maxim Belushkin
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Donatien Tafin Djoko
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Marco Esposito
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Alexandra Korneliou
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Cyril Jeannet
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Massimo Lazzerini
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
| | - Guy Jaccard
- PMI R&D, Philip Morris Products SA , Quai Jeanrenaud 5 , CH-2000 Neuchâtel , Switzerland
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34
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Wagoner KG, Berman M, Rose SW, Song E, Cornacchione Ross J, Klein EG, Kelley DE, King JL, Wolfson M, Sutfin EL. Health claims made in vape shops: an observational study and content analysis. Tob Control 2019; 28:e119-e125. [PMID: 31123104 PMCID: PMC8142343 DOI: 10.1136/tobaccocontrol-2018-054537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that conveyed Food and Drug Administration (FDA) approval/endorsement. After August 2016, additional federal prohibitions were added including false/misleading and unauthorised modified risk tobacco product (MRTP) claims. No systematic investigation of e-cigarette health claims has been conducted in the retail environment. We sought to document and characterise claims made in vape shops. METHODS Between November 2015 and February 2016, before final deeming rule implementation, two trained data collectors conducted unannounced observational assessments of 46 vape shops in North Carolina. Data collectors used wearable imaging technology to document health claims about e-cigarettes. Photos were coded for five claim types: (1) cessation device; (2) drug effect/device; (3) FDA-approved/endorsed; (4) false/misleading and (5) MRTP. Photos were double coded; differences between coders were adjudicated and reviewed by an expert panel. RESULTS At least one health claim was displayed in 41.3% (n=19) of retailers, ranging from 0 to 27 claims per retailer. All claim types were found. Cessation device claims were the most prevalent (62.2%, n=84), followed by MRTP (27.4%, n=37), drug effect/device (8.1%, n=11), false/misleading (1.5%, n=2), and FDA approved/endorsed (0.7%, n=1). Retail chains made the majority of claims compared with independent shops (88.9% vs 11.1%). CONCLUSIONS Many vape shops displayed e-cigarette health claims, which are all now FDA prohibited. These claims could mislead consumers and influence behaviour. Findings highlight the need for retailer education, continued surveillance, enforcement specific to advertising and research on consumer perceptions of claims.
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Affiliation(s)
- Kimberly G Wagoner
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Micah Berman
- Health Services Management and Policy, The Ohio State University College of Public Health and Moritz College of Law, Columbus, Ohio, USA
| | - Shyanika W Rose
- Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC, USA
| | - Eunyoung Song
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Elizabeth G Klein
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Dannielle E Kelley
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L King
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark Wolfson
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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35
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Theron AJ, Feldman C, Richards GA, Tintinger GR, Anderson R. Electronic cigarettes: where to from here? J Thorac Dis 2019; 11:5572-5585. [PMID: 32030277 DOI: 10.21037/jtd.2019.11.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although the usage of electronic (e)-cigarettes (EC) and similar devices has gained in popularity as an apparent smoking cessation strategy, serious concerns are emerging in relation to both the efficacy of this strategy, as well as the inappropriate use of these devices. While the comparative safety of e-cigarettes is based on the reasonable contention that the levels of inhaled toxicants present in the aerosols generated by these devices are considerably lower than those present in tobacco smoke, the perception that they are indeed relatively risk-free is being challenged on several fronts. Notwithstanding lack of convincing evidence of efficacy as a superior smoking cessation strategy, foremost among emerging concerns is the increasing use of electronic nicotine-delivery devices by young never-smokers. Other concerns include increasing levels of sophistication in the design and capacity of these devices in relation to nicotine content and delivery, the potential threat of manipulation of the contents of e-liquids, as well as other additives such as illicit drugs and other potentially toxic agents that can be vaporised. These issues, together with the potential risks to respiratory health, specifically "e-cigarette or vaping product use-associated lung injury" represent the major thrusts of this review.
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Affiliation(s)
- Annette J Theron
- Department Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory R Tintinger
- Department of Internal Medicine, Steve Biko Academic Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald Anderson
- Department Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Ting CY, Ahmad Sabri NA, Tiong LL, Zailani H, Wong LP, Agha Mohammadi N, Anchah L. Heavy metals (Cr, Pb, Cd, Ni) in aerosols emitted from electronic cigarettes sold in Malaysia. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2019; 55:55-62. [PMID: 31530230 DOI: 10.1080/10934529.2019.1665950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
While past studies have detected heavy metals in aerosols emitted from electronic cigarettes (ECIG), they have provided little information detailing the practical implications of the findings to the Malaysian population due to variations between products. The aims of this study were to analyse heavy metals of interest (HMOI) in the aerosols emitted from selected ECIG and to evaluate potential health risks by referring to the permissible daily exposure (PDE) from inhalational medications defined by the United States Pharmacopeia Chapter 232. All four HMOI were detected in aerosols emitted from the selected ECIG in Sarawak. Among the four, Cr was present at the highest median levels (6.86 ng/m3), followed by Ni (0.30 ng/m3), Pb (0.19 ng/m3) and Cd (0.01 ng/m3). Five out of 100 combinations (5%) of ECIG and ECIG liquids were found to emit Cr that exceed the recommended PDE. Future studies examining more heavy metal variants, using a larger sample size and different analytical techniques to compare various ECIGs are recommended.
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Affiliation(s)
- Chuo Yew Ting
- Pharmacy Enforcement Division, Sarawak State Health Department, Jalan Diplomatik, Off Jalan Bako, Kuching, Malaysia
- Institute of Borneo Studies, Universiti Malaysia Sarawak. Jalan Datuk Mohammad Musa, Kota Samarahan, Malaysia
| | | | - Lee Len Tiong
- Clinical Research Centre, Sarawak General Hospital. Jalan Hospital, Kuching, Malaysia
| | - Hazalinawati Zailani
- Department of Chemistry Malaysia Sarawak, Jalan Sultan Tengah, Petra Jaya, Kuching, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Nasrin Agha Mohammadi
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Lawrence Anchah
- Department of Pharmacy, Sarawak Heart Centre, Kuching-Samarahan Expressway, Kota Samarahan, Malaysia
- Unit of Pharmacology, Department of Paraclinical, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
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Polosa R, O'Leary R, Tashkin D, Emma R, Caruso M. The effect of e-cigarette aerosol emissions on respiratory health: a narrative review. Expert Rev Respir Med 2019; 13:899-915. [PMID: 31375047 DOI: 10.1080/17476348.2019.1649146] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Due to the uptake in the use of e-cigarettes (ECs), evidence on their health effects is needed to inform health care and policy. Some regulators and health professionals have raised concerns that the respirable aerosols generated by ECs contain several constituents of potential toxicological and biological relevance to respiratory health. Areas covered: We critically assess published research on the respiratory system investigating the effects of ECs in preclinical models, clinical studies of people who switched to ECs from tobacco cigarettes, and population surveys. We assess the studies for the quality of their methodology and accuracy of their interpretation. To adequately assess the impact of EC use on human health, addressing common mistakes and developing robust and realistic methodological recommendations is an urgent priority. The findings of this review indicate that ECs under normal conditions of use demonstrate far fewer respiratory risks than combustible tobacco cigarettes. EC users and smokers considering ECs have the right to be informed about the relative risks of EC use, and to be made aware that findings of studies published by the media are not always reliable. Expert opinion: Growing evidence supports the relative safety of EC emission aerosols for the respiratory tract compared to tobacco smoke.
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Affiliation(s)
- Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università of Catania , Catania , Italy.,Center of Excellence for the acceleration of HArm Reduction (CoEHAR), University of Catania , Catania , Italy
| | - Renée O'Leary
- Canadian Institute for Substance Use Research , Victoria , Canada
| | - Donald Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Rosalia Emma
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
| | - Massimo Caruso
- Dipartimento di Medicina Clinica e Sperimentale (MEDCLIN), University of Catania , Catania , Italy.,Dipartimento di Scienze biomediche e biotecnologiche (BIOMETEC), University of Catania , Catania , Italy
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38
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Zhao D, Navas-Acien A, Ilievski V, Slavkovich V, Olmedo P, Adria-Mora B, Domingo-Relloso A, Aherrera A, Kleiman NJ, Rule AM, Hilpert M. Metal concentrations in electronic cigarette aerosol: Effect of open-system and closed-system devices and power settings. ENVIRONMENTAL RESEARCH 2019; 174:125-134. [PMID: 31071493 PMCID: PMC7079580 DOI: 10.1016/j.envres.2019.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Electronic cigarettes (E-cigarettes) generate aerosol containing metal contaminants. Our goals were to quantify aerosol metal concentrations and to compare the effects of power setting and device type (closed-system vs. open-system) on metal release. METHODS Aerosol samples were collected from two closed-system devices (a cigalike and pod) and two open-system devices (mods). Each open-system device was operated at three different power settings to examine the effect of device power on metal release. Concentrations of 14 metals in e-cigarette aerosol collected via droplet deposition were measured using inductively coupled plasma mass spectroscopy. Aerosol metal concentrations were reported as mass fractions (μg/kg) in the e-liquid. RESULTS For open-system device 1 (OD1), median arsenic (As), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb), tin (Sn), and zinc (Zn) concentrations increased 14, 54, 17, 30, 41, 96, 14, 81, 631, and 7-fold when the device power was increased from low (20 W) to intermediate (40 W) setting. When the power was further increased from intermediate (40 W) to high (80 W) setting, concentrations of As, Cr, Cu, Mn, Ni, and Sb did not change significantly. For open-system device 2 (OD2), Cr and Mn concentrations increased significantly when device power was increased from low (40 W) to intermediate (120 W) setting, and then decreased significantly when power was further increased from intermediate (120 W) to high (200 W) setting. Among the four devices, aerosol metal concentrations were higher for the open-system than the closed-system devices, except for aluminum (Al) and uranium (U). For Cr, median (interquartile range) concentrations (μg/kg) from the open-system devices were 2.51 (1.55, 4.23) and 15.6 (7.88, 54.5) vs. 0.39 (0.05, 0.72) and 0.41 (0.34, 0.57) for the closed-system devices. For Ni, concentrations (μg/kg) from the open-system devices were 793 (508, 1169) and 2148 (851, 3397) vs. 1.32 (0.39, 3.35) and 11.9 (10.7, 22.7) from the closed-system devices. Inhalation of 0% and 100% of samples from OD1, 7.4% and 88.9% from OD2 by typical e-cigarette users would exceed chronic minimum risk levels (MRL) of Mn and Ni, respectively. No MRL exceedance was predicted for the closed-system devices. A large fraction of users of OD1 (100%) and OD2 (77.8%) would be exposed to Ni levels higher than those from reference tobacco cigarette 3R4F. CONCLUSIONS Our findings suggest that power setting and device type affect metal release from devices to aerosol which would subsequently be inhaled by users. Metal concentrations from open-system devices first increased with device power, and then leveled off for most metals. Open-system devices generate aerosol with higher metal concentrations than closed-system devices. These findings inform tobacco regulatory science, policy makers and health professionals on potential metal health risks associated with e-cigarette use, design and manufacturing.
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Affiliation(s)
- Di Zhao
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Vesna Ilievski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Vesna Slavkovich
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pablo Olmedo
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Spain
| | - Bernat Adria-Mora
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Norman J Kleiman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Markus Hilpert
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
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39
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Papaefstathiou E, Stylianou M, Agapiou A. Main and side stream effects of electronic cigarettes. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2019; 238:10-17. [PMID: 30836280 DOI: 10.1016/j.jenvman.2019.01.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
Over the last decade there has been a significant boost towards the use of electronic cigarettes (e-cigarettes), especially among youth. Different concentrations of propylene glycol (PG) or vegetable glycerin (VG), flavors and nicotine are mixed in plastic cartridges and commercially offered or privately produced by the vapers. During vaping, a mixture of air and vapors is inhaled to the lungs. Since the ingredients of the e-cigarettes are not burned but vaporized (heated), fewer chemicals are emitted. The levels of potentially toxic compounds (e.g. volatile organic compounds (VOCs), particulate matter (PM), metals, radicals, nitrosamines, etc.) emitted from vaping appear to be lower compared to that of tobacco smoking (from combustible cigarettes). Nevertheless, measurable toxic elements and VOCs are still released (e.g. acetaldehyde, formaldehyde, acrolein, benzene, etc.) along with other volatiles associated with e-liquid flavoring and device variability with PG and VG. The wide range of available flavors at various purities along with the heating temperature are important parameters affecting the evolution of VOCs and aerosols. There is lack of standardized short- and long-term epidemiological medical data (chronic exposure) on e-cigarettes effects to users, non-users and the human micro-environment (second- or third-hand exposure). Therefore, the potential health, safety and environmental effects of vaping are reviewed, examined and discussed.
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Affiliation(s)
- E Papaefstathiou
- Department of Chemistry, University of Cyprus, P.O. Box 20537, Nicosia 1678, Cyprus
| | - M Stylianou
- Department of Chemistry, University of Cyprus, P.O. Box 20537, Nicosia 1678, Cyprus; NIREAS-International Water Research Center, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
| | - A Agapiou
- Department of Chemistry, University of Cyprus, P.O. Box 20537, Nicosia 1678, Cyprus.
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40
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Skotsimara G, Antonopoulos AS, Oikonomou E, Siasos G, Ioakeimidis N, Tsalamandris S, Charalambous G, Galiatsatos N, Vlachopoulos C, Tousoulis D. Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 26:1219-1228. [PMID: 30823865 DOI: 10.1177/2047487319832975] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The electronic cigarette is marketed as a safe alternative to tobacco smoking, but electronic cigarette cardiovascular effects remain largely unknown. We systematically reviewed and meta-analysed published literature to investigate the cardiovascular effects and associated risk from electronic cigarette use. METHODS AND RESULTS We searched PubMed from January 2000 to November 2017 for published studies assessing the cardiovascular effects of the electronic cigarette. Evidence suggests that the electronic cigarette negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are from single study reports and have not been confirmed in additional studies. Conflicting evidence exists on the effects of the electronic cigarette on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. The meta-analysis of 14 studies (N + 441 participants) suggested that despite the negative acute effects of the electronic cigarette on heart rate (pooled mean difference (MD) + 2.27, 95% confidence interval (CI): 1.64 to 2.89, p < 0.001), diastolic (pooled MD + 2.01 mmHg, 95% CI: 0.62 to 3.39, p + 0.004) and systolic blood pressure (pooled MD + 2.02 mmHg, 95% CI: 0.07 to 3.97, p + 0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to chronic electronic cigarette use (systolic blood pressure pooled MD + -7.00, 95% CI: -9.63 to -4.37, p < 0.001; diastolic blood pressure pooled MD + -3.65, 95% CI: -5.71 to -1.59, p + 0.001). CONCLUSIONS The existing evidence on the cardiovascular effects of the electronic cigarette is concerning, with several unexplored issues. Unless supported by stronger evidence, the electronic cigarette should not be labelled as a cardiovascular safe product. Future studies should delineate whether electronic cigarette use is less hazardous to cardiovascular health than conventional cigarette smoking.
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Affiliation(s)
- Georgia Skotsimara
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Nikolaos Ioakeimidis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Sotirios Tsalamandris
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Georgios Charalambous
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Nikos Galiatsatos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
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Avino P, Scungio M, Stabile L, Cortellessa G, Buonanno G, Manigrasso M. Second-hand aerosol from tobacco and electronic cigarettes: Evaluation of the smoker emission rates and doses and lung cancer risk of passive smokers and vapers. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 642:137-147. [PMID: 29894873 DOI: 10.1016/j.scitotenv.2018.06.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/13/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
Smoking activities still represent the main, and preventable, cause of lung cancer risk worldwide. For this reason, a number of studies were carried out to deepen and better characterize the emission of cigarette-generated mainstream aerosols in order to perform an a-priori evaluation of the particle doses and related lung cancer risks received by active smokers. On the contrary, a gap of knowledge still exists in evaluating the dose and risk received by passive smokers in indoor private micro-environments (e.g. homes). For this purpose, in the present paper, an experimental campaign was performed to evaluate the exposure to second-hand aerosol from conventional and electronic cigarettes and to estimate the consequent dose received by passive smokers/vapers and the related lung cancer risk. Measurements of exposure levels in terms of particle number, PM10 and black carbon concentrations, as well as particle size distributions, were performed in a naturally ventilated indoor environment during smoking activities of tobacco and electronic cigarettes. The particle emission rates of smokers and vapers, for the different aerosol metrics under investigation, were evaluated. Moreover, for a typical exposure scenario, the dose received by the passive smokers/vapers in a naturally ventilated indoor micro-environment was estimated through a Multiple-Path Particle Dosimetry (MPPD) model able to assess the particle dose received in the different tracts of the respiratory systems. Furthermore, on the basis of scientific literature data about mass fraction of carcinogenic compounds contained in cigarette-emitted particles (i.e. Heavy Metals, Benzo-a-pyrene and nitrosamines) and the estimated doses, the excess life cancer risk (ELCR) for passive smokers/vapers was evaluated. Cumulative respiratory doses for passive smokers were up to 15-fold higher than for passive vapers. The ELCR for second-hand smokers was five orders of magnitude larger than for second-hand vapers.
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Affiliation(s)
- Pasquale Avino
- Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, via F. De Sanctis, I-86100 Campobasso, Italy; Institute of Ecotoxicology & Environmental Sciences, Kolkata, India
| | - Mauro Scungio
- Department of Economics, Engineering, Society and Business Organization, University of Tuscia, Viterbo, Italy
| | - Luca Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, I-03043 Cassino, FR, Italy
| | - Gino Cortellessa
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, I-03043 Cassino, FR, Italy
| | - Giorgio Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, I-03043 Cassino, FR, Italy; Queensland University of Technology, Brisbane, Australia; Department of Engineering, University "Parthenope", I-80100 Naples, Italy
| | - Maurizio Manigrasso
- DIT, INAIL Settore Ricerca, Certificazione e Verifica, via R. Ferruzzi 38/40, I-00143 Rome, Italy.
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42
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Farsalinos KE, Rodu B. Metal emissions from e-cigarettes: a risk assessment analysis of a recently-published study. Inhal Toxicol 2018; 30:321-326. [PMID: 30384783 DOI: 10.1080/08958378.2018.1523262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: A recent study reported levels of metal emissions in e-cigarette (EC) aerosol. Herein we present a risk assessment analysis of the published findings using total daily exposure limits. Methods: Median and 75th percentile metal concentrations in EC aerosols were used to determine the level of daily liquid consumption (g/d) that would exceed the permissible daily exposures (PDEs) defined for inhalation medications (cadmium, chromium, copper, nickel, lead, antimony and tin). For metals not having PDEs, minimal risk levels (manganese) or risk exposure levels (aluminum, iron and zinc) were converted into total daily exposure using an inhalation volume of 20 m3 (for 24 h) and 6.7 m3 (for 8 h) respectively. Results: The lowest amount of liquid consumption exceeding safety limits was found for nickel (73 g/day for median and 17 g/day for 75th percentile levels). The consumption corresponding to the 75th percentile could be associated with realistic use, although this would represent an extreme rather than average consumption. For chromium, the respective levels were 358 and 68 g/day and for lead 338 and 135 g/day. For all other metals, liquid consumption would need to be orders of magnitude higher, reaching to 1.5 million grams for aluminum. Conclusion: EC emissions contain trace levels of metals. For almost all metals, unrealistically high levels of liquid need to be consumed in order for total daily exposure to exceed established limits.
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Affiliation(s)
- Konstantinos E Farsalinos
- a Department of Cardiology , Onassis Cardiac Surgery Center , Kallithea , Greece.,b Department of Pharmacy , University of Patras , Rio-Patras , Greece.,c National School of Public Health , Athens, Greece
| | - Brad Rodu
- d Department of Medicine School of Medicine , University of Louisville , Louisville, KY , USA
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43
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Ghosh A, Coakley RC, Mascenik T, Rowell TR, Davis ES, Rogers K, Webster MJ, Dang H, Herring LE, Sassano MF, Livraghi-Butrico A, Van Buren SK, Graves LM, Herman MA, Randell SH, Alexis NE, Tarran R. Chronic E-Cigarette Exposure Alters the Human Bronchial Epithelial Proteome. Am J Respir Crit Care Med 2018; 198:67-76. [PMID: 29481290 PMCID: PMC6034122 DOI: 10.1164/rccm.201710-2033oc] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/16/2022] Open
Abstract
RATIONALE E-cigarettes vaporize propylene glycol/vegetable glycerin (PG/VG), nicotine, and flavorings. However, the long-term health effects of exposing lungs to vaped e-liquids are unknown. OBJECTIVES To determine the effects of chronic vaping on pulmonary epithelia. METHODS We performed research bronchoscopies on healthy nonsmokers, cigarette smokers, and e-cigarette users (vapers) and obtained bronchial brush biopsies and lavage samples from these subjects for proteomic investigation. We further employed in vitro and murine exposure models to support our human findings. MEASUREMENTS AND MAIN RESULTS Visual inspection by bronchoscopy revealed that vaper airways appeared friable and erythematous. Epithelial cells from biopsy samples revealed approximately 300 proteins that were differentially expressed in smoker and vaper airways, with only 78 proteins being commonly altered in both groups and 113 uniquely altered in vapers. For example, CYP1B1 (cytochrome P450 family 1 subfamily B member 1), MUC5AC (mucin 5 AC), and MUC4 levels were increased in vapers. Aerosolized PG/VG alone significantly increased MUC5AC protein in human airway epithelial cultures and in murine nasal epithelia in vivo. We also found that e-liquids rapidly entered cells and that PG/VG reduced membrane fluidity and impaired protein diffusion. CONCLUSIONS We conclude that chronic vaping exerts marked biological effects on the lung and that these effects may in part be mediated by the PG/VG base. These changes are likely not harmless and may have clinical implications for the development of chronic lung disease. Further studies will be required to determine the full extent of vaping on the lung.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lee M. Graves
- UNC Proteomics Core Facility, Department of Pharmacology
| | | | | | - Neil E. Alexis
- Center for Environmental Medicine Asthma and Lung Biology, University of North Carolina at Chapel Hill, North Carolina
| | - Robert Tarran
- Marsico Lung Institute
- Department of Cell Biology and Physiology
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Vasanthi Bathrinarayanan P, Brown JEP, Marshall LJ, Leslie LJ. An investigation into E-cigarette cytotoxicity in-vitro using a novel 3D differentiated co-culture model of human airways. Toxicol In Vitro 2018; 52:255-264. [PMID: 29940344 DOI: 10.1016/j.tiv.2018.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 12/21/2022]
Abstract
Currently there is a lack of consensus on the possible adverse health effects of E-cigarettes (ECs). Important factors including cell model employed and exposure method determine the physiological relevance of EC studies. The present study aimed to evaluate EC cytotoxicity using a physiologically relevant in-vitro multicellular model of human airways. Human bronchial epithelial cells (CALU-3) and pulmonary fibroblasts (MRC-5) were co-cultured at air-liquid-interface for 11-14 days post which they were exposed to whole cigarette smoke (WCS) or EC vapour (ECV) at standard ISO-3308 regime for 7 m using a bespoke aerosol delivery system. ECV effects were further investigated at higher exposure times (1 h-6 h). Results showed that while WCS significantly reduced cell viability after 7 m, ECV decreased cell viability only at exposure times higher than 3 h. Furthermore, ECV caused elevated IL-6 and IL-8 production despite reduced cell viability. ECV exposure also produced a marked increase in oxidative stress. Finally, WCS but not ECV exposure induced caspase 3/7 activation, suggesting a caspase independent death of ECV exposed cells. Overall, our results indicate that prolonged ECV exposure (≥3 h) has a significant impact on pro-inflammatory mediators' production, oxidative stress and cell viability but not caspase 3/7 activity.
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Affiliation(s)
- Pranav Vasanthi Bathrinarayanan
- Aston Institute of Materials Research, School of Engineering and Applied Science, Aston University, Birmingham B4 7ET, United Kingdom
| | - James E P Brown
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, United Kingdom; Aston Medical Research Institute, Aston University, Birmingham B4 7ET, United Kingdom
| | - Lindsay J Marshall
- Research and Toxicology Department, Humane Society International, 5, Underwood Street, London, United Kingdom
| | - Laura J Leslie
- Aston Institute of Materials Research, School of Engineering and Applied Science, Aston University, Birmingham B4 7ET, United Kingdom.
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Ratajczak A, Feleszko W, Smith DM, Goniewicz M. How close are we to definitively identifying the respiratory health effects of e-cigarettes? Expert Rev Respir Med 2018; 12:549-556. [PMID: 29856662 DOI: 10.1080/17476348.2018.1483724] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Use of electronic cigarettes (e-cigarettes) is frequently promoted as a less harmful alternative to cigarette smoking. The impact of repeated inhalation of e-cigarette aerosols on respiratory health is not well understood. Areas covered: Using results from laboratory, observational, and clinical studies, we synthesize evidence relevant to potential respiratory health effects that may result from inhalation of e-cigarette aerosols. Expert commentary: Chemical analyses reveal that e-cigarette aerosols contain numerous respiratory irritants and toxicants. There are documented cytotoxic effects of e-cigarette constituents on lung tissue. Studies among ex-smokers who switched to e-cigarettes note reduced exposure to numerous respiratory toxicants, reduced asthma exacerbations, and chronic obstructive pulmonary disease symptoms. Regular exposure to e-cigarette aerosols is associated with impaired respiratory functioning. Potential respiratory health risks resulting from secondhand e-cigarette aerosol exposure have not been sufficiently evaluated. Current evidence indicates that although e-cigarettes are not without risk, these products seemingly pose fewer respiratory health harms issues compared to tobacco cigarettes. Data from prospective studies and randomized controlled trials examining the impact of e-cigarette use on lung health are needed to better understand respiratory health risks tied to use of these products.
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Affiliation(s)
- Alexsandra Ratajczak
- a Department of Pediatric Respiratory Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Wojciech Feleszko
- a Department of Pediatric Respiratory Diseases and Allergy , Medical University of Warsaw , Warsaw , Poland
| | - Danielle M Smith
- b Department of Health Behavior , Roswell Park Comprehensive Cancer Center , Buffalo , NY , USA
| | - Maciej Goniewicz
- b Department of Health Behavior , Roswell Park Comprehensive Cancer Center , Buffalo , NY , USA
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Arnold C. Between the Tank and the Coil: Assessing How Metals End Up in E-Cigarette Liquid and Vapor. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:064002. [PMID: 29871363 PMCID: PMC6084876 DOI: 10.1289/ehp3451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
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47
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Dueck K, Morrison R, Brown K, Lobo D, Loh LC. Innovative public health response to an event on the fringe of regulatory changes. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:338-341. [PMID: 29981079 PMCID: PMC6964372 DOI: 10.17269/s41997-018-0073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 01/03/2018] [Indexed: 06/08/2023]
Abstract
SETTING During a period of regulatory uncertainty, a local public health unit in Ontario was notified of an exhibition for electronic nicotine delivery systems (ENDS) and novel tobacco delivery products (NTDs), specifically e-cigarettes and waterpipes, which have seen increasing use particularly among youth. Relevant statutes creating regulatory uncertainty included a new provincial Electronic Cigarettes Act (ECA) with certain sections awaiting proclamation, and a local waterpipe bylaw awaiting approval, which would have prohibited the use of these products in public spaces if they entered into force ahead of the exhibition date. Public health staff had concerns the event would normalize use of ENDS/NTDs, particularly among youth, and also planned to enforce already proclaimed ECA sections, as well as the existing Smoke-Free Ontario Act (SFOA) with regulations applicable to use of tobacco shisha in waterpipes. INTERVENTION Public health staff contacted event organizers and proprietors to communicate obligations under the SFOA and ECA, as well as share hypothetical implications from pending regulatory changes, including risk of charges for regulatory non-compliance if regulations came into force ahead of the planned event. OUTCOMES Following discussion with health unit staff and legal consultation, the exhibition was cancelled. IMPLICATIONS By directly communicating regulatory uncertainty, a public health unit was able to achieve local health goals. In this situation, public health advised exhibition proprietors of potential event disruption implicated by forthcoming regulatory changes. Subsequent cancellation of the event prevented potential adverse health impacts for at-risk groups. A similar communications approach could be used to achieve public health goals during a period of regulatory uncertainty.
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Affiliation(s)
- Karalyn Dueck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Reed Morrison
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Kathie Brown
- Region of Peel Public Health, 7120 Hurontario Street, RPO 667 Streetsville, Mississauga, ON, L5W 1N4, Canada
| | | | - Lawrence C Loh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Region of Peel Public Health, 7120 Hurontario Street, RPO 667 Streetsville, Mississauga, ON, L5W 1N4, Canada.
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Abstract
Tobacco smoking is the most preventable cause of morbidity and mortality. In just a few short years, electronic cigarettes (e-cigarettes) have become increasingly popular, especially for younger individuals. Many people believe that e-cigarettes are safe. The inhaled aerosols of e-cigarettes contain numerous potential toxicities, some of which could be dangerous for health with long-term use. The safety of prolonged aerosol exposure is not known. The use of e-cigarettes as a harm-reduction tool at stopping tobacco smoking is not uniformly successful. E-cigarettes may be safer than tobacco products, but repeated prolonged exposure to their aerosols has its own considerable potential risk. The long-term health consequences of their use remain to be established. Physicians should vigorously discourage the use of e-cigarettes and tobacco products, with special emphasis on abstinence for younger people and during pregnancy or lactation.
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Affiliation(s)
- Gulay Tegin
- From the University of Louisville School of Medicine, Louisville, Kentucky
| | | | - Simrat Kaur Sarai
- From the University of Louisville School of Medicine, Louisville, Kentucky
| | - Steven Lippmann
- From the University of Louisville School of Medicine, Louisville, Kentucky
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Abstract
Tobacco use and exposure to tobacco smoke remain major but avoidable causes of premature mortality and disease worldwide. Although the age-standardized prevalence of daily smoking has declined for both men and women in many countries, the number of smokers continues to increase because of global population growth. Although cigarettes are the most commonly used tobacco product, the tobacco epidemic has become tremendously complex with the emergence and popularity of alternative products such as waterpipes and electronic cigarettes (also known as e-cigarettes). Exposure sciences play a major role in characterizing the tobacco epidemic as well as in the promotion, enactment, and implementation of tobacco control initiatives including legislation and voluntary measures in countries worldwide. We reviewed several studies in Latin America and other regions, showing how high-quality exposure assessment has contributed to smoke-free policies. Although there are many toxicants in tobacco products, metals could be playing an important role in tobacco-related disease. Tobacco plants accumulate cadmium and lead from soil. In e-cigarettes, a metallic coil heats the e-liquid to produce the aerosol that is inhaled by the vaper, and studies have found high aerosol levels of nickel, chromium, lead, and zinc. Despite many tobacco control successes, including the enactment of the Framework Convention on Tobacco Control, which has been ratified by 181 countries, tobacco control faces many challenges globally. Given the continuing increase in the number of smokers worldwide and the rapid emergence of new tobacco products, additional creative efforts are needed to achieve a smoke-free world, help smokers to quit, and protect youth from initiating tobacco use.
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Affiliation(s)
- Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
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Zulkifli A, Abidin EZ, Abidin NZ, Amer Nordin AS, Praveena SM, Syed Ismail SN, Rasdi I, Karuppiah K, Rahman AA. Electronic cigarettes: a systematic review of available studies on health risk assessment. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:43-52. [PMID: 27101543 DOI: 10.1515/reveh-2015-0075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/09/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This paper primarily aimed to review articles which specifically quantified the risk of electronic cigarette's (e-cigarette) usage via the health risk assessment (HRA) approach. METHODS Systematic literature searches were conducted using PubMed search engine databases. Search terms such as "electronic cigarette", "e-cigarette", "electronic nicotine delivery systems", "electronic cigarette liquid", "electronic cigarette vapors", and "health risk assessment" were used to identify the relevant articles to be included in this review. To enable comparison, hazard quotient (HQ) and lifetime cancer risk (LCR) for the chemicals measured in the selected articles were calculated for three of the articles using the formula: [1] HQ=average daily dose (ADD)/reference dose (RfD) or exposure air concentration (EC)/reference concentration (RfC); [2] LCR=lifetime average daily dose (LADD) × cancer slope factor (CSF) or exposure air concentration (EC) × inhalation unit risk (IUR). RESULTS Four articles pertaining to HRA of e-cigarettes were critically reviewed, three of the papers focused on specific chemicals namely nicotine, propylene glycol (PG), glycerol and 1,2-propanediol, while one article evaluated the health risks posed by heavy metals contained in e-cigarettes. The calculated HQs for the chemicals in this review had large variations. HQs of the six chemicals, i.e. nicotine, PG, glycerol, cadmium, ethylene glycol, nickel, aluminum and titanium, were found to have the potential to contribute to non-carcinogenic health risks. None of the LCR calculated had risks exceeding the acceptable limit. CONCLUSION There are limited HRA studies and the ones that were available provided inconsistent scientific evidences on the health risk characterization arising from the usage of e-cigarettes. As such, there is a need to perform more studies on HRA of e-cigarettes by using uniformed and comprehensive steps and similar reference threshold levels of exposures.
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Affiliation(s)
- Aziemah Zulkifli
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Emilia Zainal Abidin
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia, Phone: +603 89472643, Fax: +603 89472395
| | - Najihah Zainol Abidin
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Amer Siddiq Amer Nordin
- Faculty of Medicine, Department of Psychological Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sarva Mangala Praveena
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Sharifah Norkhadijah Syed Ismail
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Irniza Rasdi
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Karmegam Karuppiah
- Faculty of Medicine and Health Sciences, Department of Environmental and Occupational Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Anita Abd Rahman
- Faculty of Medicine and Health Sciences, Department of Community Health, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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