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Scheelbeek PFD, Dangour AD, Jarmul S, Turner G, Sietsma AJ, Minx JC, Callaghan M, Ajibade I, Austin SE, Biesbroek R, Bowen KJ, Chen T, Davis K, Ensor T, Ford JD, Galappaththi EK, Joe ET, Musah-Surugu IJ, Alverio GN, Schwerdtle PN, Pokharel P, Salubi EA, Scarpa G, Segnon AC, Siña M, Templeman S, Xu J, Zavaleta-Cortijo C, Berrang-Ford L. The effects on public health of climate change adaptation responses: a systematic review of evidence from low- and middle-income countries. Environ Res Lett 2021; 16:073001. [PMID: 34267795 PMCID: PMC8276060 DOI: 10.1088/1748-9326/ac092c] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/30/2021] [Accepted: 06/08/2021] [Indexed: 05/11/2023]
Abstract
Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.
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Affiliation(s)
- Pauline F D Scheelbeek
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alan D Dangour
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephanie Jarmul
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grace Turner
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anne J Sietsma
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
| | - Jan C Minx
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | - Max Callaghan
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | - Idowu Ajibade
- Department of Geography, Portland State University, Portland, OR, United States of America
| | | | - Robbert Biesbroek
- Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Kathryn J Bowen
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | - Tara Chen
- E-Da Hospital, Kaohsiung City, Taiwan
| | - Katy Davis
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
| | - Tim Ensor
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
| | - James D Ford
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
| | - Eranga K Galappaththi
- Department of Fisheries and Oceans Canada, Winnipeg, Manitoba, Canada
- Department of Geography, Virginia Tech, Blacksburg, VA, United States of America
| | | | | | - Gabriela Nagle Alverio
- Nicholas School of the Environment, Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | | | | | | | - Giulia Scarpa
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
| | - Alcade C Segnon
- CGIAR Research Program on Climate Change, Agriculture and Food Security, International Crops Research Institute for the Semi-Arid Tropics, Bamako, Mali
- Faculty of Agronomic Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | | | - Jiren Xu
- University of Glasgow, Glasgow, United Kingdom
| | | | - Lea Berrang-Ford
- University of Leeds, Priestley International Centre for Climate, Leeds, United Kingdom
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Jarmul S, Dangour AD, Green R, Liew Z, Haines A, Scheelbeek PF. Climate change mitigation through dietary change: a systematic review of empirical and modelling studies on the environmental footprints and health effects of 'sustainable diets'. Environ Res Lett 2020; 15:123014. [PMID: 33897807 PMCID: PMC7610659 DOI: 10.1088/1748-9326/abc2f7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The adoption of healthy diets with low environmental impact has been widely promoted as an important climate change mitigation strategy. Typically, these diets are high in plant-sourced and low in animal-sourced and processed foods. Despite the fact that their environmental impacts vary, they are often referred to as 'sustainable diets'. Here we systematically review the available published evidence on the effect of 'sustainable diets' on environmental footprints and human health. Eight databases (OvidSP-Medline, OvidSP-Embase, EBSCO-GreenFILE, Web of Science Core Collection, Scopus, OvidSP-CAB-Abstracts, OvidSP-AGRIS, and OvidSP-Global Health) were searched to identify literature (published 1999-2019) reporting health effects and environmental footprints of 'sustainable diets'. Available evidence was mapped and pooled analysis was conducted by unique combinations of diet pattern, health and environmental outcome. Eighteen studies (412 measurements) met our inclusion criteria, distinguishing twelve non-mutually exclusive sustainable diet patterns, six environmental outcomes, and seven health outcomes. In 87% of measurements (n = 151) positive health outcomes were reported from 'sustainable diets' (average relative health improvement: 4.09% [95% CI -0.10-8.29]) when comparing 'sustainable diets' to current/baseline consumption patterns. Greenhouse gas emissions associated with 'sustainable diets' were on average 25.8%[95%CI -27.0 to -14.6] lower than current/baseline consumption patterns, with vegan diets reporting the largest reduction in GHG-emissions (-70.3% [95% CI: -90.2 to -50.4]), however, water use was frequently reported to be higher than current/baseline diets. Multiple benefits for both health and the environment were reported in the majority (n = 315[76%]) of measurements. We identified consistent evidence of both positive health effects and reduced environmental footprints accruing from 'sustainable diets'. The notable exception of increased water use associated with 'sustainable diets' identifies that co-benefits are not universal and some trade-offs are likely. When carefully designed, evidence-based, and adapted to contextual factors, dietary change could play a pivotal role in climate change mitigation, sustainable food systems, and future population health.
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Affiliation(s)
- Stephanie Jarmul
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Alan D Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre on Climate Change and Planetary Health, London School ofHygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre on Climate Change and Planetary Health, London School ofHygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Andy Haines
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre on Climate Change and Planetary Health, London School ofHygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Pauline Fd Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre on Climate Change and Planetary Health, London School ofHygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
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Aherrera A, Aravindakshan A, Jarmul S, Olmedo P, Chen R, Cohen JE, Navas-Acien A, Rule AM. E-cigarette use behaviors and device characteristics of daily exclusive e-cigarette users in Maryland: Implications for product toxicity. Tob Induc Dis 2020; 18:93. [PMID: 33209101 PMCID: PMC7668279 DOI: 10.18332/tid/128319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/13/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Few studies to date have characterized daily exclusive e-cigarette users, device characteristics, and use behaviors. This study describes daily e-cigarette user characteristics, and assesses the association between user behaviors and demographics. METHODS From 2015–2017, 100 daily exclusive e-cigarette users and 50 non-users were recruited in Maryland, USA. Sociodemographic characteristics, health status, e-cigarette/tobacco use behaviors, device characteristics, and reasons for e-cigarette use were collected by interview. Chi-squared tests (categorical variables), Student’s t-test (continuous variables), and linear regressions were used to assess relationships between variables. RESULTS Most daily exclusive e-cigarette users were men, White, former smokers, used MODs/tanks, and vaped on average 365 puffs/day (SD: 720). A third of users first vaped within 5 minutes of waking in the morning, and 56% vaped throughout the day. E-liquid consumption ranged from 5–240 mL/week (median: 32.5), with nicotine concentration 0–24 mg/mL (median: 3). E-cigarette users were more likely to report wheezing/whistling and hypertension than controls, although the finding was not statistically significant after adjustment. Less than half planned to quit vaping. CONCLUSIONS Daily e-cigarette users between 2015–2017 most commonly vaped MOD/tank devices. Being male and of lower education was associated with higher usage. Daily users with no intention to quit may be at risk for increased exposure to emissions from e-cigarettes that include inorganic (metals) and organic (e.g. acrolein, formaldehyde) compounds with known toxic effects, particularly to the lung. Further research is needed to characterize the long-term health effects of daily e-cigarette use.
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Affiliation(s)
- Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.,Division of Pediatric Pulmonary Medicine, Johns Hopkins School of Medicine, Baltimore, United States
| | - Atul Aravindakshan
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Stephanie Jarmul
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.,Department of Environmental Health Sciences, Columbia University, New York, United States.,Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.,Department of Environmental Health Sciences, Columbia University, New York, United States
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Scheelbeek PFD, Moss C, Kastner T, Alae-Carew C, Jarmul S, Green R, Taylor A, Haines A, Dangour AD. UK's fruit and vegetable supply increasingly dependent on imports from climate vulnerable producing countries. Nat Food 2020; 1:705-712. [PMID: 33225313 PMCID: PMC7116398 DOI: 10.1038/s43016-020-00179-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/01/2020] [Indexed: 01/04/2023]
Abstract
Domestic contribution to total fruit and vegetable supply in the UK decreased from 42% in 1987 to 22% in 2013. The impact of this changing pattern of UK fruit and vegetable imports, from countries with different vulnerabilities to projected climate change, on the resilience of the UK food system is currently unknown. Here, we used the UN FAO bilateral trade database over a period of 27 years to estimate changes in fruit and vegetable supply in the UK, and the NDGAIN climate vulnerability categories to assess the climate vulnerability of countries supplying fruit and vegetables to the UK. The diversity of fruit and vegetable supply has increased from 21 crops, comprising the top 80% of all fruit and vegetables supplied to the UK in 1987, to 34 crops in 2013. The contribution of tropical fruits has rapidly increased while that of more traditional vegetables, such as cabbages and carrots, has declined. The proportion of fruit and vegetables supplied to the UK market from climate vulnerable countries increased from 20% in 1987 to 32% in 2013. Sensitivity analyses - using climatic and freshwater availability indicators - supported these findings. Increased reliance on fruit and vegetable imports from climate vulnerable countries could negatively affect the availability, price and consumption of fruit and vegetables in the UK, affecting dietary intake and health particularly of older people and low-income households. Inter-sectoral actions across agriculture, health, environment, and trade are critical in both the UK and countries that export to the UK to increase the resilience of the food system, and support population health.
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Affiliation(s)
- Pauline FD Scheelbeek
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
| | - Cami Moss
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
| | - Thomas Kastner
- Senckenberg Biodiversity and Climate Research Centre Senckenberg – Frankfurt am Main, Germany
| | - Carmelia Alae-Carew
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
| | - Stephanie Jarmul
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
| | - Rosemary Green
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
- London Centre for Integrative Research on Agriculture and Health – London UK
| | | | - Andy Haines
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
- Department of Public Health, Environments and Society – London School of Hygiene & Tropical Medicine – London, UK
| | - Alan D Dangour
- Department of Population Health – London School of Hygiene & Tropical Medicine – London, UK
- Centre on Climate Change and Planetary Health – London School of Hygiene & Tropical Medicine – London, UK
- London Centre for Integrative Research on Agriculture and Health – London UK
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Jarmul S, Liew Z, Haines A, Scheelbeek P. Climate change mitigation in food systems: the environmental and health impacts of shifting towards sustainable diets, a systematic review protocol. Wellcome Open Res 2019; 4:205. [PMID: 32118121 PMCID: PMC7029755 DOI: 10.12688/wellcomeopenres.15618.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 01/06/2023] Open
Abstract
Food systems contribute greatly to global climate change due to their substantial contributions to greenhouse gas emissions, water use, and resource allocation. In addition, current food systems fail to deliver healthy and sustainable foods for all, with obesity as well as undernourishment remaining a pertinent global issue. Mounting pressures such as population growth and urbanisation urge rapid and transformational adaptations in food systems to sustainably feed a growing population. Sustainable diets have been promoted as a potential climate change mitigation strategy, and are characterized by high plant based foods and reduced animal-sourced and processed foods. While the evidence base on the potential health and environmental impacts of shifts towards sustainable diets has been growing rapidly over the past decade, there has been no recent synthesis of the evidence surrounding the health and climate mitigation benefits of sustainable consumption patterns. This systematic review will synthesize the evidence of both empirical and modelling studies assessing the direct health outcomes (such as all-cause mortality and body mass index) as well as environmental impacts (greenhouse gas emissions, land use, water use etc.) of shifts towards sustainable diets. Eight literature databases will be searched to identify studies published between 1999-2019 that report both health and environmental outcomes of sustainable diets. Evidence will be mapped and subsequently analysed based on the comparability of results and reported outcomes.
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Affiliation(s)
- Stephanie Jarmul
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Andrew Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- The Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Pauline Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Chen R, Aherrera A, Isichei C, Olmedo P, Jarmul S, Cohen JE, Navas-Acien A, Rule AM. Assessment of indoor air quality at an electronic cigarette (Vaping) convention. J Expo Sci Environ Epidemiol 2018; 28:522-529. [PMID: 29288255 DOI: 10.1038/s41370-017-0005-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/22/2017] [Indexed: 05/04/2023]
Abstract
E-cigarette (vaping) conventions are public events promoting electronic cigarettes, in which indoor use of e-cigarettes is allowed. The large concentration of people using e-cigarettes and poor air ventilation can result in indoor air pollution. In order to estimate this worst-case exposure to e-cigarettes, we evaluated indoor air quality in a vaping convention in Maryland (MD), USA. Real-time concentrations of particulate matter (PM10) and real-time total volatile organic compounds (TVOCs), CO2 and NO2 concentrations were measured. Integrated samples of air nicotine and PM10 concentrations were also collected. The number of attendees was estimated to range from 75 to 600 at any single observation time. The estimated 24-h time-weighted average (TWA) PM10 was 1800 μg/m3, 12-fold higher than the EPA 24-h regulation (150 μg/m3). Median (range) indoor TVOCs concentration was 0.13 (0.04-0.3) ppm. PM10 and TVOC concentrations were highly correlated with CO2 concentrations, indicating the high number of people using e-cigarettes and poor indoor air quality. Air nicotine concentration was 125 μg/m3, equivalent to concentrations measured in bars and nightclubs. E-cigarette aerosol in a vaping convention that congregates many e-cigarette users is a major source of PM10, air nicotine and VOCs, impairing indoor air quality. These findings also raise occupational concerns for e-cigarette vendors and other venue staff workers.
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Affiliation(s)
- Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela Aherrera
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chineye Isichei
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Stephanie Jarmul
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society and Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Olmedo P, Goessler W, Tanda S, Grau-Perez M, Jarmul S, Aherrera A, Chen R, Hilpert M, Cohen JE, Navas-Acien A, Rule AM. Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils. Environ Health Perspect 2018; 126:027010. [PMID: 29467105 PMCID: PMC6066345 DOI: 10.1289/ehp2175] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 05/19/2023]
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) generate an aerosol by heating a solution (e-liquid) with a metallic coil. Whether metals are transferred from the coil to the aerosol is unknown. OBJECTIVE Our goal was to investigate the transfer of metals from the heating coil to the e-liquid in the e-cigarette tank and the generated aerosol. METHODS We sampled 56 e-cigarette devices from daily e-cigarette users and obtained samples from the refilling dispenser, aerosol, and remaining e-liquid in the tank. Aerosol liquid was collected via deposition of aerosol droplets in a series of conical pipette tips. Metals were reported as mass fractions (μg/kg) in liquids and converted to mass concentrations (mg/m3) for aerosols. RESULTS Median metal concentrations (μg/kg) were higher in samples from the aerosol and tank vs. the dispenser (all p<0.001): 16.3 and 31.2 vs. 10.9 for Al; 8.38 and 55.4 vs. <0.5 for Cr; 68.4 and 233 vs. 2.03 for Ni; 14.8 and 40.2 vs. 0.476 for Pb; and 515 and 426 vs. 13.1 for Zn. Mn, Fe, Cu, Sb, and Sn were detectable in most samples. Cd was detected in 0.0, 30.4, and 55.1% of the dispenser, aerosol, and tank samples respectively. Arsenic was detected in 10.7% of dispenser samples (median 26.7μg/kg) and these concentrations were similar in aerosol and tank samples. Aerosol mass concentrations (mg/m3) for the detected metals spanned several orders of magnitude and exceeded current health-based limits in close to 50% or more of the samples for Cr, Mn, Ni, and Pb. CONCLUSIONS Our findings indicate that e-cigarettes are a potential source of exposure to toxic metals (Cr, Ni, and Pb), and to metals that are toxic when inhaled (Mn and Zn). Markedly higher concentrations in the aerosol and tank samples versus the dispenser demonstrate that coil contact induced e-liquid contamination. https://doi.org/10.1289/EHP2175.
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Affiliation(s)
- Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | | | - Stefan Tanda
- Institute of Chemistry, University of Graz, Graz, Austria
| | - Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stephanie Jarmul
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angela Aherrera
- 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
| | - Markus Hilpert
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute of Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Aherrera A, Olmedo P, Grau-Perez M, Tanda S, Goessler W, Jarmul S, Chen R, Cohen JE, Rule AM, Navas-Acien A. The association of e-cigarette use with exposure to nickel and chromium: A preliminary study of non-invasive biomarkers. Environ Res 2017; 159:313-320. [PMID: 28837903 DOI: 10.1016/j.envres.2017.08.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/08/2017] [Accepted: 08/07/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Nickel (Ni) and chromium (Cr) are components of e-cigarette heating coils. Whether e-cigarettes increase metal internal dose, however, is unknown. We assessed the association of e-cigarette use patterns and of e-liquid and aerosol metal concentrations with Ni and Cr biomarker levels in e-cigarette users from Maryland. METHODS We recruited 64 e-cigarette users from December 2015 to March 2016. We collected urine, saliva, and exhaled breath condensate (EBC), data on e-cigarette use, and samples from their e-cigarette device (dispenser e-liquid, aerosol, and tank e-liquid). RESULTS Median Ni and Cr levels were 0.73 and 0.39μg/g creatinine in urine, 2.25 and 1.53μg/L in saliva, and 1.25 and 0.29μg/L in EBC. In adjusted models, tertiles 2 and 3 of aerosol Ni concentrations were associated with 16% and 72% higher urine Ni and 202% and 321% higher saliva Ni compared to the lowest tertile. Tertile 3 of aerosol Cr levels were associated with 193% higher saliva Cr. An earlier time to first vape in the morning and more frequent coil change were associated with higher urine Ni. Tertile 2 of e-liquid consumption per week and voltage were associated with higher saliva Ni levels than tertile 1. CONCLUSION Positive associations of Ni and Cr aerosol concentrations with corresponding Ni and Cr biomarker levels indicate e-cigarette emissions increase metal internal dose. Increased e-cigarette use and consumption were also associated with higher Ni biomarker levels. Metal level standards are needed to prevent involuntary metal exposure among e-cigarette users.
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Affiliation(s)
- Angela Aherrera
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA.
| | - Pablo Olmedo
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA; Columbia University Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Maria Grau-Perez
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA; Columbia University Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Stefan Tanda
- Institute of Chemistry Analytical Chemistry, University of Graz, Austria
| | - Walter Goessler
- Institute of Chemistry Analytical Chemistry, University of Graz, Austria
| | - Stephanie Jarmul
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Rui Chen
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Ana M Rule
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Navas-Acien
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA; Columbia University Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, NY, USA; Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Affiliation(s)
- Stephanie Jarmul
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Angela Aherrera
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ana M Rule
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Pablo Olmedo
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rui Chen
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ana Navas-Acien
- Stephanie Jarmul, Angela Aherrera, Ana M. Rule, Pablo Olmedo, Rui Chen, and Ana Navas-Acien are with the Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Olmedo P, Navas-Acien A, Hess C, Jarmul S, Rule A. A direct method for e-cigarette aerosol sample collection. Environ Res 2016; 149:151-156. [PMID: 27200479 PMCID: PMC4910690 DOI: 10.1016/j.envres.2016.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/03/2016] [Accepted: 05/03/2016] [Indexed: 05/19/2023]
Abstract
E-cigarette use is increasing in populations around the world. Recent evidence has shown that the aerosol produced by e-cigarettes can contain a variety of toxicants. Published studies characterizing toxicants in e-cigarette aerosol have relied on filters, impingers or sorbent tubes, which are methods that require diluting or extracting the sample in a solution during collection. We have developed a collection system that directly condenses e-cigarette aerosol samples for chemical and toxicological analyses. The collection system consists of several cut pipette tips connected with short pieces of tubing. The pipette tip-based collection system can be connected to a peristaltic pump, a vacuum pump, or directly to an e-cigarette user for the e-cigarette aerosol to flow through the system. The pipette tip-based system condenses the aerosol produced by the e-cigarette and collects a liquid sample that is ready for analysis without the need of intermediate extraction solutions. We tested a total of 20 e-cigarettes from 5 different brands commercially available in Maryland. The pipette tip-based collection system condensed between 0.23 and 0.53mL of post-vaped e-liquid after 150 puffs. The proposed method is highly adaptable, can be used during field work and in experimental settings, and allows collecting aerosol samples from a wide variety of e-cigarette devices, yielding a condensate of the likely exact substance that is being delivered to the lungs.
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Affiliation(s)
- Pablo Olmedo
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Catherine Hess
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; University of California, Berkeley, School of Public Health, Prevention Research Center, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, United States
| | - Stephanie Jarmul
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Ana Rule
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
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