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Boots B, Green DS, Wright ACM, Olah-Kovacs B, Tovey L. Ecotoxicological effects of leachate from e-cigarettes and e-liquid on the performance of perennial ryegrass (Loliumperenne). Environ Pollut 2024; 348:123888. [PMID: 38548156 DOI: 10.1016/j.envpol.2024.123888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Once littered, disposable e-cigarettes present a complex type of waste in the environment. They typically contain a lithium battery, electronics to produce vapour and remnant e-liquid, all of which could leach into the environment. The effects of littered e-cigarettes are not well understood, and they have not been tested in terrestrial ecosystems. To address this, an experiment was set up to assess how leachate from e-cigarettes with or without a battery, but also e-liquid on its own can alter fundamental physical characteristics of Lolium perenne (perennial ryegrass) when irrigated with contaminated water. After 31 days, shoot length of L. perenne was not measurably affected, but the biomass was significantly reduced by 30% when e-liquid, and 24% when leachate from intact e-cigarettes was present compared to control plants. Plants grown with leachate or e-liquid displayed a significant level of early senescence of leaf apices, and the chlorophyll content was increased. Furthermore, root biomass was significantly less (29-46%) compared to the control. Leachate from used disposable e-cigarettes can affect the performance of plants when entering the soil ecosystem, therefore stricter regulations are needed to prevent this new type of electronic litter from becoming more widespread.
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Affiliation(s)
- Bas Boots
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, United Kingdom.
| | - Dannielle S Green
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, United Kingdom
| | - Amy C M Wright
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, United Kingdom
| | - Brigitta Olah-Kovacs
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, United Kingdom
| | - Louise Tovey
- Applied Ecology Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, United Kingdom
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Sun Y, Prabhu P, Li D, McIntosh S, Rahman I. Vaping: Public Health, Social Media, and Toxicity. Online J Public Health Inform 2024; 16:e53245. [PMID: 38602734 PMCID: PMC11046396 DOI: 10.2196/53245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/26/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
This viewpoint aims to provide a comprehensive understanding of vaping from various perspectives that contribute to the invention, development, spread, and consequences of e-cigarette products and vaping. Our analysis showed that the specific characteristics of e-cigarette products as well as marketing strategies, especially social media marketing, fostered the spread of vaping and the subsequent effects on human health and toxicity. We analyzed the components of e-cigarette devices and e-liquids, including the latest variants whose impacts were often overlooked. The different forms of nicotine, including salts and freebase nicotine, tobacco-derived nicotine, tobacco-free nicotine, and cooling agents (WS3 and WS23), have brought more choices for vapers along with more ways for e-cigarette manufacturers to advertise false understandings and present a greater threat to vapers' health. Our work emphasized the products of brands that have gained significant influence recently, which are contributing to severe public health issues. On the other hand, we also discussed in detail the toxicity of e-liquid components and proposed a toxicity mechanism. We also noticed that nicotine and other chemicals in e-liquids promote each other's negative effects through the oxidative stress and inflammatory nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway, a mechanism leading to pulmonary symptoms and addiction. The impact of government regulations on the products themselves, including flavor bans or regulations, has been limited. Therefore, we proposed further interventions or harm reduction strategies from a public health perspective.
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Affiliation(s)
- Yehao Sun
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Prital Prabhu
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
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Jaafar A, Albarazanchi A, Kadhim MJ, Darvin ME, Váczi T, Tuchin VV, Veres M. Impact of e-cigarette liquid on porcine lung tissue-Ex vivo confocal Raman micro-spectroscopy study. J Biophotonics 2023:e202300336. [PMID: 37851480 DOI: 10.1002/jbio.202300336] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/22/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
Ex vivo porcine lung immersed in e-liquid was investigated in-depth using confocal Raman micro-spectroscopy to assess the e-liquid influence on the lung. It was found that lung-related Raman band intensities at 1002, 1548, 1618 and 1655 cm-1 increased after first and second treatments except the surface, which was attributed to the well-known optical clearing (OC) effect due to alveoli filling with e-liquid resulting in light scattering reduction. The autofluorescence enhancement was explained by oxidative stress induced in lung during exposure to e-liquid. Moreover, e-liquid induced collagen dehydration was revealed by the I937 /I926 Raman band intensity ratio change. The effect was enhanced after the second treatment of the same lung tissue that indicates the possibility of multi-step OC treatment. We hypothesize that the nicotine-flavour-free e-liquids containing glycerol and propylene glycol could potentially be used in clinical protocols as OC agent for enhanced in-depth Raman-guided bronchoscopy.
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Affiliation(s)
- Ali Jaafar
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
- Institute of Physics, University of Szeged, Szeged, Hungary
- Ministry of Higher Education and Scientific Research, Baghdad, Iraq
| | - Abbas Albarazanchi
- Department of Physics, College of Science, Mustansiriyah University, Baghdad, Iraq
| | | | | | - Tamás Váczi
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
| | - Valery V Tuchin
- Institute of Physics and Science Medical Center, Saratov State University, Saratov, Russia
- Laboratory of Laser Diagnostics of Technical and Living Systems, Institute of Precision Mechanics and Control, FRC "Saratov Scientific Centre of the Russian Academy of Sciences", Saratov, Russia
| | - Miklós Veres
- Institute for Solid State Physics and Optics, Wigner Research Center for Physics, Budapest, Hungary
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Smiley SL, Shin H, Brown N, Geraci AA, Sussman S. Hypothetical e-liquid flavor ban and opinions among vape shop retailers in the Greater Los Angeles Area. Tob Induc Dis 2023; 21:133. [PMID: 37842544 PMCID: PMC10571508 DOI: 10.18332/tid/172078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Evaluating anticipated responses to flavor bans in the context of vape shops is needed to inform legislation and enforcement. This cross-sectional study examined vape shop retailers' opinions about the potential impacts of an e-liquid flavor ban on shop sales and customer behavior-change intentions. METHODS From December 2019 to October 2020 we conducted structured interviews over the phone with 46 brick-and-mortar vape shop retailers in the Greater Los Angeles Area. RESULTS Most participants were managers (43.5%), followed by owners (26.1%) and clerks (26.1%). More than half (52.2%) reported that sales would drop a lot if flavored e-liquids were banned in all vape shops. Controlling for store position, multivariable linear regression showed that opposition to a hypothetical ban on non-tobacco flavored e-liquids was associated with participants' opinions that customers would likely not purchase tobacco flavored e-liquids (b= -0.44, p<0.01), and would likely use combustible tobacco products (b=0.47, p<0.05). CONCLUSIONS In this cross-sectional study, vape shop retailers in the Greater Los Angeles Area reported that if a ban on non-tobacco e-liquid flavors occurred, they would oppose strongly, and that a ban would have a negative impact on their shop (e.g. loss in sales) and customer behavior (e.g. would replace vaping with smoking combustible tobacco products). Implications for research and practice are discussed.
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Affiliation(s)
- Sabrina L. Smiley
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, United States
| | - Heesung Shin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Nichelle Brown
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, United States
| | - Angela A. Geraci
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, United States
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Kolaczyk K, Jiang H. Photometric Monitoring of Electronic Cigarette Puff Topography. Sensors (Basel) 2023; 23:8220. [PMID: 37837050 PMCID: PMC10575377 DOI: 10.3390/s23198220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/12/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
To study and monitor the adverse health consequences of using electronic cigarettes, a user's puff topography, which are quantification parameters of the user's vaping habits, plays a central role. In this work, we introduce a topography sensor to measure the mass of total particulate matter generated in every puff and to estimate the nicotine yield. The sensor is compact and low-cost, and is integrated into the electronic cigarette device to promptly and conveniently monitor the user's daily puff topography. The topography sensor is comprised of a photometric sensor and a pressure sensor. The photometric sensor measures the mass concentration of the aerosol, based on scattering of near-infrared light from airborne particles, while the pressure sensor measures the flow rate. The topography sensor was tested under various conditions including a wide range of atomizer power, puff duration, and inhalation pressure. The sensor's accuracy was validated by comparing the sensor's readings with reference measurements, and the results matched closely with the trends reported by existing studies on electronic cigarettes. An example application for tracking a user's puff topography was also demonstrated. Our topography sensor holds great promise in mitigating the health risks of vaping, and in promoting quality control of electronic cigarette products.
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Haworth-Duff A, Parkes GMB, Reed NJ. Profiling flavourings in strawberry-flavoured e-liquid using headspace-gas chromatography-mass spectrometry. Drug Test Anal 2023; 15:1077-1083. [PMID: 36735626 DOI: 10.1002/dta.3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
E-liquids typically contain nicotine and flavourings in a matrix of propylene glycol (PG) and vegetable glycerine (VG). Some nicotine-free e-liquids are flavouring only in the aerosol carrier with the option for users to add their own nicotine. It is only the nicotine that is monitored in terms of level, as specified by the manufacturers. Little is known of the toxicological effect for some of the flavourings in the context of vaping as these are only regulated for ingestion and not inhalation. A method was developed to analyse volatile organic compounds (VOCs) evolved when e-liquids are vaporised based on headspace-gas chromatography-mass spectrometry (HS-GC-MS) for e-liquids. An in-house standard was prepared with sample matrix and purchased strawberry flavouring to simulate a simple e-liquid but with known levels. This standard was then used to optimise the analysis for use with e-liquid samples but not for full quantification purposes. These were purchased from a range of retailers and with different batches but mainly focussed on strawberry flavour. The results identified three key components indicative of strawberry flavour (ethyl-3-methyl butanoate, ethyl 2-methyl butanoate and ethyl butanoate) and showed considerable variation between both manufacturers and batches. Flavouring VOCs are regulated for ingestion but are not regulated for e-liquid inhalation, so these could have toxicological implications. In addition, the inconsistency between samples suggests further issues when users add their own nicotine to the e-liquids as the viscous sample matrix makes homogeneous mixing difficult.
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Affiliation(s)
- Adam Haworth-Duff
- Department of Electrical Engineering and Electronics, School of Electrical Engineering, Electronics and Computer Science, University of Liverpool, Liverpool, UK
| | - Gareth M B Parkes
- Department of Chemical and Forensic Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Natasha J Reed
- Department of Chemical and Forensic Sciences, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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Pitzer CR, Aboaziza EA, O'Reilly JM, Mandler WK, Olfert IM. Nicotine and Microvascular Responses in Skeletal Muscle from Acute Exposure to Cigarettes and Vaping. Int J Mol Sci 2023; 24:10208. [PMID: 37373356 DOI: 10.3390/ijms241210208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite claims of safety or harm reduction for electronic cigarettes (E-cig) use (also known as vaping), emerging evidence indicates that E-cigs are not likely safe, or necessarily safer than traditional cigarettes, when considering the user's risk of developing vascular dysfunction/disease. E-cigs are different from regular cigarettes in that E-cig devices are highly customizable, and users can change the e-liquid composition (such as the base solution, flavors, and nicotine level). Since the effects of E-cigs on the microvascular responses in skeletal muscle are poorly understood, we used intravital microscopy with an acute (one-time 10 puff) exposure paradigm to evaluate the individual components of e-liquid on vascular tone and endothelial function in the arterioles of the gluteus maximus muscle of anesthetized C57Bl/6 mice. Consistent with the molecular responses seen with endothelial cells, we found that the peripheral vasoconstriction response was similar between mice exposed to E-cig aerosol or cigarette smoke (i.e., 3R4F reference cigarette); this response was not nicotine dependent, and endothelial cell-mediated vasodilation was not altered within this acute exposure paradigm. We also report that, regardless of the base solution component [i.e., vegetable glycerin (VG)-only or propylene glycol (PG)-only], the vasoconstriction responses were the same in mice with inhalation exposure to 3R4F cigarette smoke or E-cig aerosol. Key findings from this work reveal that some component other than nicotine, in inhaled smoke or aerosol, is responsible for triggering peripheral vasoconstriction in skeletal muscle, and that regardless of one's preference for an E-cig base solution composition (i.e., ratio of VG-to-PG), the acute physiological response to blood vessels appears to be the same. The data suggest that vaping is not likely to be 'safer' than smoking towards blood vessels and can be expected to produce and/or result in the same adverse vascular health outcomes associated with smoking cigarettes.
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Affiliation(s)
- Christopher R Pitzer
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Eiman A Aboaziza
- West Virginia Clinical and Translational Science Institute, Morgantown, WV 26506, USA
- Center for Inhalation Toxicology, West Virginia University, Morgantown, WV 26506, USA
| | - Juliana M O'Reilly
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - W Kyle Mandler
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - I Mark Olfert
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
- Center for Inhalation Toxicology, West Virginia University, Morgantown, WV 26506, USA
- Department of Physiology, Pharmacology and Toxicology, West Virginia University, Morgantown, WV 26506, USA
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Ma S, Qiu Z, Chen J, Shang C. Synthetic nicotine e-liquids sold in US online vape shops. Prev Med Rep 2023; 33:102222. [PMID: 37181243 PMCID: PMC10172710 DOI: 10.1016/j.pmedr.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
Synthetic nicotine (relative to tobacco-derived, or "natural" nicotine) is an emerging feature of e-cigarettes including e-liquids in the online marketplace. This study investigated a total of 11,161 unique nicotine e-liquids sold in online stores in the US during 2021, using keyword matching approach to identify the feature of synthetic nicotine based on product description texts. We showed that in 2021, 2.13% of nicotine-containing e-liquids in our sample were marketed as synthetic nicotine e-liquids. About a quarter of the synthetic nicotine e-liquids that we identified were salt-based; the nicotine strength varied; and those synthetic nicotine e-liquids had a variety of flavor profiles. Synthetic nicotine containing e-cigarettes are likely to remain in the market and manufacturers might market those products as "tobacco-free," to attract consumers who this feature as healthier or less addictive. It is important to monitor synthetic nicotine in the e-cigarette marketplace and assess how this feature influences consumer behaviors.
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Corresponding authors at: The Ohio State University Center for Tobacco Research, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus OH 43214, USA.
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Riwu Bara RP, McCausland K, Swanson M, Scott L, Jancey J. "They're sleek, stylish and sexy:" selling e-cigarettes online. Aust N Z J Public Health 2023; 47:100013. [PMID: 36641959 DOI: 10.1016/j.anzjph.2022.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE We examined the product range, marketing strategies, access and marketing claims made by Australian and New Zealand (NZ) online e-cigarette retailers. METHODS Twenty Australian (n=10) and NZ (n=10) e-cigarette retail websites were identified via Google using a combination of keywords nominated by an expert panel and identified via a literature review: 'e-cigarette', 'e-cigs', 'vape', and 'vaping', combined with 'Australia', 'AU', 'New Zealand' and 'NZ' and then examined. RESULTS Products were extensive (disposable, pod-based, reusable, replacement parts), 95% (n=19) offered 'Starter Kits,' flavoured e-liquid (n=1,032), most containing nicotine (70%, n=14). Most retailers (85%, n=17) offered price discounts and free delivery. There were unsubstantiated health claims (80%, n=16), cessation claims (65%, n=13) and cost-benefit claims (50%, n=10) promoting e-cigarette use. Most (n=14) website age verification features simply required the purchaser to indicate they were aged 18 years. CONCLUSIONS Although e-cigarette regulations are different in Australia and NZ, the online product range, marketing strategies, access and marketing claims were similar and sold e-liquid containing nicotine. The health and cessation e-cigarette marketing claims were outlandish and unsubstantiated. IMPLICATIONS FOR PUBLIC HEALTH Most purchasing of e-cigarettes occurs online. Regulations and enforcement to limit access and stop unsubstantiated marketing claims must be a public health priority.
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Affiliation(s)
- Roy Pefi Riwu Bara
- Enable Institute, School of Population Health, Faculty Health Sciences, Curtin University, Western Australia, Australia; Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Western Australia, Australia
| | - Kahlia McCausland
- Enable Institute, School of Population Health, Faculty Health Sciences, Curtin University, Western Australia, Australia; Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Western Australia, Australia
| | - Maurice Swanson
- Australian Council on Smoking and Health, Western Australia, Australia
| | - Lucy Scott
- Australian Council on Smoking and Health, Western Australia, Australia
| | - Jonine Jancey
- Enable Institute, School of Population Health, Faculty Health Sciences, Curtin University, Western Australia, Australia; Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Western Australia, Australia.
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Ma S, Qiu Z, Yang Q, Bridges JFP, Chen J, Shang C. Expanding the E-Liquid Flavor Wheel: Classification of Emerging E-Liquid Flavors in Online Vape Shops. Int J Environ Res Public Health 2022; 19:ijerph192113953. [PMID: 36360834 PMCID: PMC9658901 DOI: 10.3390/ijerph192113953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Electronic cigarettes are the most popular tobacco product among U.S. youth, and over 80% of current youth users of e-cigarettes use flavored e-cigarettes, with fruit, mint/menthol, and candy/sweets being the most popular flavors. A number of new e-liquid flavors are currently emerging in the online e-cigarette market. Menthol and other flavored e-cigarettes could incentivize combustible tobacco smokers to transition to e-cigarette use. METHODS From February to May 2021, we scraped data of over 14,000 e-liquid products, including detailed descriptions of their flavors, from five national online vape shops. Building upon the existing e-liquid flavor wheel, we expanded the semantic databases (i.e., key terms) to identify flavors using WordNet-a major database for keyword matching and group discussion. Using the enriched databases, we classified 14,000+ e-liquid products into the following 11 main flavor categories: "fruit", "dessert/candy/sweets", "coffee/tea", "alcohol", "other beverages", "tobacco", "mint/menthol", "nuts", "spices/pepper", "other flavors", and "unspecified flavor". RESULTS We find that the most prominent flavor sold in the five online vape shop in 2021 was fruit flavored products, followed by dessert/candy/other sweets. Online vendors often label a product with several flavor profiles, such as fruit and menthol. CONCLUSIONS Given that online stores market products with multiple flavor profiles and most of their products contain fruit flavor, the FDA may have issued marketing denial orders to some of these products. It is important to further examine how online stores respond to the FDA flavor restrictions (e.g., compliance or non-compliance).
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Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH 43214, USA
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH 43214, USA
| | - John F. P. Bridges
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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11
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Abstract
Electronic cigarettes (ECs) are purported to be tobacco harm-reduction products whose degree of harm has been highly debated. EC use is considered less hazardous than smoking but is not expected to be harmless. Following the banning of e-liquid flavors in countries such as the US, Finland, Ukraine, and Hungary, there are growing concerns regarding the safety profile of e-liquid flavors used in ECs. While these are employed extensively in the food industry and are generally regarded as safe (GRAS) when ingested, GRAS status after inhalation is unclear. The aim of this review was to assess evidence from 38 reports on the adverse effects of flavored e-liquids on the respiratory system in both in vitro and in vivo studies published between 2006 and 2021. Data collected demonstrated greater detrimental effects in vitro with cinnamon (9 articles), strawberry (5 articles), and menthol (10 articles), flavors than other flavors. The most reported effects among these investigations were perturbations of pro-inflammatory biomarkers and enhanced cytotoxicity. There is sufficient evidence to support the toxicological impacts of diacetyl- and cinnamaldehyde-containing e-liquids following human inhalation; however, safety profiles on other flavors are elusive. The latter may result from inconsistencies between experimental approaches and uncertainties due to the contributions from other e-liquid constituents. Further, the relevance of the concentration ranges to human exposure levels is uncertain. Evidence indicates that an adequately controlled and consistent, systematic toxicological investigation of a broad spectrum of e-liquid flavors may be required at biologically relevant concentrations to better inform public health authorities on the risk assessment following exposure to EC flavor ingredients.
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Affiliation(s)
- Felix Effah
- Pharmacology Section, St George’s University of London, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
| | - Benjamin Taiwo
- Physiology Section, St George’s University of London, London, UK
| | - Deborah Baines
- Infection and Immunity Institute, St George’s University of London, London, UK
| | - Alexis Bailey
- Pharmacology Section, St George’s University of London, London, UK
| | - Tim Marczylo
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
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Abstract
E-cigarettes are battery-operated devices that heat a liquid mixture to make an aerosol that is inhaled, or vaped, by the user. Vape shops are retail environments designed to fulfill customer demand for diverse e-liquid flavors and hardware options, which create unique worker exposure concerns. To characterize exposures to vape shop workers, especially to flavoring chemicals associated with known respiratory toxicity, this study recruited vape shops from the San Francisco Bay Area. In six shops, we measured air concentrations for volatile organic compounds, formaldehyde, flavoring chemicals, and nicotine in personal and/or area samples; analyzed components of e-liquids vaped during field visits; and assessed metals on surface wipe samples. Interviews and observations were conducted over the course of a workday in the same six shops and interviews were performed in an additional six where sampling was not conducted. Detections of the alpha-diketone butter flavoring chemicals diacetyl and/or 2,3-pentanedione were common: in the headspace of purchased e-liquids (18 of 26 samples), in personal air samples (5 of 16), and in area air samples (2 of 6 shops). Two exceedances of recommended exposure limits for 2,3-pentanedione (a short-term exposure limit and an 8-hr time-weighted average) were measured in personal air samples. Other compounds detected in the area and personal air samples included substitutes for diacetyl and 2,3-pentanedione (acetoin and 2,3-hexanedione) and compounds that may be contaminants or impurities. Furthermore, a large variety (82) of other flavoring chemicals were detected in area air samples. None of the 12 shops interviewed had a health and safety program. Six shops reported no use of any personal protective equipment (PPE) (e.g., gloves, chemical resistant aprons, eye protection) and the others stated occasional use; however, no PPE use was observed during any field investigation day. Recommendations were provided to shops that included making improvements to ventilation, hygiene, use of personal protective equipment, and, if possible, avoidance of products containing the alpha-diketone flavoring chemicals. Future research is needed to evaluate the long-term health risks among workers in the vape shop retail industry and for e-cigarette use generally. Specific areas include further characterizing e-liquid constituents and emissions, evaluating ingredient health risks, evaluating the contributions of different routes of exposure (dermal, inhalation, and ingestion), and determining effective exposure mitigation measures.
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Affiliation(s)
- Kathleen R Attfield
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California
| | | | - Leonard M Zwack
- Hazard Evaluations and Technical Assistance Branch, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Eric K Glassford
- Hazard Evaluations and Technical Assistance Branch, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Ryan F LeBouf
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Barbara L Materna
- Occupational Health Branch, California Department of Public Health, Richmond, California
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13
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Singh A. Adolescent e-cigarette or vaping product use-associated lung injury: A case series and review of the literature. Pediatr Pulmonol 2022; 57:1076-1084. [PMID: 35072351 DOI: 10.1002/ppul.25832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adolescent e-cigarette or vaping product use-associated lung injury (EVALI) has increased in prevalence, and while cases describing various pulmonary manifestations have been reported, reports on the presentations and outcomes in teenage patients are sparse. METHODS We retrospectively describe eight EVALI patients with different presentations, laboratory and imaging findings, treatment, and concomitant diagnoses. We review the literature and describe how our analysis adds to the literature. FINDINGS Eight males, aged 15-18 years of age presented with various symptoms. Four patients were Caucasian while four were of Hispanic origin. All patients presented with respiratory symptoms; six also had GI symptoms; five were hypoxemic; all but one patient admitted to using products containing tetrahydrocannabinol (THC). All patients had changes on imaging with ground-glass opacities. One patient underwent lung biopsy and bronchoscopy showing eosinophilic pneumonia. All patients received antimicrobial therapies without improvement until systemic steroids were administered. Six patients underwent pulmonary function testing, and five required medications for newly diagnosed persistent asthma. One patient developed pulmonary hypertension, which resolved after treatment. One patient required noninvasive ventilation. No patients were positive for SARS-CoV2. Two had coinfections with other microbes. Five patients required escalation of asthma therapies at follow-up with pulmonology. CONCLUSION This analysis of eight adolescent males hospitalized for EVALI highlights the unpredictable spectrum of disease presentation and management. These patients can be misdiagnosed without proper screening and may have residual respiratory complications necessitating outpatient management by a pulmonologist.
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Affiliation(s)
- Alvin Singh
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, Missouri, USA
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14
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Do EK, O'Connor K, Kreslake JM, Friedrichsen SC, Vallone DM, Hair EC. Influence of Flavors and Nicotine Concentration on Nicotine Dependence in Adolescent and Young Adult E-Cigarette Users. Subst Use Misuse 2022; 57:632-639. [PMID: 35138226 DOI: 10.1080/10826084.2022.2034876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: The objective of this study is to examine the relationships between e-cigarette flavors, nicotine concentration, and their interaction on measures of nicotine dependence.Methods: Survey data are drawn from a cross-sectional convenience sample of past 30-day e-cigarette users aged 15 to 24 years (N = 2037) collected between October 2020 and November 2020. Participants were asked to provide information about the e-cigarette products they used most regularly. Only those with available information on flavors (fruit, mint, menthol/ice, and tobacco), nicotine concentration (0-2.9%, 3-4.9%, and 5% or greater), and time to first vape after waking (within 30 minutes, greater than 30 minutes) were included in analyses (N = 1430). Generalized linear regression models were used with log link and binary distribution to assess the relationship between flavors, nicotine concentration, and nicotine dependence. Effect modification by nicotine concentration was assessed using an interaction term for flavors by nicotine concentration. Models were adjusted for age, race/ethnicity, gender, and financial situation.Findings: Fruit, mint, and menthol flavor user groups had a very similar dose-response relationship between nicotine concentration and prevalence of vaping within 30 minutes. These groups showed that the prevalence of vaping within 30 minutes gradually increased as nicotine concentration increased. Meanwhile, tobacco flavor user groups demonstrated a decrease in prevalence of vaping within 30 minutes, as nicotine concentration increased.Conclusion: Results highlight the need for understanding how e-cigarette product characteristics like flavors and nicotine concentration can facilitate nicotine dependence to e-cigarettes. Findings suggest that comprehensive e-cigarette product regulation of all flavors and reducing nicotine concentration will help to reduce the risk for nicotine dependence among young people.
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Affiliation(s)
- Elizabeth K Do
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
- Department of Epidemiology, George Washington University Milken Institute of Public Health, Washington, DC, USA
| | - Katie O'Connor
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Jennifer M Kreslake
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Global Public Health, New York University, New York, New York, USA
| | - Elizabeth C Hair
- Schroeder Institute at Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Global Public Health, New York University, New York, New York, USA
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15
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Dickinson AJG, Turner SD, Wahl S, Kennedy AE, Wyatt BH, Howton DA. E-liquids and vanillin flavoring disrupts retinoic acid signaling and causes craniofacial defects in Xenopus embryos. Dev Biol 2022; 481:14-29. [PMID: 34543654 PMCID: PMC8665092 DOI: 10.1016/j.ydbio.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/03/2023]
Abstract
Environmental teratogens such as smoking are known risk factors for developmental disorders such as cleft palate. While smoking rates have declined, a new type of smoking, called vaping is on the rise. Vaping is the use of e-cigarettes to vaporize and inhale an e-liquid containing nicotine and food-like flavors. There is the potential that, like smoking, vaping could also pose a danger to the developing human. Rather than waiting for epidemiological and mammalian studies, we have turned to an aquatic developmental model, Xenopus laevis, to more quickly assess whether e-liquids contain teratogens that could lead to craniofacial malformations. Xenopus, like zebrafish, has the benefit of being a well-established developmental model and has also been effective in predicting whether a chemical could be a teratogen. We have determined that embryonic exposure to dessert flavored e-liquids can cause craniofacial abnormalities, including an orofacial cleft in Xenopus. To better understand the underlying mechanisms contributing to these defects, transcriptomic analysis of the facial tissues of embryos exposed to a representative dessert flavored e-liquid vapor extract was performed. Analysis of differentially expressed genes in these embryos revealed several genes associated with retinoic acid metabolism or the signaling pathway. Consistently, retinoic acid receptor inhibition phenocopied the craniofacial defects as those embryos exposed to the vapor extract of the e-liquid. Such malformations also correlated with a group of common differentially expressed genes, two of which are associated with midface birth defects in humans. Further, e-liquid exposure sensitized embryos to forming craniofacial malformations when they already had depressed retinoic acid signaling. Moreover, 13-cis-retinoic acid treatment could significantly reduce the e-liquid induced malformation in the midface. Such results suggest the possibility of an interaction between retinoic acid signaling and e-liquid exposure. One of the most popular and concentrated flavoring chemicals in dessert flavored e-liquids is vanillin. Xenopus embryos exposed to this chemical closely resembled embryos exposed to dessert-like e-liquids and a retinoic acid receptor antagonist. In summary, we determined that e-liquid chemicals, in particular vanillin, can cause craniofacial defects potentially by dysregulating retinoic acid signaling. This work warrants the evaluation of vanillin and other such flavoring additives in e-liquids on mammalian development.
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Affiliation(s)
| | - Stephen D Turner
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA; Signature Science LLC, Charlottesville, VA, USA
| | - Stacey Wahl
- Research and Education Department, Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Allyson E Kennedy
- Directorate for Computer and Information Science and Engineering, National Science Foundation, Alexandria, VA, USA
| | - Brent H Wyatt
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | - Deborah A Howton
- Department of Biology, Virginia Commonwealth University, Richmond, VA, USA
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16
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Singh A. A commentary on adolescent electronic cigarette use and nicotine addiction. Pediatr Pulmonol 2021; 56:3580-3585. [PMID: 34520125 DOI: 10.1002/ppul.25676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
Adolescent electronic cigarette (e-cigarette) use has continued due to the ongoing struggle with nicotine addiction affecting teenagers. By briefly discussing the timeline of the emergence of e-cigarettes and nicotine addiction in adolescents, this author hopes to shed some light on mitigation strategies to curtail this ongoing epidemic of youth e-cigarette use and nicotine addiction through public health education and advocacy.
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Affiliation(s)
- Alvin Singh
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, Missouri, USA
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17
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Snoderly HT, Nurkiewicz TR, Bowdridge EC, Bennewitz MF. E-Cigarette Use: Device Market, Study Design, and Emerging Evidence of Biological Consequences. Int J Mol Sci 2021; 22:12452. [PMID: 34830344 PMCID: PMC8619996 DOI: 10.3390/ijms222212452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/12/2022] Open
Abstract
Electronic cigarettes are frequently viewed as a safer alternative to conventional cigarettes; however, evidence to support this perspective has not materialized. Indeed, the current literature reports that electronic cigarette use is associated with both acute lung injury and subclinical dysfunction to the lung and vasculature that may result in pathology following chronic use. E-cigarettes can alter vascular dynamics, polarize innate immune populations towards a proinflammatory state, compromise barrier function in the pulmonary endothelium and epithelium, and promote pre-oncogenic phenomena. This review will summarize the variety of e-cigarette products available to users, discuss current challenges in e-cigarette study design, outline the range of pathologies occurring in cases of e-cigarette associated acute lung injury, highlight disease supporting tissue- and cellular-level changes resulting from e-cigarette exposure, and briefly examine how these changes may promote tumorigenesis. Continued research of the mechanisms by which e-cigarettes induce pathology benefit users and clinicians by resulting in increased regulation of vaping devices, informing treatments for emerging diseases e-cigarettes produce, and increasing public awareness to reduce e-cigarette use and the onset of preventable disease.
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Affiliation(s)
- Hunter T. Snoderly
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
| | - Timothy R. Nurkiewicz
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Elizabeth C. Bowdridge
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Margaret F. Bennewitz
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA;
- Center for Inhalation Toxicology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (T.R.N.); (E.C.B.)
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18
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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. Int J Environ Res Public Health 2021; 18:ijerph182111655. [PMID: 34770169 PMCID: PMC8582700 DOI: 10.3390/ijerph182111655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
- Correspondence:
| | - 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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19
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Davis ES, Ghosh A, Coakley RD, Wrennall JA, Lubamba BA, Rowell TR, Dang H, Pawlak EA, Li Q, Alexis NE, Ribeiro CMP, Tarran R. Chronic E-Cigarette Exposure Alters Human Alveolar Macrophage Morphology and Gene Expression. Nicotine Tob Res 2021; 24:395-399. [PMID: 34519792 DOI: 10.1093/ntr/ntab186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/13/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Alveolar macrophages (AMs) are lung-resident immune cells that phagocytose inhaled particles and pathogens, and help coordinate the lung's immune response to infection. Little is known about the impact of chronic e-cigarette use (i.e. vaping) on this important pulmonary cell type. Thus, we determined the effect of vaping on alveolar macrophage (AM) phenotype and gene expression. METHODS We recruited never-smokers, smokers, and e-cigarette users (vapers) and performed research bronchoscopies to isolate AMs from bronchoalveolar lavage fluid (BALF) samples and epithelial cells from bronchial brushings. We then performed morphological analyses and used the Nanostring platform to look for changes in gene expression. RESULTS AMs obtained from smokers and vapers were phenotypically distinct from those obtained from non-smokers, and from each other. Immunocytochemistry revealed that vapers AM's had significantly elevated inducible nitric oxide synthase (iNOS; M1) expression and significantly reduced CD301a (M2) expression compared to non-smokers or smokers. Vapers' AMs and bronchial epithelia exhibited unique changes in gene expression compared to non-smokers or smokers. Moreover, vapers' AMs were the most affected of all groups and had 124 genes uniquely downregulated. Gene ontology analysis revealed that vapers and smokers had opposing changes in biological processes. CONCLUSIONS These data indicate that vaping causes unique changes to AMs and bronchial epithelia compared to non-smokers and smokers which may impact pulmonary host defense. IMPLICATIONS These data indicate that normal "healthy" vapers have altered AMs and may be at risk of developing abnormal immune responses to inflammatory stimuli.
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Affiliation(s)
- Eric S Davis
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Arunava Ghosh
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Raymond D Coakley
- Department of Medicine; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Joe A Wrennall
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Bob A Lubamba
- Marsico Lung Institute; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Temperance R Rowell
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Hong Dang
- Marsico Lung Institute; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Erica A Pawlak
- Center for Environmental Medicine Asthma and Lung Biology, The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Quefeng Li
- Department of Biostatistics, The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Neil E Alexis
- Center for Environmental Medicine Asthma and Lung Biology, The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Carla M P Ribeiro
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA.,Department of Medicine; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA.,Marsico Lung Institute; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
| | - Robert Tarran
- Department of Cell Biology & Physiology; The University of North Carolina at Chapel Hill. Chapel Hill, NC, 27599, USA
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20
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Bizoń M, Maciejewski D, Kolonko J. E-cigarette or vaping product use-associated acute lung injury (EVALI) as a therapeutic problem in anaesthesiology and intensive care departments. Anaesthesiol Intensive Ther 2020; 52:219-25. [PMID: 32876409 DOI: 10.5114/ait.2020.97989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Based on the data currently available in literature, the factors inducing acute lung injury resulting from the increasingly widespread use of e-cigarettes (vaping) (EVALI) were analysed. Although the number of traditional smokers in the population has been declining, vaping may be dangerous to health due to the substances contained in various e-cigarette liquids and cause acute respiratory failure during various forms of pneumonitis. In addition to tetrahydrocannabinol (THC), cannabidiol (CB) and other opioids, the major injuring factors include standard ingredients of e-liquid, such as propylene glycol, vegetable glycerine, colouring dyes, and flavouring agents. Vaping-associated lung injury impairs the alveolar-capillary barrier and distribution of respiratory volume manifesting the features of atelectasis, which is particularly pronounced in lipoid pneumonia. Due to critical gas exchange disorders, ICU treatment is required in an increasing number of patients. The management is essentially based on steroid and antibiotic therapy; whenever the ventilator is needed, the principles of lung-protective ventilation should be strictly followed. If mechanical ventilation fails, ECMO should be considered.
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21
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Holt AK, Poklis JL, Cobb CO, Peace MR. The Identification of Gamma-Butyrolactone in JUUL Liquids. J Anal Toxicol 2021; 45:892-900. [PMID: 34100536 DOI: 10.1093/jat/bkab067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Gamma-Butyrolactone (GBL), a commonly used industrial solvent, is used recreationally as a central nervous system (CNS) depressant and, therefore, a United States Drug Enforcement Agency (DEA) List 1 chemical of the Controlled Substances Act. GBL was identified presumptively in the liquid from JUUL Virginia Tobacco flavored pods during routine untargeted screening analysis of e-cigarette products by gas chromatography-mass spectrometry (GC-MS). Methods for the confirmation and quantitation of GBL were developed for GC-MS and liquid chromatography-tandem mass spectrometry (LC-MS-MS) in the liquids and the aerosol generated from the liquid. Three flavors of JUUL pods available at the time of analysis were obtained by direct purchase from the manufacturer, purchase from a local vape shop, and via submission from a 3rd party. The only liquid flavor to contain GBL was Virginia Tobacco, with an average of 0.37 mg/mL of GBL, and it was detected in the aerosol. Studies evaluating the pharmacological effects of inhaling GBL do not exist, however a case report of chronic oral GBL ingestion indicates acute lung injury. The identification of GBL in an e-cigarette product purportedly compliant with federal regulation continues to demonstrate public health and public safety concerns.
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Affiliation(s)
- Alaina K Holt
- Department of Forensic Science.,Integrative Life Sciences Doctoral Program
| | | | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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22
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Eshraghian EA, Al-Delaimy WK. A review of constituents identified in e-cigarette liquids and aerosols. Tob Prev Cessat 2021; 7:10. [PMID: 33585727 PMCID: PMC7873740 DOI: 10.18332/tpc/131111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/29/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Identification of chemicals present in e-liquids and aerosols is a vital first step in assessing the human health effects of e-cigarettes. We aim to identify the qualitative and quantitative constituents present in e-cigarette liquids and aerosols. METHODS A comprehensive search of scientific databases included literature up to July 2020. A total of 28 articles met inclusion criteria; 18 articles assessed e-liquid constituents and 15 articles assessed aerosol constituents. Of these, 5 assessed constituents present in both mediums. We included English-language publications that examine qualitative and/or quantitative constituents in e-cigarette liquids and aerosols. RESULTS In total, articles identified 60 compounds in e-liquids and 47 compounds in aerosols. A total of 22 compounds were identified in both e-liquids and aerosols. These are: acenaphthylene, acetaldehyde, acetol, antimony, benzaldehyde, benzene, chromium, copper, diacetyl, formaldehyde, glycerol, lead, limonene, naphthalene, nickel, nicotine, nicotine-N'-oxides, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N-Nitrosonornicotine (NNN), propylene glycol, toluene, and vegetable glycerin. Some of the identified chemicals have been labeled as harmful, toxic, or cancerous through human, animal, and cell line studies. A variety of laboratory methods were used for analyses, which made reported levels less consistent. CONCLUSIONS E-liquids and aerosols contain a variety of chemicals with potential health effects from inhaling them. Further, secondhand health effects are unknown because of limited understanding of the dose of exposure by non-users. Identification of constituents in e-cigarettes is the first step to determine their risks to humans and support evidence-based regulations and health policies.
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Affiliation(s)
- Emily A Eshraghian
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, United States
| | - Wael K Al-Delaimy
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, United States
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24
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Scarpino M, Rosso T, Lanzo G, Lolli F, Bonizzoli M, Lazzeri C, Mannaioni G, Baronti R, Fattapposta F, Grippo A. Severe neurological nicotine intoxication by e-cigarette liquids: Systematic literature review. Acta Neurol Scand 2021; 143:121-130. [PMID: 32866996 DOI: 10.1111/ane.13338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022]
Abstract
Electronic cigarettes are a popular, easily purchased, alternative source of nicotine that is considered safer than conventional tobacco. However, Intentional or accidental exposure to e-liquid substances, mainly nicotine, can lead to serious, potentially fatal toxicity. Emergency and critical care physicians should keep in mind acute intoxication of this poison with a biphasic toxic syndrome. We highlight its potentially fatal outcome and suggest monitoring the adverse effects of nicotine according to a multimodal protocol integrating somatosensory evoked potentials, electroencephalography and neuroimaging data with anamnestic report and toxicological and laboratory data.
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Affiliation(s)
- Maenia Scarpino
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
- IRCCS Don Carlo Gnocchi Florence Italy
| | - Tiziana Rosso
- UOC Neurologia Distretto di Asolo Azienda ULSS 2 Marca Trevigiana Treviso Italia
| | - Giovanni Lanzo
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Francesco Lolli
- Biomedical Science Department Mario Serio University of Florence Florence Italy
| | - Manuela Bonizzoli
- Traumatic Intensive Care Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Chiara Lazzeri
- Traumatic Intensive Care Unit Neuromuscolar Department AOU Careggi Florence Italy
| | - Guido Mannaioni
- Section of Pharmacology and Toxicology Department of Neuroscience, Psychology, Drug Research and Child Health (NEURORFARBA) University Florence Florence Italy
| | - Roberto Baronti
- Laboratory of Clinical Toxicology and Antidoping Azienda USL Toscana Centro Florence Italy
| | | | - Antonello Grippo
- Neurophysiopathology Unit Neuromuscolar Department AOU Careggi Florence Italy
- IRCCS Don Carlo Gnocchi Florence Italy
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25
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Jacobson K, Martinez J, Larroque S, Jones IW, Paschke T. Nicotine pharmacokinetics of electronic cigarettes: A pooled data analysis from the literature. Toxicol Rep 2021; 8:84-95. [PMID: 33437651 DOI: 10.1016/j.toxrep.2020.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Evaluating the pharmacokinetics of nicotine absorption from electronic cigarettes. Nicotine absorption into the blood is influenced by several factors. These include e-liquid composition, user behavior and device characteristics. Any regulation of nicotine levels in e-liquids should reflect this heterogeneity.
Several regulatory initiatives around the world restrict the amount of nicotine permitted in electronic cigarette liquids in an attempt to reproduce the nicotine delivery of combusted tobacco products, such as cigarettes, and or reduce the risk of consumers absorbing too much nicotine into their body at one time. Such an approach, however, assumes that (i) there is a strong correlation between the levels of nicotine in electronic cigarette liquids and nicotine intake into the body and (ii) that this correlation holds true across the various different types of electronic cigarette devices currently available on the market. In order to test these hypotheses, this study examines the available scientific literature on nicotine intake from electronic cigarettes, as measured by levels in the blood. Analysis of the published data reveals that nicotine absorption into the body is influenced by a combination of many factors, including electronic cigarette liquid composition, user behavior and device characteristics. Notably, it was observed that open-tank (refillable) electronic cigarettes, which often enable users to vary device power, can deliver high nicotine levels to consumers, sometimes at greater doses than a conventional tobacco cigarette, even at the lower nicotine liquid concentrations typically available. For electronic cigarettes to be viable alternative choices to smoking, they should provide consumers with an equally satisfying experience, including in terms of nicotine absorption into the body. Therefore, any regulation seeking to restrict the amount of nicotine in electronic cigarette liquids should take all the factors influencing nicotine intake into account.
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Vardavas CI, Girvalaki C, Odani S, Nikitara K, de Vries I, van Riel A, van Sommeren-de Potter I, Grass JN, Grassi MC, Deim S, Balázs A, Fosztó S, Schiel H, Arif T, Eronen AK, Alonso AA, Menor JLC, Arrieta RM, Babić Ž, Turk R, Vardavas AI, Tsatsakis A. Profile of incidental exposures to e-cigarette liquids in Europe, 2018-2019. Hum Exp Toxicol 2020; 40:1045-1050. [PMID: 33272061 DOI: 10.1177/0960327120975828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Following the implementation of the European Union Tobacco Product Directive (EU TPD) regulations on e-cigarette products in 2016, we assessed the current profile of e-cigarette liquid exposure incidents and their associated health outcomes. METHODS De-identified data were received from poison centers in eight EU Member States (Sweden, the Netherlands, Italy, Hungary Austria, Finland, Spain and Croatia) reporting on e-cigarette liquid exposure incidents between August 2018 to December 2019. Descriptive analysis was conducted to present incident characteristics and health outcomes. Chi-square tests and multivariable logistic regression analysis were used to test associations. RESULTS Of the 223 e-liquid exposure incidents recorded by poison centers in multiple EU MS, 64.7% of the cases were unintentional exposures, ranging from 48.4% among adults aged ≥19 years to 100.0% among children aged 0-5 years (p < 0.05). The most frequent route of exposure was ingestion (73.5%) while55.2% experienced any clinical symptoms, including nausea (16.6%), vomiting (11.1%), and dizziness (9.0%). 57.8% of the cases were treated at the residence or on-site. CONCLUSION Further monitoring is warranted, using uniform reporting requirements, to ensure the continued compliance to the EU TPD and assess its long-term impact on related incident characteristics.
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Affiliation(s)
- Constantine I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Charis Girvalaki
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Satomi Odani
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Katerina Nikitara
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Irma de Vries
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoinette van Riel
- Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Maria Caterina Grassi
- Clinical Toxicology-Poison Control Centre and Drug Dependence Unit, Policlinico Umberto I-"Sapienza University of Rome", Rome, Italy
| | - Szilvia Deim
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Andrea Balázs
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | - Szabolcs Fosztó
- National Public Health Center, Department for Chemical Safety and Competent Authority, Unit for Health Toxicological Information Service and Notification, Hungary
| | | | - Tara Arif
- Poisons Information Centre, Vienna, Austria
| | | | | | | | | | - Željka Babić
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Croatian Poison Control Centre at Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Alexander I Vardavas
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, 37778Medical School, University of Crete, Voutes, Heraklion, Crete, Greece
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27
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Lucas JH, Muthumalage T, Wang Q, Friedman MR, Friedman AE, Rahman I. E-Liquid Containing a Mixture of Coconut, Vanilla, and Cookie Flavors Causes Cellular Senescence and Dysregulated Repair in Pulmonary Fibroblasts: Implications on Premature Aging. Front Physiol 2020; 11:924. [PMID: 33013432 PMCID: PMC7500211 DOI: 10.3389/fphys.2020.00924] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022] Open
Abstract
Electronic cigarette (e-cig) usage has risen dramatically worldwide over the past decade. While they are touted as a safe alternative to cigarettes, recent studies indicate that high levels of nicotine and flavoring chemicals present in e-cigs may still cause adverse health effects. We hypothesized that an e-liquid containing a mixture of tobacco, coconut, vanilla, and cookie flavors would induce senescence and disrupt wound healing processes in pulmonary fibroblasts. To test this hypothesis, we exposed pulmonary fibroblasts (HFL-1) to e-liquid at varying doses and assessed cytotoxicity, inflammation, senescence, and myofibroblast differentiation. We found that e-liquid exposure caused cytotoxicity, which was accompanied by an increase in IL-8 release in the conditioned media. E-liquid exposure resulted in elevated senescence-associated beta-galactosidase (SA-β-gal) activity. Transforming growth factor-β1 (TGF-β1) induced myofibroblast differentiation was inhibited by e-liquid exposure, resulting in decreased α-smooth muscle actin and fibronectin protein levels. Together, our data suggest that an e-liquid containing a mixture of flavors induces inflammation, senescence and dysregulated wound healing responses.
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Affiliation(s)
- Joseph H Lucas
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Thivanka Muthumalage
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Michelle R Friedman
- Department of Chemistry & Biochemistry, The College of Brockport, The State University of New York, New York, NY, United States
| | - Alan E Friedman
- Department of Materials Design and Innovation, School of Engineering and Applied Sciences, University at Buffalo, Buffalo, NY, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States
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28
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Scarpino M, Bonizzoli M, Lanzi C, Lanzo G, Lazzeri C, Cianchi G, Gambassi F, Lolli F, Grippo A. Brain death following ingestion of E-cigarette liquid nicotine refill solution. Brain Behav 2020; 10:e01744. [PMID: 32722878 PMCID: PMC7507521 DOI: 10.1002/brb3.1744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/13/2020] [Accepted: 06/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) is very common worldwide. To date, an increase of nicotine intoxication following an accidental or intentional ingestion/injection of refill solution (e-liquid) has been detected. CASE A 23-year-old man presented with sudden loss of consciousness, bradycardia, and respiratory muscle paralysis after intentional ingestion of e-liquid. Early clinical data, brain computed tomography, and neurophysiological tests (electroencephalogram [EEG] and somatosensory evoked potentials [SEPs]) did not show features with a poor neurological prognostic meaning of an hypoxic encephalopathy. After 4 days, the patient showed bilateral loss of the pupillary reflex, and severe and cytotoxic edema was detected on brain magnetic resonance imaging. SEPs showed a bilateral loss of cortical responses and EEG a suppressed pattern. Nine days after the onset of coma, the patient evolved toward brain death (BD). DISCUSSION Because nicotine intoxication might cause respiratory muscle paralysis, without cardiac arrest (CA), it would be important to understand the mechanisms underlying brain damage and to take into account that the current neurological prognostic evidence for hypoxic-ischemic encephalopathy, based on data from patients who all experienced CA may not be reliable. Reporting cases of nicotine intoxication through e-liquid is relevant in order to improve regulatory parameters for e-liquid sale.
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Affiliation(s)
- Maenia Scarpino
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi, Florence, Italy
| | - Manuela Bonizzoli
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | - Cecilia Lanzi
- Clinical Toxicology, Emergency Department, AOU Careggi, Florence, Italy
| | - Giovanni Lanzo
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy
| | - Chiara Lazzeri
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | - Giovanni Cianchi
- Traumatic Intensive Care Unit, Neuromuscolar Department, AOU Careggi, Florence, Italy
| | | | - Francesco Lolli
- Biomedical Science Department Mario Serio, University of Florence, Florence, Italy
| | - Antonello Grippo
- Neurophysiopathology Unit, Neuromuscular Department, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi, Florence, Italy
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29
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Son Y, Weisel C, Wackowski O, Schwander S, Delnevo C, Meng Q. The Impact of Device Settings, Use Patterns, and Flavorings on Carbonyl Emissions from Electronic Cigarettes. Int J Environ Res Public Health 2020; 17:E5650. [PMID: 32764435 PMCID: PMC7460324 DOI: 10.3390/ijerph17165650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022]
Abstract
Health impacts of electronic cigarette (e-cigarette) vaping are associated with the harmful chemicals emitted from e-cigarettes such as carbonyls. However, the levels of various carbonyl compounds under real-world vaping conditions have been understudied. This study evaluated the levels of carbonyl compounds (e.g., formaldehyde, acetaldehyde, glyoxal, and diacetyl, etc.) under various device settings (i.e., power output), vaping topographies, and e-liquid compositions (i.e., base liquid, flavor types). The results showed that e-vapor carbonyl levels were the highest under higher power outputs. The propylene glycol (PG)-based e-liquids generated higher formaldehyde and acetaldehyde than vegetable glycerin (VG)-based e-liquids. In addition, fruit flavored e-liquids (i.e., strawberry and dragon fruit) generated higher formaldehyde emissions than mint/menthol and creamy/sweet flavored e-liquids. While single-top coils formed 3.5-fold more formaldehyde per puff than conventional cigarette smoking, bottom coils generated 10-10,000 times less formaldehyde per puff. In general, increases in puff volume and longer puff durations generated significantly higher amounts of formaldehyde. While e-cigarettes emitted much lower levels of carbonyl compounds compared to conventional cigarettes, the presence of several toxic carbonyl compounds in e-cigarette vapor may still pose potential health risks for users without smoking history, including youth. Therefore, the public health administrations need to consider the vaping conditions which generated higher carbonyls, such as higher power output with PG e-liquid, when developing e-cigarette product standards.
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Affiliation(s)
- Yeongkwon Son
- Division of Atmospheric Sciences, Desert Research Institute, Reno, NV 89512, USA
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (C.W.); (S.S.); (Q.M.)
| | - Clifford Weisel
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (C.W.); (S.S.); (Q.M.)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
| | - Olivia Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (O.W.); (C.D.)
- Cancer Prevention & Control Research Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Stephan Schwander
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (C.W.); (S.S.); (Q.M.)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (O.W.); (C.D.)
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, NJ 07102, USA
| | - Cristine Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (O.W.); (C.D.)
- Cancer Prevention & Control Research Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Qingyu Meng
- Department of Environmental and Occupational Health, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (C.W.); (S.S.); (Q.M.)
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA
- Center for Tobacco Studies, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA; (O.W.); (C.D.)
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30
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Massey ZB, Li Y, Holli J, Churchill V, Yang B, Henderson K, Ashley DL, Huang J, Popova L. Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos. J Med Internet Res 2020; 22:e17104. [PMID: 32348288 PMCID: PMC7298628 DOI: 10.2196/17104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. OBJECTIVE This study aimed to analyze the content of YouTube videos depicting modifications of ENDS. METHODS YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. RESULTS Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). CONCLUSIONS This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications.
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Affiliation(s)
- Zachary B Massey
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Yachao Li
- Department of Communication Studies and Department of Public Health, The College of New Jersey, Ewing, NJ, United States
| | - Jessica Holli
- Research and Training Institute, John Snow Incorporated, Boston, MA, United States
| | - Victoria Churchill
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Bo Yang
- Department of Communication, University of Arizona, Tuscon, AZ, United States
| | - Katherine Henderson
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, United States
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Abstract
PURPOSE OF REVIEW This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes. RECENT FINDINGS In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States. The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology. SUMMARY Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.
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32
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Obertova N, Navratil T, Zak I, Zakharov S. Acute exposures to e-cigarettes and heat-not-burn products reported to the Czech Toxicological Information Centre over a 7-year period (2012-2018). Basic Clin Pharmacol Toxicol 2020; 127:39-46. [PMID: 32012431 DOI: 10.1111/bcpt.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 11/29/2022]
Abstract
E-cigarettes and heat-not-burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e-cigarettes, e-liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7-year period (2012-2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e-cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e-liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low-to-moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures.
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Affiliation(s)
- Nikola Obertova
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Navratil
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Electrochemistry at the Nanoscale, J. Heyrovsky Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ivan Zak
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergey Zakharov
- Toxicological Information Centre, General University Hospital, Prague, Czech Republic.,Department of Occupational Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
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33
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Baran W, Madej-Knysak D, Sobczak A, Adamek E. The influence of waste from electronic cigarettes, conventional cigarettes and heat-not-burn tobacco products on microorganisms. J Hazard Mater 2020; 385:121591. [PMID: 31727528 DOI: 10.1016/j.jhazmat.2019.121591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/23/2019] [Accepted: 10/31/2019] [Indexed: 05/11/2023]
Abstract
Tobacco smoking, especially conventional cigarettes, is widespread throughout the world. Simultaneously, there is a growing interest in new alternative products that allow delivering nicotine to the users' organisms, including electronic cigarettes and heat-not-burn tobacco products. However, there are few scientific reports regarding the effect of waste generated from the above-mentioned products on microorganisms. The aim of the manuscript was to investigate the influence of substances leached from conventional cigarette butts, butts from heat-not-burn tobacco products, cartridges and e-liquids for electronic cigarettes on microorganisms. The commercial multispecies MARA (microbial assay for risk assessment) test and non-selected microorganisms from the Brynica River (Poland), as well as an effluent from the wastewater treatment plant (Sosnowiec-Zagórze, Poland), were used in the ecotoxicity assessment of the investigated waste. The results of the experiments revealed that the waste from electronic cigarettes, i.e. cartridges and e-liquids, does not pose a considerable threat to the microbiocenosis. On the other hand, a particularly strong ecotoxic effect on the investigated microorganisms has been reported for leachate from smoked cigarette butts and butts from heat-not-burn tobacco products. Their high ecotoxicity combined with a high supply is worrying and it can require interventions to protect the aquatic environment. The retention of the waste can have an adverse effect on microorganisms in reservoirs surface waters or a sludge activity in wastewater treatment plants.
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Affiliation(s)
- Wojciech Baran
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Jagiellońska 4, 41-200 Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Daria Madej-Knysak
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Jagiellońska 4, 41-200 Sosnowiec, Medical University of Silesia, Katowice, Poland.
| | - Andrzej Sobczak
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Jagiellońska 4, 41-200 Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Ewa Adamek
- Department of General and Analytical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Jagiellońska 4, 41-200 Sosnowiec, Medical University of Silesia, Katowice, Poland
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34
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Merecz-Sadowska A, Sitarek P, Zielinska-Blizniewska H, Malinowska K, Zajdel K, Zakonnik L, Zajdel R. A Summary of In Vitro and In Vivo Studies Evaluating the Impact of E-Cigarette Exposure on Living Organisms and the Environment. Int J Mol Sci 2020; 21:ijms21020652. [PMID: 31963832 PMCID: PMC7013895 DOI: 10.3390/ijms21020652] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/03/2020] [Accepted: 01/15/2020] [Indexed: 12/11/2022] Open
Abstract
Worldwide use of electronic cigarettes has been rapidly expanding over recent years, but the long-term effect of e-cigarette vapor exposure on human health and environment is not well established; however, its mechanism of action entails the production of reactive oxygen species and trace metals, and the exacerbation of inflammation, which are associated with potential cytotoxicity and genotoxicity. The present study examines the effects of selected liquid chemicals used in e-cigarettes, such as propylene glycol/vegetable glycerin, nicotine and flavorings, on living organisms; the data collected indicates that exposure to e-cigarette liquid has potentially detrimental effects on cells in vitro, and on animals and humans in vivo. While e-liquid exposure can adversely influence the physiology of living organisms, vaping is recommended as an alternative for tobacco smoking. The study also compares the impact of e-cigarette liquid exposure and traditional cigarette smoke on organisms and the environmental impact. The environmental influence of e-cigarette use is closely connected with the emission of airborne particulate matter, suggesting the possibility of passive smoking. The obtained data provides an insight into the impact of nicotine delivery systems on living organisms and the environment.
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Affiliation(s)
- Anna Merecz-Sadowska
- Department of Economic Informatics, University of Lodz, 90-214 Lodz, Poland; (K.M.); (L.Z.); (R.Z.)
- Correspondence: ; Tel.: +48-663-626-667
| | - Przemyslaw Sitarek
- Department of Biology and Pharmaceutical Botany, Medical University of Lodz, 90-151 Lodz, Poland;
| | | | - Katarzyna Malinowska
- Department of Economic Informatics, University of Lodz, 90-214 Lodz, Poland; (K.M.); (L.Z.); (R.Z.)
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725 Lodz, Poland;
| | - Karolina Zajdel
- Department of Medical Informatics and Statistics, Medical University of Lodz, 90-645 Lodz, Poland;
| | - Lukasz Zakonnik
- Department of Economic Informatics, University of Lodz, 90-214 Lodz, Poland; (K.M.); (L.Z.); (R.Z.)
| | - Radoslaw Zajdel
- Department of Economic Informatics, University of Lodz, 90-214 Lodz, Poland; (K.M.); (L.Z.); (R.Z.)
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35
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Gray N, Halstead M, Gonzalez-Jimenez N, Valentin-Blasini L, Watson C, Pappas RS. Analysis of Toxic Metals in Liquid from Electronic Cigarettes. Int J Environ Res Public Health 2019; 16:E4450. [PMID: 31766137 DOI: 10.3390/ijerph16224450] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 01/01/2023]
Abstract
As the technology of electronic nicotine delivery systems (ENDS), including e-cigarettes, evolves, assessing metal concentrations in liquids among brands over time becomes challenging. A method for quantification of chromium, nickel, copper, zinc, cadmium, tin, and lead in ENDS liquids using triple quadrupole inductively coupled plasma mass spectrometry was developed. The method’s limits of detection (LODs) were 0.031, 0.032, 3.15, 1.27, 0.108, 0.099, 0.066 µg/g for Cr, Ni, Cu, Zn, Cd, Sn, and Pb respectively. Liquids analyzed were from different brands and flavors of refill bottles or single-use, rechargeable, and pod devices from different years. Scanning electron microscopy with energy dispersive spectroscopy further evaluated the device components’ compositions. Refill liquids before contacting a device were below lowest reportable levels (LRL) for all metals. Copper and zinc were elevated in liquids from devices containing brass. Cadmium was <LRL in all liquids and was not observed in device components. Cr, Ni, Cu, Zn, Sn, and Pb, reported in µg/g, ranged from <LRL to 0.396, 4.04, 903, 454, 0.898, and 13.5 respectively. Elevated metal concentrations in the liquid were also elevated in aerosol from the corresponding device. The data demonstrates the impact of device design and materials on toxic metals in ENDS liquid.
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Truman P, Stanfill S, Heydari A, Silver E, Fowles J. Monoamine oxidase inhibitory activity of flavoured e-cigarette liquids. Neurotoxicology 2019; 75:123-128. [PMID: 31536738 DOI: 10.1016/j.neuro.2019.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Monoamine oxidase inhibitors have been hypothesised to be important in tobacco dependence, reinforcing the brain's response to nicotine by delaying the degradation of neurotransmitters by monoamine oxidases. The development of electronic cigarettes has provided an alternative nicotine delivery system, which is widely viewed as less toxic than tobacco smoke. However, significant data gaps remain. This paper reports the results of measurements of monoamine oxidase inhibitory activity in a small sample of commercially available, flavoured e-liquids. METHODS Twelve e-liquids were tested for monoamine oxidase inhibitory activity, using the kynuramine assay and monoamine oxidase enzymes (human, recombinant). Control samples of carrier liquids, propylene glycol and glycerol, and nicotine were also tested. RESULTS Four e-liquids contained high levels of inhibitory activity, four more were moderately inhibitory. The remaining four e-liquids were mildly inhibitory, while the carrier liquids, and nicotine were inactive at relevant concentrations. The active compounds in the e-liquids were subsequently identified as vanillin and ethyl vanillin. Under some conditions of use, the sampled e-liquids with the highest concentrations of monoamine oxidase inhibitory activity have the potential to expose consumers to physiologically significant levels of MAO inhibitory activity. CONCLUSIONS While only a small sample of e-liquids was tested, the findings suggest that some flavours have pharmacological actions, with potential to enhance the response to nicotine or to other drugs. The public health implications of these preliminary findings on addiction and smoking cessation warrant exploration and further research.
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Affiliation(s)
- Penelope Truman
- School of Health Sciences, Massey University Wellington, New Zealand.
| | - Stephen Stanfill
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ali Heydari
- School of Health Sciences, Massey University Wellington, New Zealand
| | | | - Jefferson Fowles
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
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Maessen GC, Wijnhoven AM, Neijzen RL, Paulus MC, van Heel DAM, Bomers BHA, Boersma LE, Konya B, van der Heyden MAG. Nicotine intoxication by e-cigarette liquids: a study of case reports and pathophysiology. Clin Toxicol (Phila) 2019; 58:1-8. [PMID: 31286797 DOI: 10.1080/15563650.2019.1636994] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Electronic cigarettes (e-cigarettes), the smokeless alternative to conventional tobacco cigarettes, have become increasingly popular. E-cigarettes vaporise e-liquid, a solution of highly concentrated nicotine, propylene glycol (PG) and vegetable glycerine (VG). With the popularity of e-cigarettes, e-liquid refills have become easily accessible and several cases of intoxication due to the ingestion of e-liquid have been reported. We provide an overview of these cases, their pathophysiology and patients' characteristics.Methods: We carried out a retrospective evaluation of the scientific literature reporting on cases of liquid nicotine intoxication, using the following inclusion criteria: (1) the article is or contains a case report, (2) describes an intoxication with e-liquid, (3) the substance contains nicotine, and (4) intake is oral, intravenous or subcutaneous.Results: We found 26 case reports describing a total of 31 patients who suffered from e-liquid intoxication. All intoxications up to the age of six were reported as unintentional, whereas nearly all cases from ages 13 to 53 were due to suicide attempts. The three most prevalent symptoms of e-liquid intoxication were tachycardia, altered mental status and vomiting. Eleven cases resulted in the death of the patient. In the survivors, the highest plasma concentration of nicotine was 800 µg L-1, while the lowest concentration in the non-survivors was 1600 µg L-1.Conclusions: There is a mismatch between the generally accepted lethal oral nicotine dose of 60 mg, resulting in approximately 180 µg L-1 plasma concentration, and the 4.4- to 8.9-fold higher lethal plasma concentrations we found in cases of e-liquid intoxication. In these severe intoxications, plasma cotinine concentration does not act as a more reliable indicator of nicotine intoxication than nicotine itself. The ages of the patients display a bimodal distribution. In patients above the age of 10, intoxication results mainly from suicide attempts rather than accidental ingestion. The role of PG and VG in e-liquid intoxications is remarkably unclear. However, the similarity across nicotine and PG toxicity symptoms leads us to believe a cumulative effect cannot be excluded.
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Affiliation(s)
- Gerdinique C Maessen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anjali M Wijnhoven
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosalie L Neijzen
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michelle C Paulus
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dayna A M van Heel
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart H A Bomers
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucie E Boersma
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Burak Konya
- Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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38
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Lechasseur A, Altmejd S, Turgeon N, Buonanno G, Morawska L, Brunet D, Duchaine C, Morissette MC. Variations in coil temperature/power and e-liquid constituents change size and lung deposition of particles emitted by an electronic cigarette. Physiol Rep 2019; 7:e14093. [PMID: 31140749 PMCID: PMC6540444 DOI: 10.14814/phy2.14093] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
Abstract
Electronic cigarette uses propylene glycol and glycerol to deliver nicotine and flavors to the lungs. Given the hundreds of different brands, the thousands of flavors available and the variations in nicotine concentrations, it is likely that electronic cigarette settings and e-liquid composition affect the size distribution of particles emitted and ultimately pulmonary deposition. We used the inExpose e-cigarette extension to study two separate modes of operation of electronic cigarettes, namely power-controlled and the temperature-controlled. We also assessed several e-liquids based on propylene glycol and glycerol concentrations, nicotine content, and selected monomolecular flavoring agents (menthol, vanillin, and maltol). Particle size distribution was measured using a Condensation Particle Counter and a Scanning Mobility Particle Sizer spectrometer. Lung deposition was predicted using the International Commission on Radiological Protection model. For all resistance coils, increase in power delivery generated larger particles while maintaining a higher coil temperature generated smaller particles. Increase in glycerol concentration led to the generation of larger particles. With regard to flavors, we showed that despite minor effect of menthol and maltol, vanillin dramatically increased particle size. Presence of nicotine also increased particle size. Finally, particles emitted by the electronic cigarette were predicted to mainly deposit in the alveoli and conditions generating larger particle sizes led to a reduction in predicted lung deposition. This study shows that coil temperature, propylene glycol and glycerol concentrations, presence of nicotine, and flavors affect the size of particles emitted by an electronic cigarette, directly affecting predicted lung deposition of these particles.
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Affiliation(s)
- Ariane Lechasseur
- Quebec Heart and Lung Institute ‐ Université LavalQuebecQuebecCanada
- Faculty of MedicineUniversité LavalQuebecQuebecCanada
| | - Simon Altmejd
- SCIREQ Scientific Respiratory Equipment Inc.MontrealCanada
| | - Natalie Turgeon
- Quebec Heart and Lung Institute ‐ Université LavalQuebecQuebecCanada
| | - Giorgio Buonanno
- University of Cassino and Southern LazioCassinoItaly
- Queensland University of TechnologyBrisbaneAustralia
| | | | - David Brunet
- SCIREQ Scientific Respiratory Equipment Inc.MontrealCanada
| | - Caroline Duchaine
- Quebec Heart and Lung Institute ‐ Université LavalQuebecQuebecCanada
- Departement of Biochemistry, Microbiology and BioinformaticsUniversité LavalQuebecQuebecCanada
| | - Mathieu C. Morissette
- Quebec Heart and Lung Institute ‐ Université LavalQuebecQuebecCanada
- Department de MedicineUniversité LavalQuebecQuebecCanada
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Azevedo A, Lobo I, Selores M. Allergic contact dermatitis and electronic cigarettes: Is nickel to blame? Contact Dermatitis 2019; 81:135-136. [PMID: 30834540 DOI: 10.1111/cod.13257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Azevedo
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Lobo
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuela Selores
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Faculty of Medicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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40
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Clapp PW, Lavrich KS, van Heusden CA, Lazarowski ER, Carson JL, Jaspers I. Cinnamaldehyde in flavored e-cigarette liquids temporarily suppresses bronchial epithelial cell ciliary motility by dysregulation of mitochondrial function. Am J Physiol Lung Cell Mol Physiol 2019; 316:L470-L486. [PMID: 30604630 DOI: 10.1152/ajplung.00304.2018] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aldehydes in cigarette smoke (CS) impair mitochondrial function and reduce ciliary beat frequency (CBF), leading to diminished mucociliary clearance (MCC). However, the effects of aldehyde e-cigarette flavorings on CBF are unknown. The purpose of this study was to investigate whether cinnamaldehyde, a flavoring agent commonly used in e-cigarettes, disrupts mitochondrial function and impairs CBF on well-differentiated human bronchial epithelial (hBE) cells. To this end, hBE cells were exposed to diluted cinnamon-flavored e-liquids and vaped aerosol and assessed for changes in CBF. hBE cells were subsequently exposed to various concentrations of cinnamaldehyde to establish a dose-response relationship for effects on CBF. Changes in mitochondrial oxidative phosphorylation and glycolysis were evaluated by Seahorse Extracellular Flux Analyzer, and adenine nucleotide levels were quantified by HPLC. Both cinnamaldehyde-containing e-liquid and vaped aerosol rapidly yet transiently suppressed CBF, and exposure to cinnamaldehyde alone recapitulated this effect. Cinnamaldehyde impaired mitochondrial respiration and glycolysis in a dose-dependent manner, and intracellular ATP levels were significantly but temporarily reduced following exposure. Addition of nicotine had no effect on the cinnamaldehyde-induced suppression of CBF or mitochondrial function. These data indicate that cinnamaldehyde rapidly disrupts mitochondrial function, inhibits bioenergetic processes, and reduces ATP levels, which correlates with impaired CBF. Because normal ciliary motility and MCC are essential respiratory defenses, inhalation of cinnamaldehyde may increase the risk of respiratory infections in e-cigarette users.
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Affiliation(s)
- Phillip W Clapp
- Curriculum in Toxicology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.,Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Katelyn S Lavrich
- Curriculum in Toxicology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | | | - Eduardo R Lazarowski
- Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Johnny L Carson
- Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina , Chapel Hill, North Carolina
| | - Ilona Jaspers
- Curriculum in Toxicology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.,Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina , Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina , Chapel Hill, North Carolina
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41
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Affiliation(s)
- Eshen Ang
- School of Medicine, Cardiff University, Cardiff, UK
| | - David Tuthill
- Department of Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - John Thompson
- National Poisons Information Service, Cardiff Unit, University Hospital Llandough, Cardiff, UK
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42
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Holbrook LT, Zeman KL, Burke A, Jaspers I, Bennett WD. Radiolabeling an Electronic Cigarette Aerosol Using Technetium Carbon Ultrafine Particles. J Aerosol Med Pulm Drug Deliv 2018; 32:47-53. [PMID: 30376396 DOI: 10.1089/jamp.2017.1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Electronic cigarettes (ECIGs) are widely used, but their health effects are not well known. ECIG exposure is difficult to quantify, and a direct measurement of deposition would be beneficial to in vivo and in vitro toxicity studies. The aim of this study was to demonstrate effective radiolabeling of an ECIG. METHODS A technetium-99m-labeled carbon ultrafine (TCU) aerosol was generated and introduced to a fourth-generation ECIG before nucleation and aerosol formation. The aerosolized e-liquid was a commercially available strawberry flavor containing 1.2% nicotine in a 55% propylene glycol and 45% vegetable glycerine base. An ECIG power setting of 100 W was selected. Mass and radioactivity were measured on each stage within a Sierra Cascade Impactor at 14 L/min to verify the labeling technique using the calculated aerodynamic diameters. A strong positive correlation (R2 > 0.95) between the percent activity and percent mass deposition on each stage provides a reliable validation of colocation. RESULTS Unlabeled ECIG aerosol from the chosen e-liquid produced a mass median aerodynamic diameter (MMAD) of 0.85 μm. An ECIG labeled with TCU produced an aerosol with an activity median aerodynamic diameter of 0.84 μm and an MMAD of 0.84 μm. The relative mass versus radioactivity on each plate was highly correlated (average R2 = 0.973, p < 0.001). CONCLUSION A TCU radiolabel was generated and shown to associate with the mass of an aerosol produced by a typical commercially available ECIG. Thus, the radioactivity of the deposited aerosol may be used to determine ECIG aerosol deposition for the future in vivo and in vitro dosimetry studies of the third- and fourth-generation ECIGs.
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Affiliation(s)
- Landon T Holbrook
- 1 Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kirby L Zeman
- 1 Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alyssa Burke
- 1 Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ilona Jaspers
- 1 Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,2 School of Medicine, Department of Pediatrics and Curriculum in Toxicology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William D Bennett
- 1 Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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43
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Li Q, Wang C, Liu R, Wang L, Zeng DD, Leischow SJ. Understanding Users' Vaping Experiences from Social Media: Initial Study Using Sentiment Opinion Summarization Techniques. J Med Internet Res 2018; 20:e252. [PMID: 30111530 PMCID: PMC6115599 DOI: 10.2196/jmir.9373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/21/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background E-liquid is one of the main components in electronic nicotine delivery systems (ENDS). ENDS review comments could serve as an early warning on use patterns and even function to serve as an indicator of problems or adverse events pertaining to the use of specific e-liquids—much like types of responses tracked by the Food and Drug Administration (FDA) regarding medications. Objective This study aimed to understand users’ “vaping” experience using sentiment opinion summarization techniques, which can help characterize how consumers think about specific e-liquids and their characteristics (eg, flavor, throat hit, and vapor production). Methods We collected e-liquid reviews on JuiceDB from June 27, 2013 to December 31, 2017 using its public application programming interface. The dataset contains 27,070 reviews for 8058 e-liquid products. Each review is accompanied by an overall rating and a set of 4 aspect ratings of an e-liquid, each on a scale of 1-5: flavor accuracy, throat hit, value, and cloud production. An iterative dichotomiser 3 (ID3)-based influential aspect analysis model was adopted to learn the key elements that impact e-liquid use. Then, fine-grained sentiment analysis was employed to mine opinions on various aspects of vaping experience related to e-liquids. Results We found that flavor accuracy and value were the two most important aspects that affected users’ sentiments toward e-liquids. Of reviews in JuiceDB, 67.83% (18,362/27,070) were positive, while 12.67% (3430/27,070) were negative. This indicates that users generally hold positive attitudes toward e-liquids. Among the 9 flavors, fruity and sweet were the two most popular. Great and sweet tastes, reasonable value, and strong throat hit made users satisfied with fruity and sweet flavors, whereas “strange” tastes made users dislike those flavors. Meanwhile, users complained about some e-liquids’ steep or expensive prices, bad quality, and harsh throat hit. There were 2342 fruity e-liquids and 2049 sweet e-liquids. There were 55.81% (1307/2342) and 59.83% (1226/2049) positive sentiments and 13.62% (319/2342) and 12.88% (264/2049) negative sentiments toward fruity e-liquids and sweet e-liquids, respectively. Great flavors and good vapors contributed to positive reviews of fruity and sweet products. However, bad tastes such as “sour” or “bitter” resulted in negative reviews. These findings can help businesses and policy makers to further improve product quality and formulate effective policy. Conclusions This study provides an effective mechanism for analyzing users’ ENDS vaping experience based on sentiment opinion summarization techniques. Sentiment opinions on aspect and products can be found using our method, which is of great importance to monitor e-liquid products and improve work efficiency.
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Affiliation(s)
- Qiudan Li
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Can Wang
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ruoran Liu
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lei Wang
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Department of Management Information Systems, Eller College of Management, The University of Arizona, Tucson, AZ, United States
| | - Scott James Leischow
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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44
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Zhang H, Pang Y, Luo Y, Li X, Chen H, Han S, Jiang X, Zhu F, Hou H, Hu Q. Enantiomeric composition of nicotine in tobacco leaf, cigarette, smokeless tobacco, and e-liquid by normal phase high-performance liquid chromatography. Chirality 2018; 30:923-931. [PMID: 29722457 DOI: 10.1002/chir.22866] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/26/2018] [Accepted: 03/26/2018] [Indexed: 11/10/2022]
Abstract
Evaluating the source of nicotine in e-liquid is a problem. Tobacco-derived nicotine contains predominantly (S)-(-)-nicotine, whereas tobacco-free nicotine products may not. Thus, we developed a new normal phase high-performance liquid chromatography method to determinate the enantiomeric composition of nicotine in 10 kinds of flue-cured tobacco, 3 kinds of burley, 1 kind of cigar tobacco, 2 kinds of oriental tobacco, 5 kinds of Virginia cigarette, 5 kinds of blend cigarette, 10 kinds of e-liquid, and 4 kinds of smokeless tobacco. The amount of (R)-(+)-nicotine ranged from ~0.02% to ~0.76% of total nicotine. An e-liquid sample had the highest level of (R)-(+)-nicotine. The extraction and purification processes used to obtain commercial (S)-(-)-nicotine from the tobacco do not decrease the amount of (R)-(+)-nicotine in tobacco. So the amount of (R)-(+)-nicotine in samples in our work were the same as tobacco samples.
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Affiliation(s)
- Hongfei Zhang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Yongqiang Pang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Yanbo Luo
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Xiangyu Li
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Huan Chen
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Shulei Han
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Xingyi Jiang
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Fengpeng Zhu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Hongwei Hou
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
| | - Qingyuan Hu
- China National Tobacco Quality Supervision and Test Center, Zhengzhou, China
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Abstract
OBJECTIVES Using the triangle test, this study explores whether established vapers can distinguish small differences between e-liquid propylene glycol: vegetable glycerin (PG:VG) ratios at fixed levels of nicotine and flavor, in order to examine the extent to which solvent ratios affects sensory experiences. METHODS Watermelon flavored e-liquids (16mg/mL nicotine) used for this study differed in the ratio of PG:VG (30:70, 50:50; 70:30). Current vapers were randomized to one of 3 possible study conditions differing by PG:VG ratio. Participants sampled products following the triangle test, which presents 3 blinded products, 2 of which are identical. They were asked to identify and rate the 'odd' product. RESULTS Of the 14 participants who completed the study, 34.9% were able to determine the 'odd' product. Ratings on the subjective response scales for the 'odd' product were quite low. Aversion scores differed significantly by correct identification of the 'odd' product (p = .045). CONCLUSIONS Established vapers in this study were unable to consistently distinguish PG:VG ratios, even for relatively large differences, and correct identification inconsistently related to subjective effects ratings. These preliminary findings suggest that the PG:VG ratio may not be a salient feature of vaping.
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Affiliation(s)
- Liane M Schneller
- Liane M. Schneller, Pre-Doctoral Trainee, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Taylor S. Vanderbush, Laboratory Technician, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Richard J. O'Connor, Professor of Oncology, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Taylor S Vanderbush
- Liane M. Schneller, Pre-Doctoral Trainee, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Taylor S. Vanderbush, Laboratory Technician, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Richard J. O'Connor, Professor of Oncology, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Richard J O'Connor
- Liane M. Schneller, Pre-Doctoral Trainee, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Taylor S. Vanderbush, Laboratory Technician, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Richard J. O'Connor, Professor of Oncology, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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46
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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. Rev Environ 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Electronic cigarettes (ECs) have been growing rapidly in popularity among youth and adults in the United States over the last decade. This increasing prevalence is driven partially by the ability to customize devices, flavors, and nicotine content and the general notion that ECs are harmless, particularly in comparison with conventional cigarettes. In vitro and in vivo murine models have demonstrated a number of harmful biological effects of e-liquids and their aerosols. However, limited clinical data exist on whether these effects translate into detrimental long-term outcomes in human subjects. The short-term harmful respiratory effects of EC use demonstrated in nonsmokers argue against their use. However, slightly more favorable data exist for the respiratory benefits of substituting conventional cigarettes with ECs and the short-term efficacy of ECs as smoking cessation tools. Nonetheless, available research is severely limited in regard to long-term outcomes and by study designs fraught with bias, pointing to the need for additional research efforts with well-designed longitudinal studies to guide US Food and Drug Administration regulatory efforts. The hurdle presented by diverse device designs and e-liquid permutations, which contribute to the inconsistency of available data, also highlights the need for legislative standardization of ECs.
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Affiliation(s)
- Amika K Sood
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Matthew J Kesic
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michelle L Hernandez
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Zainol Abidin N, Abidin EZ, Zulkifli A, Syed Ismail SN, Karuppiah K, Amer Nordin AS, Musbah Z, Zulkipli NF, Praveena SM, Rasdi I, Abd Rahman A. Vaping Topography and Reasons of Use among Adults in Klang Valley, Malaysia. Asian Pac J Cancer Prev 2018; 19:457-462. [PMID: 29480664 PMCID: PMC5980934 DOI: 10.22034/apjcp.2018.19.2.457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Consistency and accuracy of results in assessing health risks due to vaping or e-cigarette use are difficult to achieve without established consumption data. The present report covers baseline data on vaping topography and reasons for use among local users in Klang Valley, Malaysia. Methods: An 80-item survey regarding socio-demographic characteristics, smoking topography and reasons for e-cigarette use was employed to assess e-cigarette users recruited from several public universities and private organisations. The survey questionnaire was self-administered. Data were analysed using statistical software. Results: Eighty-six current e-cigarette users participated with more than half (51.2%) of them aged ≥ 25 years old. Significant proportions of the sample were single (51.2%), had a tertiary education level (63.5%) and a household income of less than USD1000 per month (65.2%). Median duration of e-cigarette use was less than a year; users drew approximately 50 puffs per day and refilled twice a day. The majority (74%) used e-liquids containing nicotine with a concentration of 6 μg/mL. Daily users spent USD18-23 per month. Reasons for using the e-cigarette included enjoyment of the products (85.9%), perception of lower toxicity than tobacco (87%), and the fact that it was a cheaper smoking alternative (61%). Conclusion: The data on e-cigarette smoking topography obtained in this study are novel. The reasons of usage were mainly users’ enjoyment of e-cigarettes, preparation for quitting smoking, perception of low toxicity and a healthier smoking substitute and cheapness in the long run. The results establish basic knowledge for the local vaping topography and reference material for future e-cigarette-related research.
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Affiliation(s)
- Najihah Zainol Abidin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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Eddingsaas N, Pagano T, Cummings C, Rahman I, Robinson R, Hensel E. Qualitative Analysis of E-Liquid Emissions as a Function of Flavor Additives Using Two Aerosol Capture Methods. Int J Environ Res Public Health 2018; 15:ijerph15020323. [PMID: 29438289 PMCID: PMC5858392 DOI: 10.3390/ijerph15020323] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/05/2023]
Abstract
This work investigates emissions sampling methods employed for qualitative identification of compounds in e-liquids and their resultant aerosols to assess what capture methods may be sufficient to identify harmful and potentially harmful constituents present. Three popular e-liquid flavors (cinnamon, mango, vanilla) were analyzed using qualitative gas chromatography-mass spectrometry (GC-MS) in the un-puffed state. Each liquid was also machine-puffed under realistic-use flow rate conditions and emissions were captured using two techniques: filter pads and methanol impingers. GC-MS analysis was conducted on the emissions captured using both techniques from all three e-liquids. The e-liquid GC-MS analysis resulted in positive identification of 13 compounds from the cinnamon flavor e-liquid, 31 from mango, and 19 from vanilla, including a number of compounds observed in all e-liquid experiments. Nineteen compounds were observed in emissions which were not present in the un-puffed e-liquid. Qualitative GC-MS analysis of the emissions samples identify compounds observed in all three samples: e-liquid, impinge, and filter pads, and each subset thereof. A limited number of compounds were observed in emissions captured with impingers, but were not observed in emissions captured using filter pads; a larger number of compounds were observed on emissions collected from the filter pads, but not those captured with impingers. It is demonstrated that sampling methods have different sampling efficiencies and some compounds might be missed using only one method. It is recommended to investigate filter pads, impingers, thermal desorption tubes, and solvent extraction resins to establish robust sampling methods for emissions testing of e-cigarette emissions.
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Affiliation(s)
- Nathan Eddingsaas
- College of Science, Rochester Institute of Technology, Rochester, NY 14623, USA.
| | - Todd Pagano
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623, USA.
| | - Cody Cummings
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623, USA.
| | - Irfan Rahman
- UR Medical Center, University of Rochester, Rochester, NY 14627, USA.
| | - Risa Robinson
- Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA.
| | - Edward Hensel
- Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA.
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DeVito EE, Krishnan-Sarin S. E-cigarettes: Impact of E-Liquid Components and Device Characteristics on Nicotine Exposure. Curr Neuropharmacol 2018; 16:438-459. [PMID: 29046158 PMCID: PMC6018193 DOI: 10.2174/1570159x15666171016164430] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use has increased substantially in recent years. While e-cigarettes have been proposed as a potentially effective smoking cessation tool, dualuse in smokers is common and e-cigarettes are widely used by non-smokers, including youth and young-adult non-smokers. Nicotine, the primary addictive component in cigarettes, is present at varying levels in many e-liquids. E-cigarettes may lead to initiation of nicotine use in adult and youth non-smokers, re-initiation of nicotine dependence in ex-smokers or increased severity of nicotine dependence in dual-users of cigarettes and e-cigarettes. As such, there are important clinical and policy implications to understanding factors impacting nicotine exposure from e-cigarettes. However, the broad and rapidly changing range of e-liquid constituents and e-cigarette hardware which could impact nicotine exposure presents a challenge. Recent changes in regulatory oversight of e-cigarettes underscore the importance of synthesizing current knowledge on common factors which may impact nicotine exposure. METHODS This review focuses on factors which may impact nicotine exposure by changing e-cigarette use behavior, puff topography, altering the nicotine yield (amount of nicotine exiting the e-cigarette mouth piece including nicotine exhaled as vapor) or more directly by altering nicotine absorption and bioavailability. RESULTS Topics reviewed include e-liquid components or characteristics including flavor additives (e.g., menthol), base e-liquid ingredients (propylene glycol, vegetable glycerin), components commonly used to dissolve flavorants (e.g., ethanol), and resulting properties of the e-liquid (e.g., pH), e-cigarette device characteristics (e.g., wattage, temperature, model) and user behavior (e.g., puff topography) which may impact nicotine exposure. CONCLUSION E-liquid characteristics and components, e-cigarette hardware and settings, and user behavior can all contribute substantially to nicotine exposure from e-cigarettes.
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Affiliation(s)
- Elise E. DeVito
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
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