Article

Comparing the cancer potencies of emissions from vapourised nicotine products including e-cigarettes with those of tobacco smoke

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Abstract

Background Quantifying relative harm caused by inhaling the aerosol emissions of vapourised nicotine products compared with smoking combustible tobacco is an important issue for public health. Methods The cancer potencies of various nicotine-delivering aerosols are modelled using published chemical analyses of emissions and their associated inhalation unit risks. Potencies are compared using a conversion procedure for expressing smoke and e-cigarette vapours in common units. Lifetime cancer risks are calculated from potencies using daily consumption estimates. Results The aerosols form a spectrum of cancer potencies spanning five orders of magnitude from uncontaminated air to tobacco smoke. E-cigarette emissions span most of this range with the preponderance of products having potencies<1% of tobacco smoke and falling within two orders of magnitude of a medicinal nicotine inhaler; however, a small minority have much higher potencies. These high-risk results tend to be associated with high levels of carbonyls generated when excessive power is delivered to the atomiser coil. Samples of a prototype heat-not-burn device have lower cancer potencies than tobacco smoke by at least one order of magnitude, but higher potencies than most e-cigarettes. Mean lifetime risks decline in the sequence: combustible cigarettes >> heat-not-burn >> e-cigarettes (normal power)≥nicotine inhaler. Conclusions Optimal combinations of device settings, liquid formulation and vaping behaviour normally result in e-cigarette emissions with much less carcinogenic potency than tobacco smoke, notwithstanding there are circumstances in which the cancer risks of e-cigarette emissions can escalate, sometimes substantially. These circumstances are usually avoidable when the causes are known.

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... As shown in Figure 3, the mass percentages of SVOCs released from e-cigarettes with respect to TVOCs were the highest, followed by those of cigarettes and HTPs. [43]. Ethyl acetate, ethanol, DL-menthol, and benzoic acid are the main additives in e-liquid formulations. ...
... The formaldehyde and acetaldehyde contents in the mainstream aerosols of e-cigarettes measured in this study were 1.13 ± 0.22 × 10 −2 and 5.64 ± 1.09 × 10 −3 µg/mL (converted at 55 mL per puff), which coincide with the results of Stephens et al. (8.07 × 10 −3 and 4.41 × 10 −3 µg/mL) [43]. Ethyl acetate, ethanol, DL-menthol, and benzoic acid are the main additives in e-liquid formulations. ...
... The classical exposure model reported by the USEPA [36] considers all the above exposure factors. Stephens et al. [43] established a new aggregate model to estimate the LCR of combustible tobacco based only on Ci, exposure time (ET), and IR. Considering that the main purpose of smoking is to relieve addiction, nicotine at 41.85 mg/day is the basis for the risk assessment in the classical exposure model. ...
Article
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The differences in aerosol composition between new tobacco types (heated tobacco products and electronic cigarettes) and conventional cigarettes have not been systematically studied. In this study, the emissions of volatile organic compounds (VOCs), carbon monoxide (CO), nicotine, and tar from heated tobacco products (HTPs), electronic cigarettes (e-cigarettes) and conventional cigarettes were compared, and their health risks were evaluated by applying the same smoking regime and a loss mechanism of smoking. Twenty VOCs were identified in aerosols from HTPs, 18 VOCs were identified in aerosols from e-cigarettes, and 97 VOCs were identified in aerosols from cigarettes by GC–MS and HPLC analysis. The concentrations of total VOCs (TVOCs) emitted by the three types of tobacco products decreased as follows: e-cigarettes (795.4 mg/100 puffs) > cigarettes (83.29 mg/100 puffs) > HTPs (15.65 mg/100 puffs). The nicotine content was 24.63 ± 2.25 mg/100 puffs for e-cigarettes, 22.94 ± 0.03 mg/100 puffs for cigarettes, and 8.817 ± 0.500 mg/100 puffs for HTPs. When using cigarettes of the same brand, the mass concentrations of VOCs, tar, and CO emitted by HTPs were approximately 81.2%, 95.9%, and 97.5%, respectively, lower than the amounts emitted by cigarettes. The health risk results demonstrated that the noncarcinogenic risk of the three types of tobacco products decreased as follows: cigarettes (3609.05) > HTPs (2449.70) > acceptable level (1) > e-cigarettes (0.91). The lifetime cancer risk (LCR) decreased as follows: cigarettes (2.99 × 10−4) > HTPs (9.92 × 10−5) > e-cigarettes (4.80 × 10−5) > acceptable level (10−6). In general, HTPs and e-cigarettes were less harmful than cigarettes when the emission of VOCs and CO was considered.
... However, cig-a-likes (39) and e-cigarettes in general (40) were often found to be unsatisfactory. An unpleasant problem is so-called dry wicking, more commonly known as "dry puff", which is caused when the wick in the atomizer is not saturated, leading to the coil be-coming overheated and thermal breakdown of solvents in e-liquid (41)(42)(43)(44)(45)(46)(47). The dry wick effect can occur when the e-liquid runs out and the user puffs deeply or if the voltage on modifiable devices is too high for the heating system. ...
... Aldehyde formation may be influenced by e-liquid ingredients, overheating and dry wicking (41)(42)(43)(44)(45)(46)(47) and e-liquid oxidation through direct contact with the nickel-chromium heater coil (133)(134) are the dominant causes. Improved coil designs and wicking materials that enhance e-liquid flow to the heaters can reduce the risk of these phenomena (135)(136)(137). ...
... Computational risk assessment methodologies have been proposed to compare cancer potencies across tobacco products (47,184). Cancer potency can be calculated from EC chemical emissions data and enable comparisons between products by factoring consumer exposure to different products. ...
Article
While smoking remains a main global cause of preventable morbidity and mortality, a potential inflection point has arrived where it could become possible for non-combustible nicotine products to displace cigarettes and reduce risk for smokers who transition completely from smoking. These have proven consumer satisfaction and are now widely and increasingly available globally. One of the most prominent of these nicotine products are electronic cigarettes (ECs), which are used daily by millions of current and former smokers. The category is not without controversy as these products are not risk free and can cause nicotine dependence. The differing interpretation of science assessing ECs has transpired into inconsistent regulation and product standards, providing an environment for its fragmented manufacturing base which allows for variable product quality and in turn, product quality variability has impacted on how they are viewed. In this review, we assess published scientific evidence to evaluate whether, on balance, ECs fulfil a tobacco harm reduction role by reducing health risks relative to smoking and providing a viable alternative for smokers while having limited appeal to non-smokers.
... The methodology for assessing ECA's biological effects is similar, if not identical, to those used for assessing TS effects [154][155][156][157][158][159][160][161][162]. The most often used technique is collecting the ECA on membranes [158][159][160][161][162]. ...
... Compared to many elements in TS, such as aldehydes, PAHs, AAs, and metals, both the solvents found in E-cig, PG and VG, and the nicotine in E-liquid are significantly less cytotoxic [147,156,157,159,160]. Therefore, it was not surprising to find that ECA extracts are much less cytotoxic than TS extracts towards cultured cardiomyocytes and fibroblasts [158,159,161,162]. ...
Article
The allure of tobacco smoking is linked to the instant gratification provided by inhaled nicotine. Unfortunately, tobacco curing and burning generates many mutagens including more than 70 carcinogens. There are two types of mutagens and carcinogens in tobacco smoke (TS): direct DNA damaging carcinogens and procarcinogens, which require metabolic activation to become DNA damaging. Recent studies provide three new insights on TS-induced DNA damage. First, two major types of TS DNA damage are induced by direct carcinogen aldehydes, cyclic-1,N²-hydroxy-deoxyguanosine (γ-OH-PdG) and α-methyl-1, N²-γ-OH-PdG, rather than by the procarcinogens, polycyclic aromatic amines and aromatic amines. Second, TS reduces DNA repair proteins and activity levels. TS aldehydes also prevent procarcinogen activation. Based on these findings, we propose that aldehydes are major sources of TS induced DNA damage and a driving force for carcinogenesis. E-cigarettes (E-cigs) are designed to deliver nicotine in an aerosol state, without burning tobacco. E-cigarette aerosols (ECAs) contain nicotine, propylene glycol and vegetable glycerin. ECAs induce O⁶-methyl-deoxyguanosines (O⁶-medG) and cyclic γ-hydroxy-1,N²--propano-dG (γ-OH-PdG) in mouse lung, heart and bladder tissues and causes a reduction of DNA repair proteins and activity in lungs. Nicotine and nicotine-derived nitrosamine ketone (NNK) induce the same types of DNA adducts and cause DNA repair inhibition in human cells. After long-term exposure, ECAs induce lung adenocarcinoma and bladder urothelial hyperplasia in mice. We propose that E-cig nicotine can be nitrosated in mouse and human cells becoming nitrosamines, thereby causing two carcinogenic effects, induction of DNA damage and inhibition of DNA repair, and that ECA is carcinogenic in mice. Thus, this article reviews the newest literature on DNA adducts and DNA repair inhibition induced by nicotine and ECAs in mice and cultured human cells, and provides insights into ECA carcinogenicity in mice.
... Data for age group (15)(16)(17)(18)(19) years, 20-29, 30-39, 40-49, 50-59, 60-73), gender (man or woman), education (junior high school or high school, college or university and more), marital status (married, unmarried, and divorced or widowed), combustible-cigarette smoking status (non-smoker or current smoker), HTP using status (non-user or current user), and self-rated health (good or poor) were used as covariates. Married was defined as those who were married at the time of the survey; unmarried as those who had never married, and divorced or widowed. ...
... While HTPs operate differently than electronic cigarettes (e-cigarettes), reported health effects may be similar [15]. The aerosol from e-cigarettes has caused sore throat, cough, patho-physiological cardiovascular effects or airway obstructions [16,17]. ...
Article
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Although secondhand cigarette smoke is known to cause various health consequences, even the short-term effects of exposure to secondhand heated-tobacco-product (HTP) aerosol are unknown. The purpose of this study was to examine short-term symptoms related to secondhand HTP aerosol exposure. An internet-based self-reported questionnaire survey was conducted in 2019 as a part of the Japan Society and New Tobacco Internet Survey (JASTIS) study. In total, 8784 eligible respondents aged 15–73 years were analyzed. We examined the frequency (%) of secondhand combustible cigarette smoke and HTP aerosol exposure, and the exposure-related subjective symptoms (sore throat, cough, asthma attack, chest pain, eye pain, nausea, headache, and other symptoms). Overall, 56.8% of those exposed to secondhand cigarette smoke had any subjective symptoms, compared to 39.5% of those exposed to HTP aerosol. Asthma attack and chest pain were reported more frequently when associated with secondhand HTP exposure (10.9 and 11.8%, respectively) than with secondhand cigarette smoke exposure (8.4 and 9.9%, respectively). Sore throat, cough, eye pain, nausea, and headache were also more frequently reported when associated with secondhand cigarette smoke than with secondhand HTP exposure. This is the first study to examine severe subjective symptoms such as asthma attacks and chest pains, and to suggest that respiratory and cardiovascular abnormalities could be related to secondhand heated-tobacco-product aerosol exposure. Further careful investigations are necessary.
... [132][133][134] Like vaping products, HTPs are inhaled and have similar sensorimotor experiences and "throat-hit" to cigarettes. 132,133 Although appearing to have more toxicants than vaping products, 135 these products may be preferred over vaping products for some smokers. As one financial analyst stated, "Juul appeals to millennials/ hipsters and IQOS appeals to slightly older and more affluent smokers." ...
... However, the health risk of HTPs appears greater than for vaping products. 135,[236][237][238] In addition, IQOS is used along with cigarettes by many smokers in Japan, 151 suggesting that smokers may use HTPs in conjunction with cigarettes instead of as a substitute for cigarettes. Notably, the Altria-Juul Labs deal occurred at the same time as Altria was seeking approval to market IQOS. ...
Article
On December 19, 2018, Altria announced an offer of $12.8 billion for Juul Labs, combining the largest U.S. cigarette manufacturer with the largest U.S. e-cigarette company. This deal is currently being challenged by the Federal Trade Commission (FTC). We consider the antitrust implications. We also consider population health implications, which we argue are essential to a comprehensive analysis of the impact on consumers. Although the FTC antitrust investigation has focused on closed vaping systems, we argue that the relevant market is the broader nicotine delivery product market, which includes all vaping products along with tobacco products. With Altria having a large market share in the key nicotine delivery product submarkets and with important entry barriers, the merger potentially places Altria in a dominant position in the relevant market. In particular, competition in the vaping submarket is reduced, thereby likely to reduce the availability of less harmful alternatives to cigarettes.
... НППВ получили такой статус в соответствии с тем, что содержание в них веществ, образующихся в результате горения табака, на порядок-два меньше, чем содержание веществ в дыме ОС [8][9][10]. Подчеркнем, что в качестве НППВ мы не рассматриваем вейпинг, который, по данным последних лет, может вызывать состояние, получившее название «повреждение легких, связанное с употреблением электронных сигарет» (от англ. ...
Article
Research objective: Quantitative estimation of social-demographic and social-economic impact of the switch of traditional cigarettes smoking to modified risk tobacco products consumption, based on effect upon smoking-related mortality and diseases rates. Methods. Target group – consumers of smoking tobacco: conventional cigarettes (CC) and modified risk tobacco products (MRTP). Base of calculations – analysis of available time series for: CC and MRTP consumption, life expectancy and healthy life expectancy coefficients, statistics on smoking-related mortality and diseases rates, including data on key nosologies (malignant neoplasms of respiratory system, digestive organs, urinary tract; chronic obstructive pulmonary disease; circulatory diseases; cerebrovascular diseases. Results. We implemented prognoses for all the above mentioned parameters to year 2035, calculated direct medical and indirect costs for demographic and economic loss with attention to budget impact analysis, developed five scenarios based on different CC and MRTP consumption. The model of switching from CC to MRTP consumption proves a significant decline of demographic and economic burden even with rather modest MRTP replacement for CC. With current practices of switching from CC to MRTP remaining, during 2021–2035 summary impact would result in 3.6 mln of years saved, 7.7 mln of healthy years saved, 120 thous. of mortal cases and 345 thous. diseases cases prevented. The economic burden would be 3.3 trillion rubles lower. Conclusion. Smoking cessation is the optimal method to reduce health risks, and state policy for stimulation of smoking quitting is necessary. Along with that, transition from CC to MRTP may be an alternative way to reduce health risks for those smokers with long smoking history and either psychological or physiological causes who cannot quit smoking. Even small in the terms of percent transition from CC to MRTP may result in significant decrease of demographic and economic burden on the national scale.
... NVP use is often estimated at 5% to 15% of the excess mortality risks of cigarettes [6,[40][41][42][43][44]78], although there is considerable controversy on the precise level of the difference [44,79,80]. HTPs are likely more harmful than NVPs, with some estimates ranging from 1.5 to 2 times more harmful than NVPs [43,61,65,[81][82][83], implying HTP risks at about 7.5% to 30% of the excess mortality risks of cigarettes. Due to difficulties in identifying regular patterns of multi-product use [84], we do not distinguish dual (with either NVPs or HTPs) from exclusive cigarette use and assume the same health risks for dual-use and exclusive smoking. ...
Article
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Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
... anhydrolinalool oxide) 12,35 . Similarly, genotoxic compounds, including formaldehyde, acetaldehyde, and acrolein, via dehydration and oxidation of the humectants, propylene glycol and glycerin are generated by heating HTPs device 36,37 . ...
Article
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Introduction Heated tobacco products (HTPs) appear to be less harmful to health than conventional cigarettes (CCs). However, limited analytical data are available to support this claim. This study aimed to compare the cytotoxic, genotoxic, and toxicogenomic effects of HTPs and CCs in carcinogenesis via multistep gene mutations in the oral mucosal cells. Methods Cigarette smoke extract (CSE) was obtained from HTPs and CCs. Primary human oral keratinocytes (HOKs) were treated with 5% and 20% CSE from HTPs and CCs. Cell survival rate assays were performed after 6, 12, and 24 h. After 6 h, DNA double-strand breaks (DSBs) were evaluated using anti-γH2AX antibodies with immunohistochemistry. mRNAs expressions of mediator of DNA damage checkpoint 1 (MDC1) and ataxia telangiectasia and Rad3-related protein (ATR), were analyzed. Expressions of miR-22 and miR-185 were analyzed because miR- 22 targets MDC1 and miR-185, ATR. Results The HOKs had equivalent survival rates after exposure to the same concentrations of CSE from CCs and HTPs. HTPs increased foci formation of γH2AX in HOKs, as did CCs (without CSE vs 20% HTP, p
... levels than the burning of tobacco [4,9]. However, EVP aerosols may contain some chemicals like carbonyls, volatile organic constituents, and metals [5,10]. The inhaled EVP constituents are delivered to the user's mouth, throat, and lungs during use and may be released into the environment during exhalation. ...
Article
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Potential secondhand exposure of exhaled constituents from e-vapor product (EVP) use is a public health concern. We present a computational modeling method to predict air levels of exhaled constituents from EVP use. We measured select constituent levels in exhaled breath from adult e-vapor product users, then used a validated computational model to predict constituent levels under three scenarios (car, office, and restaurant) to estimate likely secondhand exposure to non-users. The model was based on physical/thermodynamic interactions between air, vapor, and particulate phase of the aerosol. Input variables included space setting, ventilation rate, total aerosol amount exhaled, and aerosol composition. Exhaled breath samples were analyzed after the use of four different e-liquids in a cartridge-based EVP. Nicotine, propylene glycol, glycerin, menthol, formaldehyde, acetaldehyde, and acrolein levels were measured and reported based on a linear mixed model for analysis of covariance. The ranges of nicotine, propylene glycol, glycerin, and formaldehyde in exhaled breath were 89.44–195.70 µg, 1199.7–3354.5 µg, 5366.8–6484.7 µg, and 0.25–0.34 µg, respectively. Acetaldehyde and acrolein were below detectable limits; thus, no estimated exposure to non-EVP users is reported. The model predicted that nicotine and formaldehyde exposure to non-users was substantially lower during EVPs use compared to cigarettes. The model also predicted that exposure to propylene glycol, glycerin, nicotine and formaldehyde among non-users was below permissible exposure limits.
... However, vaping causes less serious side effects namely, nausea, vomiting, mouth and throat inflammation, and coughing (Damle, 2015). In developing cancer risks from the emitted vapour, the vaping behaviour, e-juice contents, and device settings determine how great the risks can be to the user (Stephens, 2017). Vaping also give harmful effects to bystanders whereby they may get irritated eyes and upper respiratory tract, and experience nicotine effects like escalated heart rate and high systolic blood pressure (Visser at al., 2019). ...
Article
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Background: Healthcare professionals have a prominent role to play in addressing the tobacco epidemic and the rapid increase of e-cigarette use in the population. The growing interest of electronic cigarettes has led to a broad debate whether e-cigarettes can be used as a harm reduction tool towards smoking. Objectives: This study aims to explore the knowledge, attitude, and perceived harm of vaping behaviour among medical and dental undergraduate students in UiTM. Methods: A questionnaire-based survey was administered using Google Form to all participants. Demographics and data from four domains of knowledge, attitude towards vaping behaviour, mass media exposure of e-cigarettes and perception of health-related risks of vaping were collected. Results: Data were obtained from 309 undergraduates with a mean age of 20.6 (SD ± 1.60). The majority of them have never smoked (96.1%) or used e-cigarettes (99.0%). Nine in 10 believe they play a role in their patient’s smoking cessation therapy in the future (91.3%). Slightly more than half (62.1%) have poor knowledge of e-cigarette, less favourable attitude towards vaping (50.8%) and perceived e-cigarettes to be less harmful (56.0%). The majority of them also claimed high exposure towards e-cigarette marketing from the mass media (85.1%). Conclusion: UiTM medical and dental undergraduates have less favourable attitudes towards e-cigarettes but lacked knowledge on the issue. They also perceived the e-cigarettes to be less harmful to health compared to conventional cigarettes. This points out the urgent need to further educate health professionals and also to provide clear guidelines at every level to regulate vaping behaviour among the population.
... To evaluate the health impact of novel TRPs as compared with conventional cigarettes, it is important to study the total chemical burden in the emissions of new tobacco and related products, rather than focusing on isolated components [11]. Previously, Slob et al. developed and published a model that allowed us to make an assessment of the expected change in cumulative exposure (CCE) based on eight compounds found in the emissions of conventional cigarettes and HTPs [12]. ...
Article
Full-text available
Many novel tobacco products have been developed in recent years. Although many may emit lower levels of several toxicants, their risk in the long term remains unclear. We previously published a method for the exposure assessment of mixtures that can be used to compare the changes in cumulative exposure to carcinogens among tobacco products. While further developing this method by including more carcinogens or to explore its application to non-cancer endpoints, we encountered a lack of data that are required for better-substantiated conclusions regarding differences in exposure between products. In this special communication, we argue the case for more data on adverse health effects, as well as more data on the composition of the emissions from tobacco products. Such information can be used to identify significant changes in relevance to health using the cumulative exposure method with different products and to substantiate regulatory decisions.
... Such approaches have been applied for components with related structures such as polycyclic aromatic hydrocarbons, dioxines and cholinesterase inhibitors (organophosphates and carbamates) [29][30][31][32]. In addition, studies have been conducted to estimate the carcinogenic potency of a tobacco product as a whole and relative to a (reference) tobacco cigarette [3,33]. In this approach, data from carcinogenicity studies are used to determine the carcinogenic potency of every component by using a modelled linear relation between exposure level and the number of tumours induced. ...
Article
Full-text available
Health risk assessment of tobacco and related products (TRPs) is highly challenging due to the variety in products, even within the product class, the complex mixture of components in the emission and the variety of user behaviour. In this paper, we summarize methods that can be used to assess the health risks associated with the use of TRPs. The choice of methods to be used and the data needed are dependent on the aim. Risk assessment can be used to identify the emission components of highest health concern. Alternatively, risk assessment methods can be used to determine the absolute risk of a TRP, which is the health risk of a product, not related to other products, or to determine the relative risk of a TRP, which is the health risk of a TRP compared to, for example, a cigarette. Generally, health risk assessment can be based on the effects of the complete mixture (whole smoke) or based on the (added) effects of individual components. Data requirements are dependent on the method used, but most methods require substantial data on identity and quantity of components in emissions and on the hazards of these components. Especially for hazards, only limited data are available. Currently, due to a lack of suitable data, quantitative risk assessment methods cannot be used to inform regulation.
... These products raise concerns about their safety. 3,[5][6][7] In fact, although HTPs produce lower levels of some carcinogens and toxic chemicals compared to conventional cigarettes, they are not riskfree. 5,8,9 Moreover, they produce new substances not generated by conventional cigarettes, 7 having uncertain impact on health. ...
Article
Background: Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective was to analyze the prevalence and associations of use of HTP across 11 countries in Europe. Methods: Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects. Results: Overall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio [aOR] 1.47; 95% confidence interval [CI], 1.11-1.95). Ever HTP use was inversely related to age (P for trend <0.001) and more frequent in ex-smokers (compared with never smokers, aOR 4.32; 95% CI, 2.69-6.95) and current smokers (aOR 8.35; 95% CI, 5.67-12.28), and in electronic cigarette past users (compared with never users, aOR 5.48; 95% CI, 3.46-8.68) and current users (aOR 5.92; 95% CI, 3.73-9.40). Conclusions: In 2017-2018, HTP use was still limited in Europe among the general population; however, the dual use of these products, their high use among younger generations, and the interest of non-smokers in these products are worrying and indicate the need for close monitoring in terms of prevalence and the characteristics of users.
... Ces données suggèrent qu'une exposition passive aux émissions d'iQOS pourrait poser un problème sanitaire, comme pour la cigarette (Tabuchi et al., 2018). En utilisant les données disponibles en termes d'émissions de substances toxiques et cancérogènes, une étude indépendante a estimé que le risque de cancer associé à la consommation de tabac chauffé était réduit comparé à celui associé au tabagisme.Cependant, le risque associé au vapotage a été évalué encore plus faible(Stephens, 2018).Adriaens et al. ont mesuré une augmentation du monoxyde de carbone exhalé beaucoup moins importante chez les consommateurs d'iQOS que chez les fumeurs ; aucune augmentation n'a été détectée chez les vapoteurs. Les auteurs rapportent cependant qu'en terme de « satisfaction », les utilisateurs préfèrent l'iQOS à l'e-cig (Adriaens et al., ...
Thesis
Le tabagisme est responsable de 8 millions de morts par an dans le monde. Le sevrage tabagique est actuellement la seule solution pour endiguer cette mortalité mais il est rendu difficile du fait de l’addiction à la nicotine. Depuis quelques années, de nouveaux dispositifs de délivrance de nicotine sont arrivés sur le marché : la cigarette électronique (e-cig) et le tabac chauffé. ien qu’ils soient généralement perçus comme des alternatives plus saines à la cigarette, leur impact précis sur la santé humaine reste à déterminer.Le premier objectif de cette thèse était d’analyser la composition chimique et la toxicité in vitro des émissions d’e-cig de différentes puissances (un modèle de deuxième génération et un modèle de troisième génération (Modbox) réglé à une puissance faible, Mb18W, ou forte, Mb30W) et du tabac chauffé et de les comparer à la fumée de cigarette. Nous avons pu montrer que le tabac chauffé génère beaucoup moins de composés carbonylés et de HAP que la cigarette, mais bien plus que l’e-cig, quel que soit le modèle. e manière concordante, l’exposition de cellules épithéliales bronchiques humaines (BEAS-2 ) cultivées à l’interface air-liquide aux émissions des différents dispositifs a permis de mettre en évidence que les émissions de tabac chauffé induisent une cytotoxicité réduite par rapport à la fumée de cigarette, mais bien plus élevée que les émissions d’e-cig. De plus, des expositions à 12 bouffées de tabac chauffé ou à 120 bouffées d’e-cig induisent un stress oxydant et la sécrétion de certaines cytokines pro-inflammatoires. Des effets similaires sont observés pour la fumée de cigarette mais seulement après 1 bouffée. e manière intéressante, en ce qui concerne l’e-cig, nous avons pu démontrer que la quantité de composés carbonylés émis et le stress oxydant augmentent avec la puissance du dispositif.Le deuxième objectif de mon projet doctoral consistait à évaluer sur un modèle murin la toxicité respiratoire sur le long terme des émissions d’e-cig de troisième génération. Des souris BALB/c ont été exposées exclusivement par voie nasale pendant 4 jours, 3 mois ou 6 mois aux aérosols de Mb18W ou de Mb30W, ou à la fumée de cigarette. Nos expérimentations in vivo ont montré que, d’une part, les émissions d’e-cig générées à 18 W et 30 W sont responsables de modifications épigénétiques induisant sur le long terme une hyper méthylation de l’ N et la dérégulation de certains mi RN à tous les temps d’exposition, mais que, d’autre part, seules celles générées à 30 W sont capables de provoquer des lésions oxydatives de l’ N, sans pour autant aboutir à des aberrations chromosomiques ou des mutations géniques. Les données transcriptomiques obtenues après 6 mois d’exposition aux aérosols d’e-cig ont mis en évidence la dérégulation de plusieurs voies de signalisation impliquées notamment dans la réponse inflammatoire, le stress oxydant et le métabolisme de composés carbonylés et, en particulier, des métabolites du propylène glycol. Cependant, le faible nombre de gènes impactés dans chacune de ces voies ne garantit pas que les dérégulations observées aient un réel impact biologique. Par comparaison, la fumée de cigarette a induit, dans les mêmes conditions d’exposition, la dérégulation d’un nombre plus important de voies de signalisation, notamment en lien avec l’inflammation et le métabolisme des H P, et impliquant chacune un nombre de gènes plus conséquent.Globalement, nos analyses chimiques et in vitro suggèrent que les émissions de tabac chauffé sont moins toxiques que la fumée de cigarette conventionnelle mais bien plus nocives que celles des e-cig, quelle que soit leur puissance. Par ailleurs, les expérimentations in vivo décrites dans ce travail n’ont pas permis de mettre en évidence une toxicité avérée des émissions d’e-cig sur le long terme [...]
... It should be noted that cigarette smoke not only affects the cardiovascular system but also has other negative effects on health, and e-cigarette aerosols contain much lower amounts of harmful and potentially harmful substances than cigarette smoke [20,32,65]. Thus, a complete switch from tobacco cigarettes to e-cigarettes is widely acknowledged to reduce the exposure to many carcinogens and other toxicologically relevant compounds [21,66]. ...
Article
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Background: The widespread use of the JUUL™ device ignited a discussion about the effects these products have on harm reduction. Therefore, we conducted a study directly comparing the JUUL™ device with a cigarette, a heated tobacco product, and a nicotine-free e-cigarette to examine the acute effects on arterial stiffness. Methods: This crossover-designed study examines 20 occasional smokers (age 25.2 ± 2.5 years). Study participants used each of the four smoking devices for a duration of 5 min following a protocol. Peripheral blood pressure and parameters of arterial stiffness and endothelial vasodilator function such as the reactive hyperemia index and the augmentation index were measured using the EndoPAT™2000 before and after. Results: In addition to significant peripheral hemodynamic changes after 5 and 10 min (p < 0.05), the reactive hyperemia index showed a significant decrease for all devices 15 min after consumption and remained significantly decreased after 60 min (p < 0.01). The augmentation index adjusted for a heart rate of 75 bpm increased significantly for all devices 15 and 60 min after consumption (p < 0.01). Conclusions: In conclusion, the increases in blood pressure and arterial stiffness are similar after smoking, JUUL™ing, heating, and vaping. These changes may be associated with an increase in cardiovascular risks; however, an evaluation of the long-term effects of JUUL™ing, vaping and heating is needed.
... It should be noted that cigarette smoke not only affects the cardiovascular system but also has other negative effects on health, and e-cigarette aerosols contain much lower amounts of harmful and potentially harmful substances than cigarette smoke 10,25,51 . Thus, a complete switch from tobacco cigarettes to e-cigarettes is widely acknowledged to reduce the exposure to many carcinogens and other toxicologically relevant compounds 11,52 . ...
Article
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Introduction: The rapid growth in the e-cigarette market after the launch of JUUL e-cigarettes led to much discussion on the potential benefits and risks of pods, JUUL devices, and conventional e-cigarettes compared with combustible cigarettes. Independent data are required to assess the effects of these products on cardiovascular surrogate parameters and cardiovascular risk. Methods: We conducted a single-center three-arm study comparing combustible cigarettes with JUUL e-cigarettes with the old and new technology. We recruited 32 participants who were active smokers (n=15) or vapers (n=17) and performed a total of 39 measurements before and 5, 15, and 30 minutes, after participants smoked a combustible cigarette or vaped a JUUL e-cigarette with the new or old technology. Measurements included peripheral and central blood pressures and parameters of arterial stiffness, including pulse wave velocity and augmentation index. Results: Peripheral systolic blood pressure, central blood pressure, and peripheral pulse rate increased significantly in all three groups (each p<0.05). Heart rate (HR) changes lasted significantly longer than blood pressure changes. The augmentation index and pulse wave velocity increased in all three groups, and a multivariate analysis of variance showed that the increases were independent of systolic blood pressure, sex, age, device, and HR. Conclusions: Changes in blood pressure and arterial stiffness are similar after cigarette smoking and JUUL use. These changes may be associated with an increased cardiovascular risk compared with no product use. However, a long-term follow-up evaluation of JUUL use and a head-to-head comparison with conventional e-cigarettes are still needed.
... In 2018, Staudt et al, showed that even short-term use of e-cigarettes induces tumor and metastasis promoting factors related to lung cancer in small airway epithelium [13]. Stephens et al showed that vaporized nicotine emissions from e-cigarettes contain carcinogens generally in lower concentrations with cancer potencies < 1% that of tobacco smoke [14]. Mean lifetime cancer risks decline from traditional smoking to e-cigarettes. ...
Article
Full-text available
Background: It is well known that traditional smoking causes various types of cancer, leading to the current decline in traditional smoking among US adults from 20.9% in 2005 to 14.0% in 2019. Electronic cigarettes (e-cigarettes) are commonly marketed as a safe alternative and gaining popularity especially among never-smokers and adolescents. However, there is limited evidence of effects of e-cigarette on cancer. Hence, we aim to find the prevalence and association of e-cigarette and traditional smoking among cancer respondents. Methods: We conducted a retrospective cross-sectional study using the NHANES database from 2015 to 2018. We assessed history of cancer (MCQ220), type of cancers (MCQ230a), and smoking status (e-cigarette: SMQ900 or SMQ905 and traditional smoking: SMQ020) using questionnaires. We performed multivariable logistic regression models to find the association of e-cigarette use, traditional smoking, and no smoking with cancer after adjusting for confounding variables. Results: A total of 154,856 participants were included, of whom 5% were e-cigarette users, 31.4% were traditional smokers, and 63.6% were nonsmokers. There is a higher prevalence of e-cigarette use among younger participants, females (49 vs. 38) in comparison to traditional smokers (P < 0.0001). The e-cigarette users have lower prevalence of cancer compared to traditional smoking (2.3% vs. 16.8%; P < 0.0001), but they were diagnosed with cancer at a younger age. Among cancer subtypes, cervical cancer (22 vs. 2.6), leukemia (8.5 vs. 1.1), skin cancer (non-melanoma) (15.6 vs. 12.3), skin (other) (28 vs. 10) and thyroid (10.6 vs. 2.4) had higher prevalence of e-cigarette use compared to traditional smokers (P < 0.0001). Our regression analysis showed that e-cigarette users have 2.2 times higher risk of having cancer compared to non-smokers (odds ratio (OR): 2.2; 95% confidence interval (CI): 2.2 - 2.3; P < 0.0001). Similarly, traditional smokers have 1.96 higher odds of having cancer compared to nonsmokers (OR: 1.96; 95% CI: 1.96 - 1.97; P < 0.0001). Conclusion: In our study, e-cigarette users had an early age of cancer onset and higher risk of cancer. Hence, this is stepping stone for future research to evaluate the safety and effects of e-cigarettes in patients with cancer.
... 29 They also stated Contains aerosol that has an average of 95% lower levels of harmful constituents and is much less toxic than cigarette smoke iQOS aerosol was found to have volatile organic compounds, polycyclic aromatic hydrocarbons, and carbon monoxide. It may or may not be less toxic than cigarette smoke as side-by-side studies have not been done Reduces exposure to harmful constituents to users who switch to iQOS Calculated lifetime cancer risk of HnB products is higher when compared to e-cigarettes 39 Will have a positive impact on a smoker's health With high levels of nicotine delivery and other harmful constituents, it is unlikely that there will be a positive impact on smokers ...
Article
Full-text available
While cigarette smoking is still a major source of morbidity and mortality, e-cigarette usage is skyrocketing, and the tobacco industry is finding new ways to market nicotine. With updated published research highlighting the dangers of cigarette smoking and now vaping, the industry has been developing new techniques and devices that circumvent this research to hook users on tobacco and nicotine. The FDA allowed Philip Morris International (PMI) to sell their heat not burn tobacco products known as iQOS in 2019. By 2019, 49 countries had permitted the sale of iQOS. This commentary summarizes the recent research on heat not burn cigarettes, also known as heated tobacco products and their effects on public policy. We urge policy makers to consider the research published regarding these new products and prevent the widespread use of these products that will harm public health.
... Die Werte an Formaldehyd und Acetyldehyde liegen 9 bis 450mal unter denen einer normalen Zigarette(Goniewicz et al., 2014). Und grundsätzlich sind weniger Krebs erzeugende Stoffe im Dampf als im Rauch: Geschätzt um einen Faktor 1000 mal wenigerund damit liegt der Schadensbereich beim Dampfen bezüglich kanzerogener Stoffe in einem klinisch irrelevanten Bereich(Stephens, 2018).Mehrere Untersuchungen belegen, dass Dampfen einen zytotoxischen (zell-und gewebeschädigenden) Effekt hat(Azzopardi et al., 2016;Leigh, Lawton, Hershberger & Goniewicz, ...
Chapter
E-cigarettes and its use in smoking cessation and as harm reduction
... Some publications suggest that nicotine salt e-liquids can produce satisfaction levels similar to those of traditional cigarettes to quench nicotine desire (14,(17)(18)(19)(20). Although there is a global consensus that the use of e-cigarettes lowers exposure to many harmful compounds compared to combustible tobacco cigarettes (21), the use of e-cigarettes remains controversial due to the high concentrations of their e-liquid components. Gly, PG, flavoring additives and nicotine salts are present in high concentrations in some of these e-liquids and could contribute to health problems. ...
Article
Full-text available
The new pod devices like JUUL TM , Vuse Alto TM , myblu TM , and other “pod-mod” related products had a huge impact on the e-cigarette market, especially among teens and young adults due in particular to aggressive marketing on social media, wide availability, and discrete use due to their special design. These pod devices are designed to deliver nicotine levels per puff comparable to combustible cigarettes while producing smaller amounts of visible exhaled aerosol from the heating of e-liquids. Some of these liquids contain high concentrations of acids, such as benzoic acid, to allow higher nicotine deliveries with less harshness and throat irritation. Benzoic acid is a potential source of the human carcinogen benzene and a chemical of concern. Besides acids, flavoring agents such as benzyl alcohol, a local anesthetic that could facilitate tobacco smoke inhalation are also common in these devices. Both benzoic acid and benzyl alcohol in e-liquids might be of relevance for the health risk of vapers. An isotope dilution high-performance liquid chromatography-tandem mass spectrometry (ID-HPLC-MS/MS) method has been developed for the detection of benzoic acid and benzyl alcohol in the JUUL TM brand e-liquids. The sample preparation consisted of a simple dilution followed by a mechanical stirring process. ID-HPLC-MS/MS was used to separate, identify, and quantify the benzoic acid and/or benzyl alcohol in diluted extracts. Detection limits were 0.11 and 9.05 ng/μL for benzyl alcohol and benzoic acid, respectively. Product variability estimated from the analysis of seven different e-liquids in triplicates (n = 21) yielded relative standard deviations ranging from 4.3% to 16.0% for benzyl alcohol and 6.3% to 11.1% for benzoic acid. The amount of benzoic acid (32.8 ± 2.8 mg/g; 3.3 ± 0.3%, w/w) and the nicotine-benzoic acid molar ratio (1.15 ± 0.02) remained relatively consistent among pod flavors. [Contrib. Tob. Nicotine Res. 30 (2021) 212–220]
... A possible suitability check can be done by testing the conformity of recently published data, which have not been used for calculating the intake and uptake for chemicals in the 6 consumer groups (mainly because they were not yet available when the relative exposure level system was developed). In total, 17 studies on either one or several of the consumer groups of interest were tested for conformity, 9 studies on the release of chemicals from tobacco/nicotine products (86,(129)(130)(131)(132)(133)(134)(135)(136) and 8 studies on biomarker levels (137)(138)(139)(140)(141)(142)(143)(144). For testing the exposure levels for daily intake, 140 comparisons could be performed, comprising tests for 21 different chemicals and 3 products (26 tests with CCs, 12 with HNB products and 114 with ECs). ...
Article
Full-text available
With increasing use of new generation tobacco/nicotine products (TNPs) instead or in addition to conventional cigarettes (CCs), the question arises, whether the user of these new TNPs and CCs can be distinguished on the basis of their exposure in terms of intake and uptake of specific chemicals. For this purpose, the exposure to chemicals for users of 5 product types including CCs, HNB (heat-not-burn products), electronic cigarettes (ECs), oral tobacco products (OT, with the focus on snus), nicotine replacement therapy (NRT) products (only nicotine gum (NG) was considered in this study) was evaluated on the basis of published data. For both intake and biomarker-based uptake, 4 relative exposure levels with the assigned values from 1 (lowest exposure) to 4 (highest exposure) were defined resulting in exposure level patterns. Unique single-biomarker-based exposure levels were found for smokers (11 chemicals), vapers (1 chemical) and non-users (NU, 1 chemical). A few selected biomarkers (usually with relative levels of 3–4) were found to be sufficient for unequivocal differentiation of one user/NU group from the other 5 groups. The impact of dual-product use is also briefly discussed. [Contrib. Tob. Nicotine Res. 30 (2021) 167–198]
... The rapid growth of ECs and HTPs (Caputi, 2017;Glasser, et al., 2017) makes it critical to develop warning labels for ECs and HTPs, but most studies on warning labels have focused on cigarettes, and to a lesser extent, on smokeless tobacco (Noar & Sutfin, 2017). While the longterm health effects of HTPs and ECs are still largely unknown, some agencies such as U.S. Food and Drug Administration have proposed positioning them on a "continuum of risk" relative to cigarettes, where cigarettes present the highest level of exposure to harmful chemicals to the user, with current evidence indicating that HTPs present lower exposures and ECs even lower than that (Leigh, Palumbo, Marino, O'Connor, & Goniewicz, 2018;Leigh, Tran, O'Connor, & Goniewicz, 2018;Stephens, 2018;U.S. Food and Drug Administration, 2020). ...
Article
Full-text available
Background Warning labels are a fundamental public health strategy for communicating about tobacco product risks, but effective warning labels for heated tobacco products (HTPs) and e-cigarettes (ECs) are yet to be determined. We examined the effect of two warning label systems for communicating the relative risks of using cigarettes, HTPs, and ECs. Methods 1,280 Korean adults were recruited from an online commercial panel, including susceptible non-users of cigarettes, HTPs, or ECs aged 19 to 29 (n = 444) and current users of these tobacco products aged 19 or older (n = 836). Participants viewed packages for cigarettes, HTPs, and ECs in a 2 × 2 between-subject experiment: “dashboard” icons integrated into warnings vs. no dashboard; different-sized warnings (70% of cigarette packages, 50% of HTP packs, 30% of EC packages) vs. current equal-sized warnings (50% of cigarette/HTP/EC packages). Results Participants exposed to the dashboard warning system were more likely than those who were not to report higher perceived harm of cigarettes than ECs, cigarettes than HTPs, and HTPs than ECs, as well as perceived benefit of switching from cigarettes to HTPs, cigarettes to ECs, and HTPs to ECs. Participants exposed to the different-sized warning system did not report differences in perceived relative harm or benefit compared to those who were not, and no interaction of dashboard warnings with warning sizes was found. Conclusion The use of dashboard icons with texts and colors representing different levels of risk may promote public understanding about the continuum of risk across tobacco products.
... However, initiating or increasing EC use whilst cigarette smoking is maintained is unlikely to lead to substantial improved health outcomes [15]. Despite the concerns vis-à-vis the increasing prevalence rates amongst youth [16,17] and potential health harms specifically for users who continue to smoke concurrently [18], findings from emission, biomarker and switching studies suggest that EC are considerably less harmful than tobacco cigarettes [15,[19][20][21][22][23][24][25][26][27], a conclusion endorsed by public health agency reviews [28,29]. ...
Article
Full-text available
Background Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to (1) develop and test a selection of relative risk messages for e-cigarette products; (2) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and (3) explore differences between smokers, non-smokers and dual users. Method Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. Results On all three constructs combined, the two TPD messages rated the highest, closely followed by four relative risk messages “Completely switching to e-cigarettes lowers your risk of smoking related diseases”, “Use of this product is much less harmful than smoking”, “Completely switching to e-cigarettes is a healthier alternative to smoking”, and “This product presents substantially lower risks to health than cigarettes” which did not differ statistically from the TPD messages. Non-smokers rated TPD1 significantly higher overall than dual users. Dual users rated “This product is a safer alternative to smoking” significantly higher than non-smokers. Messages did not differ on understandability. Conclusions These alternative messages provide a useful resource for future research and for policy makers considering updating e-cigarette product labelling.
... Therefore, attempts were made to estimate the carcinogenicity of the aerosol of the HnB product based on detailed toxicological data. In a study published in Tobacco Control BMJ, the carcinogenic potency was defined as at least one order of magnitude lower than that of cigarette smoke [67]. Public institutions in some countries also performed their own detailed oncological risk assessment of the use of tobacco heating systems. ...
... The author called for high levels of caution with the use of such products, highlighting the existence of hazardous combinations of liquid formulation and consumption behaviors. 23 In an animal lung model, Canistro et al 24 demonstrated that e-cigarette vapors induced strong carcinogenic effects, including boosting the activity of a carcinogen-bioactivating enzyme, increasing oxygen free radical production, and enhancing DNA damage at both the chromosomal and genetic levels. Such findings provide evidence of the carcinogenic risk associated with e-cigarettes, especially among youngsters and vulnerable users. ...
Article
Full-text available
Background: To assess knowledge and attitudes about e-smoking among undergraduate medical students, specifically focused on favorable view of therapeutic e-cigarette use for smoking cessation or harm reduction. Methods: This cross-sectional study included medical students at King Abdulaziz University, Saudi Arabia. A six-item subscale was used to explore knowledge and attitudes about the therapeutic use of e-cigarettes, measuring participants' likelihood of favoring such use. A four-item questionnaire measured confidence and importance of being educated about smoking and e-smoking, in addition to sources of knowledge about e-cigarettes. Results: A total of 399 students participated. Smoking history included current smokers (19.8%) and ex-smokers (6.5%), while e-cigarettes were tried by 36.6% and are currently used by 11.5%. A minority (13.5%) believed that e-cigarettes are FDA-approved for smoking cessation, while approximately one-third believed e-smoking lowers cancer risks (31.1%) and could help with smoking cessation (31.1%). Further, 35.9% agreed or strongly agreed that e-cigarettes are better for patients than tobacco products, and 17.5% were likely to recommend e-smoking to their patients for smoking cessation. Reliability of the six-item scale showed Cronbach's alpha = 0.676, which was enhanced to 0.746 after deletion of one item about addictiveness. Using the corrected five-item scale, 23.6% of the participants would favor therapeutic use of e-cigarettes. Conclusion: We observed several misconceptions about addictiveness and inadequate awareness about e-cigarettes' harmful effects, leading to non-scientific opinions about its therapeutic use for harm reduction or in smoking cessation. Academic programs around this topic should be updated in accordance with majority expert recommendations.
... In contrast, heating an e-liquid consisting of carrier constituents (e.g., propylene glycol or glycerin), nicotine, water, and avors generates far fewer harmful chemicals in much lower levels than the burning of tobacco [4,9]. However, EVP aerosols may contain some chemicals like carbonyls, volatile organic constituents, and metals [5,10]. The inhaled EVP constituents are delivered to the user's mouth, throat, and lungs during use and may be released into the environment during exhalation. ...
Preprint
Full-text available
Background: The potential secondhand exposure of exhaled constituents from e-vapor use, particularly under various real-world setting, is a public health concern. We present a computational modelling method to predict air levels of constituents exhaled from e-vapor product use. Methods: We first conducted a clinical study to measure select constituent levels in exhaled breath from adult e-vapor product users. We then used a computational model to predict levels of these constituents in three scenarios – in a car, office and restaurant to determine likely secondhand exposure to nonusers. Exhaled breath samples (10 controlled puffs) were analyzed after the use of four different e-liquids in a cartridge-based e-vapor product. Seven selected analytes were measured: nicotine, propylene glycol (PG), glycerin, menthol, formaldehyde, acetaldehyde, and acrolein and reported based on a linear mixed model for analysis of covariance. Results: The ranges of nicotine, propylene glycol, glycerin, and formaldehyde in exhaled breath were 89.44-195.70 µg, 1,199.7-3,354.5 µg, 5,366.8-6,484.7 µg, and 0.25-0.34 µg, respectively. Menthol was only detected following mentholated e-vapor product use (21.11-31.01 µg); acetaldehyde and acrolein were below detectable limits. Conclusions: We utilized a previously validated well-mixed model to estimate aerosol dispersion and room air levels of individual constituents. The model was based on physical and thermodynamic interactions between air, vapor, and the particulate phase of the aerosol to predict vapor-particle partitioning and air-levels of constituents over time, as they travel through a defined indoor space. Input variables included space setting (space type and volume such as car, office space, or a restaurant), ventilation rate, the amount of total aerosol exhaled by all users and aerosol composition. The computational model predicted that air levels of nicotine, formaldehyde, acrolein, and acetaldehyde were below the permissible exposure limits set by authoritative bodies and substantially lower during e-vapor use compared to conventional cigarettes. The relatively low levels suggest minimal exposure to nonusers. Trial registration: Awaiting Clintrials Registry Number. In the process of retrospectively registering the study in the US Clinicaltrials Registry (http://www.clintrials.gov) will update the information as soon as registered.
... The findings of lower emissions in ENDS compared to tobacco smoke were corroborated in the review by the European Respiratory Society [18] and other reviews [19,20]. Stephens [21] calculated the cancer potency of ENDS emissions to have 0.004 of the relative lifetime cancer risk of tobacco smoke. While major assumptions and guesswork are required to translate reductions in emissions into an estimate of actual health risks, it is impossible to believe that the orders-of-magnitude differences do not represent enormously lower risk. ...
Article
Full-text available
Background In preparation for the 2021 revision of the European Union Tobacco Products Directive, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) has posted its Preliminary Opinion on Electronic Cigarettes . They concluded that e-cigarettes only achieve a sub-optimal level of protection of human health. In this paper, we provide evidence that the Opinion’s conclusions are not adequately backed up by scientific evidence and did not discuss the potential health benefits of using alternative combustion-free nicotine-containing products as substitute for tobacco cigarettes. Methods Searches for articles were conducted in PubMed and by citation chasing in Google Scholar. Articles were also retrieved with a review of references in major publications. Primary data from World Health Organization surveys, the conclusions of reviews, and peer-reviewed non-industry studies were cited to address errors and omissions identified in the Opinion . Results The Opinion omitted reporting on the individual and population health benefits of the substitution of e-cigarettes (ENDS) for cigarette smoking. Alternative hypotheses to the gateway theory were not evaluated. Its assessment of cardiovascular risk is contradicted by numerous reviews. It cites ever-use data that do not represent current patterns of use. It did not report non-nicotine use. It presented erroneous statements on trends in ENDS prevalence. It over-emphasized the role of flavours in youth ENDS initiation. It did not discuss cessation in sufficient length. Conclusions For the delivery of a robust and comprehensive final report, the members of the Working Group of the Scientific Committee on Health, Environmental and Emerging Risks will need to consider (1) the potential health benefits of ENDS substitution for cigarette smoking, (2) alternative hypotheses and contradictory studies on the gateway effect, (3) its assessment of cardiovascular risk, (4) the measurements of frequency of use, (5) non-nicotine use, (6) the role of flavours, and (7) a fulsome discussion of cessation.
... Die Werte an Formaldehyd und Acetyldehyde liegen 9 bis 450mal unter denen einer normalen Zigarette(Goniewicz et al., 2014). Und grundsätzlich sind weniger Krebs erzeugende Stoffe im Dampf als im Rauch: Geschätzt um einen Faktor 1000 mal wenigerund damit liegt der Schadensbereich beim Dampfen bezüglich kanzerogener Stoffe in einem klinisch irrelevanten Bereich(Stephens, 2018).Mehrere Untersuchungen belegen, dass Dampfen einen zytotoxischen (zell-und gewebeschädigenden) Effekt hat(Azzopardi et al., 2016;Leigh, Lawton, Hershberger & Goniewicz, ...
Thesis
The Suchthilfe Ost in Olten, Schweiz, analyzed its project "Mit der E-Zigarette zum Rauchstopp" after 18 months of duration. The Author Hélène Neuhaus gathered information about relevant details of this project and wrote her Bachelor Thesis about the current state of knowledge of e-cigarettes (ENDS).
... These products raise concerns about their safety. 3,[5][6][7] In fact, although HTPs produce lower levels of some carcinogens and toxic chemicals compared to conventional cigarettes, they are not riskfree. 5,8,9 Moreover, they produce new substances not generated by conventional cigarettes, 7 having uncertain impact on health. ...
Article
Background Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective is to analyse the prevalence and associations of use of HTP across 11 countries in Europe. Methods Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study with information on HTP use in the following countries: Bulgaria, England, France, Germany, Greece, Italy, Latvia, Poland, Portugal, Romania and Spain. In each country, face-to-face interviews were performed on a representative sample of around 1,000 subjects aged ≥15 years, for a total of 10,839 subjects. Results Overall, 27.8% of study participants were aware of HTPs, 1.8% were ever HTP users (ranging from 0.6% in Spain to 8.3% in Greece), and 0.1% were current users. Men were more frequently HTP ever users than women (adjusted odds ratio, aOR=1.47; 95% confidence interval, CI: 1.11-1.95). Ever HTP use was inversely related to age (p for trend<0.001) and more frequent in ex-smokers (compared with never smokers, aOR=4.32, 95% CI: 2.69-6.95) and current smokers (aOR=8.35, 95% CI: 5.67-12.28), and in electronic cigarette past users (compared with never users, aOR=5.48, 95% CI: 3.46-8.68) and current users (aOR=5.92, 95% CI: 3.73-9.40). Conclusions In 2017-2018, HTP use was still limited in Europe among the general population, however the dual use of these products, their high use among younger generations and the interest of non-smokers in these products are worrying and indicate the need for close monitoring in terms of prevalence and the characteristics of users.
Article
Purpose Several technical features influencing bronchodilator delivery were evaluated using different vaping drug delivery systems (VDDS). Methods Terbutaline in powder form, combined with 1, 3- propanediol used as e-liquid was tested at different concentrations (1 and 2.5 mg/mL), power levels (15 W and 30 W), and set applied resistances (0.15 to 1.5 O) to compare the efficiency of three VDDS (GS AIR2, GS TANK, CUBIS). Samples were collected with a Glass Twin Impinger (GTI). A High Performance Liquid Chromatography (HPLC) was used for drug quantification. The Next Generation Impactor (NGI) measured particle size distribution. Results were also considered with a clinical jet nebulizer (Cirrus TM 2, 2 mL of terbutaline at 2.5 mg/mL). Results GS AIR2 with resistance = 1.5 O; power = 15 W, and [Terbutaline] = 2.5 mg/mL represents the optimal VDDS conditions to deliver a respirable dose of 20.05 ± 4.2 µg/puff with a mass median aerodynamic diameter (MMAD) of 1.41 ± 0.03 µm. Thus, 52 puffs were required (lasting approximately 15 min of vaping) to reach similar respirable dose and MMAD compared to nebulization. Conclusion We proved that several crucial VDDS technical parameters govern the performance of respiratory bronchodilator delivery including the resistance, power level and atomizer design.
Article
Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.
Article
Background: The nicotine products relative risk assessment estimates the relative risk of tobacco-related diseases due to use of 15 nicotine products. This update adds new data to the original analysis and creates separate categories for United States and rest of world varieties of smokeless tobacco, as well as bidi cigarettes. Methods: The PubMed®, MEDLINE and Clinicaltrials.gov databases were searched systematically. The study lists were exported, screened at the title, abstract and full-text level according to pre-defined inclusion/exclusion criteria. The study quality was assessed, and risk of bias was accounted for in the screening criteria. The extracted data was synthesized into a toxin emissions/content analysis for 12 Group 1 carcinogens, used to estimate lifetime cancer risk, and epidemiological meta-analysis of over 40 tobacco-related diseases. The two analyses were integrated into a combined risk score for each nicotine product, weighted by the risk of bias due to missing data, and incorporated into the relative risk spectrum. Results: In this update, 70 new studies were added to the synthesis, making a total of 123 studies included. All combustible tobacco products score between 40 and 100, with bidis and smokeless (rest of world) also in this range. All other products have a combined risk score of 10 or less, including U.S. chewing tobacco, U.S. dipping tobacco, snus, heat-not-burn tobacco, electronic cigarettes, non-tobacco pouches and nicotine replacement therapy. Discussion: Consistent with previous studies, we define a group of high-risk nicotine products, scoring between 40 and 100 on the spectrum, and reduced risk nicotine products, scoring less than 10. Limitations of this study include the potential for bias due to missing data, the heterogeneity of the data included in the relative risk hierarchy synthesis, and the assumed consumption levels.
Article
The Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) 2018 position statement supports increased, regulated availability of e-cigarettes (ECs) as a harm-reduction measure and recommends further research into their use. Aligned with this recommendation, we aimed to critically evaluate the RANZCP’s stance on this issue through a literature review focused on the areas identified in the position statement as requiring further investigation: (1) the adverse health effects attributable to ECs; (2) use of ECs for smoking cessation (particularly for people living with severe mental illness); and (3) EC-associated risks for nicotine naïve young people. We identified and summarised evidence of harm attributable to ECs that is particularly relevant to young people through direct adverse health sequelae, onset of nicotine dependence and increased risk of combustible cigarette (CC) use. A small number of studies suggest ECs can be used for harm-reduction purposes in people diagnosed with nicotine dependence and severe mental illness. However, these results must be considered alongside robust evidence supporting the effectiveness of existing pharmacological interventions for smoking cessation in people with severe mental illness. The position statement is in urgent need of review in line with the available evidence.
Article
PurposeElectronic cigarettes (e-cigarettes) are used widely, and e-cigarettes containing caffeine (Caf) have recently become commercially available. However, no risk evaluation of these Caf-containing products has been performed to date. Such an evaluation requires a sensitive analytical method for quantifying Caf in smoke from e-cigarettes. The aim of this study was to establish a liquid chromatography–tandem mass spectrometry (LC–MS/MS) method for quantifying vaporized Caf from commercially available e-cigarettes, and to determine minor components related to Caf in cigarette smoke extract (CSE).MethodsA sampling system for Caf using a suction pump was designed and sampling conditions were optimized.ResultsThe optimized LC–MS/MS conditions allowed the sensitive determination of Caf in smoke with a limit of detection of 0.03 ng/mL at a signal-to-noise ratio of 3. The method was applied to CSEs from five e-cigarette products and the concentration of Caf ranged from 0.894 ± 0.090 to 3.32 ± 0.14 μg/mL smoke (n = 3). Additionally, minor components related to Caf, such as theobromine, theophylline, and paraxanthine, were detected in CSE and in e-liquid at very low concentrations, indicating that they were impurities in e-liquid and vaporized along with Caf.Conclusion This is the first report to determine the concentration of vaporized Caf using an LC–MS/MS method and to clarify several minor components in smoke from e-cigarettes.
Article
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Background Tobacco Heating Products (THPs) are tobacco products that heat rather than burn tobacco with temperatures less than 350 oC. Because of this operating principle, they produce substantially fewer and lower levels of tobacco smoke toxicants than combustible cigarette smoke produced when tobacco is burnt, which occurs at much higher temperatures of around 90⁰⁰C. This paper analyses data on a THP, gloTM, and assesses whether its use would result in reduced health risks compared to the health risks of smoking cigarettes. It also looks at the possibility of bridging datasets across the different variants of the gloTM product. Methods The approach is to consider whether datasets from behavioural, chemical, toxicological and clinical studies provide consistent findings of reductions in toxicant exposure with gloTM use by subjects who switch completely from smoking cigarettes to using gloTM and whether these reductions are similar to those who stop smoking cigarettes without switching to gloTM or any other tobacco or nicotine product. We also examine the similarities and differences of different versions of the gloTM product and benchmark it against a THP from another manufacturer. Results The studies indicate that the use of the gloTM results in substantial and prolonged reductions in toxicant exposure for smokers who switch to gloTM completely. A long-term clinical study shows substantial reductions in toxicant exposure over a period of time, similar to reduction of some biomarkers of exposure found following smoking cessation without switching to gloTM or any other tobacco product, and biomarkers of potential harm trending in a favourable manner for both groups that switch to gloTM and that quit all tobacco and nicotine use. Data suggests that all iterations of gloTM result in substantial reductions in toxicant exposure compared to smoking cigarettes and that bridging across datasets is feasible. Conclusions Given the accumulated scientific data summarised in this paper, and particularly the findings from a long-term clinical study, the data demonstrate that gloTM is a reduced exposure product compared to combustible cigarettes and is reasonably deemed to reduce the risk of smoking-related diseases and supports the conclusion that smokers who would have otherwise continued to smoke and instead switch entirely to THP gloTM use, will reduce their relative risk of developing smoking-related diseases as compared to continued smoking. The extent of reduction in risk compared to continuing to smoke is likely to vary by smoking-related disease and by an individuals’ smoking history, other risk factors and an individual’s susceptibility to disease. Use of the THP will present some level of increased health risk as compared to cessation of tobacco and nicotine products and will cause dependence. As long as the principles of heat-not-burn are maintained, THP use will result in substantially reduced exposure to smoke toxicants as compared to continued conventional cigarette smoking. It is possible to use bridging or read across to apply these conclusions to new iterations of the gloTM product, extending the utility and validity of the evidence generated through study of prior iterations.
Article
(word count 231) Vaping by adolescents and young adults is a legitimate concern as there is a risk that some may start smoking and that electronic cigarette (EC) use may have adverse effects in the developing lungs of adolescents. This commentary provides updated information on vaping patterns among adolescents and young adults in the United States, as well as the impact of EC usage on respiratory health. EC use has surged greatly among high school students and young adults over the last decade but fortunately has declined significantly since its peak in 2019. During the same time period, smoking rates have constantly fallen to new low record levels. These trends argue against EC use as a gateway to smoking. Most EC usage is infrequent and unlikely to increase a person's risk of negative health consequences. Furthermore, the majority of EC usage has happened among those who have previously smoked. There is a dearth of data on the long-term health implications of EC usage in adolescents and young adults. We do not know whether short-term or intermittent use of EC in youth can lead to negative health outcomes in adulthood, and long-term high-quality studies in well-defined groups are needed. Although vaping has been linked to respiratory symptoms, they tend to be transient and of uncertain significance. This commentary provides up-to-date information so health care providers can give objective and responsible medical advice on EC usage.
Chapter
Das vorliegende Kapitel bietet die Behandlungsempfehlungen der Tabakleitlinie mit ihren Hintergrundtexten. Es ist untergliedert in die Abschnitte Motivationsbehandlung und Kurzinterventionen, Harm Reduction, Psychotherapeutische Interventionen, Arzneimittel zur Entzugsbehandlung und Rückfallprophylaxe, Somatische Therapieverfahren, Gender- und Altersaspekte, Somatische Komorbidität, Psychische Komorbidität sowie Setting, Versorgungsorganisation und Aspekte der Finanzierung.
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Resumen El tabaquismo sigue siendo la principal causa de morbimortalidad a nivel mundial. Por su clara influencia en las enfermedades cardiovasculares y respiratorias, es un factor importante en la consulta de medicina interna. Aunque la tasa de abandono del hábito tabáquico está ascendiendo en los últimos años, existe un porcentaje de pacientes que continúan fumando porque no pueden o no quieren cesar el hábito, a pesar de haber probado las terapias farmacológicas y no farmacológicas existentes. Para este grupo de paciente existen unas estrategias que se basan en intervenciones destinadas a reducir los efectos negativos del tabaco sin la necesidad de extinguir por completo su consumo. En esta revisión se contempla como gracias a la ausencia de combustión de la materia orgánica que se da en el cigarrillo convencional, en snus, cigarrillo electrónico y productos de tabaco calentado se genera un nivel significativamente inferior de sustancias tóxicas.
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Background High cigarette smoking prevalence and low quit rates in people with serious mental illness (SMI) contribute to disparate rates of chronic disease and premature death. This prospective trial tested the impact of switching to a potentially lower harm nicotine-containing product on smoking in this population. Methods 240 cigarette smokers with SMI who tried but were currently unwilling to quit were randomly assigned to receive disposable e-cigarettes for 8 weeks or not, with assessments at baseline, 2, 4, 6, 8, 13, and 26 weeks. Generalized linear mixed models examined the effects of e-cigarette provision on e-cigarette appeal, cigarettes per day (CPD), breath carbon monoxide (CO), nicotine dependence, and side effects. Clinical Trial registration: NCT03050853 Results Self-reported smoking was similar between groups at baseline (mean=18.7 CPD). By week 2, 79% of the e-cigarette group were using e-cigarettes daily. During weeks 2-8, CPD and CO decreased in the e-cigarette vs. assessment only group (e.g., 7.5 CPD [95% CI 5.9, 9.2] vs. 18.1 CPD [CI 16.4, 19.8] and 16.4ppm [CI 13.4, 19.5] vs 25.4ppm [CI 22.4, 28.9 respectively] at week 2). Additionally, 19-22% in the e-cigarette group reported smoking no cigarettes in weeks 2-8 compared to 0% in the assessment only group. By 13 and 26 weeks, group differences in CPD, but not CO, remained significant. Nicotine dependence did not increase and side effects were minor. Conclusions Providing e-cigarettes for 8 weeks to smokers with SMI resulted in substantial reductions in CPD and CO. Enhancing and maintaining switching from cigarettes to e-cigarettes warrant further study. Implications This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with serious mental illness (SMI) who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.
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A quantitative method was developed to measure four harmful carbonyls (acetaldehyde, acrolein, crotonaldehyde, and formaldehyde) in aerosol generated from e-cigarette, or vaping, products (EVPs). The method uses a commercially available sorbent bed treated with a derivatization solution to trap and stabilize reactive carbonyls in aerosol emissions from EVPs to reduce reactive analyte losses and improve quantification. Analytes were extracted from the sorbent material using acetonitrile and analyzed via high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The method was applied to aerosols generated from products obtained from case patients with EVP use-associated lung injury (EVALI). The method accuracy ranged from 93.6 to 105% in the solvent and 99.0 to 112% in the matrix. Limits of detection (LODs) were in the low nanogram range at 0.735-2.10 ng for all analytes, except formaldehyde at 14.7 ng. Intermediate precision, as determined from the replicate measurements of quality-control (QC) samples, showed a relative standard deviation (RSD) of less than 20% for all analytes. The EVALI case-related products delivered aerosol containing the following ranges of carbonyls: acetaldehyde (0.0856-5.59 μg), acrolein (0.00646-1.05 μg), crotonaldehyde (0.00168-0.108 μg), and formaldehyde (0.0533-12.6 μg). At least one carbonyl analyte was detected in every product. Carbonyl deliveries from EVALI-associated products of all types are consistent with the previously published results for e-cigarettes, and levels are lower than those observed in smoke from combustible cigarettes. This method is rugged, has high throughput, and is well suited for quantifying four harmful carbonyls in aerosol emissions produced by a broad spectrum of devices/solvents, ranging from e-cigarette containing polar solvents to vaping products containing nonpolar solvents.
Article
Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers that would otherwise continue to smoke conventional cigarettes. Given the rapid development of this product category, the aim of this review was to examine the available peer-reviewed scientific evidence related to heated tobacco products and highlight any research gaps. In recent years, manufacturers of heated tobacco products have published a number of studies on their respective heated tobacco products. Whilst there is limited research that is independent of commercial interests, the available scientific evidence indicates that heated tobacco products produce a much simpler aerosol than conventional cigarette smoke, with fewer and substantially lower levels of harmful toxicants. Toxicology assessments indicate these reductions in aerosol toxicants translate to reduced biological effects. Biomarker and clinical data from studies in which product use is controlled within a clinical setting, indicate changes in biomarker levels and clinical end-points similar to observations in cessation studies, indicating the potential for reduced harm. The scientific evidence also indicates that exposure of non-users to emissions from heated tobacco products in indoor environments is significantly reduced compared to exposure resulting from smoking conventional cigarettes. Overall, the available scientific evidence indicates that heated tobacco products hold promise as a less harmful alternative to conventional cigarettes, but more independent data is required to validate industry findings. As a growing product category, epidemiological studies and independent population modelling studies are outstanding, and empirical data on how dual tobacco product category use by consumers affects their risk profile is lacking.
Article
The impact of combustible cigarettes on active and passive smokers has become a medical and social problem. In recent years, heated tobacco products (HTPs) have been available in Japan. HTPs are tobacco products in which the user inhales the aerosol produced by heating the tobacco. HTPs do not produce secondhand smoke from combustion and are therefore expected to reduce the adverse effects on human health. However, the health impact of HTPs has not been fully understood. Recent studies reported that HTPs have basically reduced levels of some chemicals, compared to combustible cigarettes; however, several chemicals have been reported to be increased in HTP. Because of the insufficient scientific evidence, there is concern about the long-term effects of exposures to HTPs. To understand the relationship between cigarette smoking and cancer, we have investigated the component of cigarette smoking using cancer stem cells, which give rise to many types of cancer. We identified that nicotine and NNK can induce the proliferation of human cancer stem cells. We also found that tobacco smoke extracts from HTPs induce the proliferation of cancer stem cells. It is necessary to identify other chemicals in tobacco smoke extracts from HTPs to understand the health risk of the long-term use of HTPs.
Chapter
Smoking is one of the most lethal addictions, with more than 8 million premature deaths being recorded annually from smoking-related diseases, according to the WHO. While nicotine is the main substance linked to dependence, harm is predominantly caused by combustion products or other harmful compounds present in cured tobacco. Due to the difficulty in quitting smoking and the relatively low effectiveness of smoking cessation medications, the concept of tobacco harm reduction, a strategy of providing cleaner form of nicotine, has generated interest. Electronic cigarettes are nicotine products that do not contain tobacco and are today widely available globally. This chapter presents the prospects and challenges of electronic cigarettes, discussing their safety/risk profile and their potential benefits and risks for public health.
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Smoking-related diseases generally occur after decades of smoking, and the reduction in excess risk following smoking cessation is slow. Therefore, epidemiological studies that aim to assess the reduction in disease risk associated with switching from cigarette smoking to the use of electronic nicotine delivery products (ENDPs) are difficult to execute and will require time. Therefore, animal models of disease are critical for comparing the effects of ENDP aerosols with those of cigarette smoke. Here, we present several available models that can be used in this context and summarize results of studies conducted with electrically heated tobacco products and e-vapor products.
Chapter
The ability to reproducibly generate, collect, and administer aerosols is critical for characterization and preclinical assessment of electronic nicotine delivery products (ENDPs), such as electrically heated tobacco products and e-vapor products. The aerosols generated by ENDPs are qualitatively and quantitatively highly different from cigarette smoke (CS). This constitutes technical and experimental challenges for comparing the toxicity of ENDP aerosols with CS. The methods and experimental setups that have been developed for the study of CS cannot be directly transposed to the study of ENDP aerosols. This chapter describes adapted and new experimental setups and methods suitable for the study of ENDP aerosols.
Chapter
The scientific assessment of electronic nicotine delivery products is based on a framework that considers both the known epidemiology of smoking and cessation and the natural law of toxicology. Here we describe the fundamental scientific principles underpinning this framework and how this can be implemented in a comprehensive assessment program that covers many disciplines ranging from analytical chemistry to clinical sciences. We also describe the key challenges faced by this assessment and scientific approaches to address them. Finally, we discuss the importance of transparent sharing of methods and study data in this field of science as well as a platform to enable this.
Chapter
Smoking is a major cause of noncommunicable diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular diseases (CVDs). While the risk of smoking-related disease increases with the number of cigarettes smoked and the duration of smoking, it also decreases upon smoking cessation. The development of electronic nicotine delivery products (ENDPs) is aimed at providing smokers who will not quit with alternatives to cigarettes that present less risk of harm and smoking-related disease than cigarettes. It is necessary to rigorously assess the risk reduction potential of ENDPs through various types of studies to ensure ENDPs meet this objective. Premarket assessment of the disease risk reduction potential of ENDPs is hampered by (i) the dearth of biomarkers of potential harm that are predictive of future disease development, (ii) the latency of disease manifestation, and (iii) the slow reduction in excess risk upon cessation and, a fortiori, upon switching from cigarette smoking to the use of ENDPs. Long-term epidemiological data will allow to definitively verify that an ENDP reduces the risk of smoking-related disease compared with cigarettes and, if it does, to quantify the reduction in excess disease risk associated with an ENDP. For this to be possible, the ENDP would need to be available in the market and used exclusively by a large proportion of current smokers. Here, we propose that a mechanism-based approach represents a solid alternative to demonstrate in a premarket setting that switching to an ENDP is likely to significantly reduce the risk of smoking-related disease. This approach is based on the causal chain of events that leads from smoking to disease and leverages both nonclinical and clinical studies as well as the principles of systems toxicology. In this chapter, we review the available scientific evidence in the context of lung cancer, COPD, and CVD for both heated tobacco products and e-vapor products.
Chapter
A typical method for measuring the carcinogenic risk of chemical substances is to multiply the unit risk (the incremental risk of cancer for each μg/m³ of a chemical substance absorbed over a lifetime) of each substance by the quantity absorbed (degree of concentration). Researchers have modeled the respective cancer risks of conventional cigarettes, heated tobacco, and e-cigarettes, based on data on the harmful chemical substances contained in tobacco smoke [1]. The cancer risks, in decreasing order, are conventional cigarettes > heated tobacco > e-cigarettes. Current figures show that 2400 of every 100,000 smokers of 15 of conventional cigarettes per day are likely to develop cancer compared with 57 of every 100,000 users of 15 capsules per day of heated tobacco, and 9.5 of every 100,000 users of 30 L per day of e-cigarette aerosol inhaled. Switching to new tobacco products does greatly reduce the risk of cancer. However, these results cannot simply be taken at face value. Does it even make sense to compare these risks to the risk of conventional cigarettes? I will discuss this in detail later (see Chap. 8), but first, there are the three reasons why these statistics should not be taken at face value.
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Background: Although some studies have identified hazardous substances in electronic cigarette (EC) liquids and emissions, there is limited information about the health risks of using ECs. Methods: In this study, the U.S. Environmental Protection Agency (EPA) health risk assessment model and findings of a literature review were used to determine and profile hazards. Focus was put on the toxicants reported in the literature on conventional cigarette (CC) smoke that most strongly associated with adverse health effects. To evaluate their health risks, dose-response relationships and standard-use conditions were used to estimate average hazard exposures and to calculate the overall health risks of ECs and CCs, benchmarked against international guideline levels for each hazard. Results: Four hazards (acrolein, diethylene glycol, propylene glycol and cadmium) reported in EC emissions and seven hazards (acetaldehyde, acrolein, formaldehyde, cadmium, CO, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), N0-nitrosonornicotine (NNN)) reported in CC emissions had maximum exposure levels higher than the guideline levels. Two hazards (acrolein, propylene glycol) in EC emissions and five hazards (acetaldehyde, acrolein, formaldehyde, cadmium, NNN) in CC emissions had average exposure levels higher than the guideline levels. Conclusions: Based on the conditions of use, ECs should be a safer nicotine-delivery product than CCs.
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Knowledge of the mechanism of formation, levels and toxicological profiles of the chemical products in the aerosols (i.e., vapor plus particulate phases) of e-cigarettes is needed in order to better inform basic research as well as the general public, regulators, and industry. To date, studies of e-cigarette emissions have mainly focused on chromatographic techniques for quantifying and comparing the levels of selected e-cigarette aerosol components to those found in traditional cigarettes. E-cigarettes heat and aerosolize the solvents propylene glycol (PG) and glycerol (GLY), thereby affording unique product profiles as compared to traditional cigarettes. The chemical literature strongly suggests that there should be more compounds produced by PG and GLY than have been reported in e-cigarette aerosols to date. Herein we report an extensive investigation of the products derived from vaporizing PG and GLY under mild, single puff conditions. This has led to the discovery of several new compounds produced under vaping conditions. Prior reports on e-cigarette toxin production have emphasized temperature as the primary variable in solvent degradation. In the current study, the molecular pathways leading to enhanced PG/GLY reactivity are described, along with the most impactful chemical conditions promoting byproduct production.
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Background: Given the rapid increase in the popularity of e-cigarettes and the paucity of associated longitudinal health-related data, the need to assess the potential risks of long-term use is essential. Objective: To compare exposure to nicotine, tobacco-related carcinogens, and toxins among smokers of combustible cigarettes only, former smokers with long-term e-cigarette use only, former smokers with long-term nicotine replacement therapy (NRT) use only, long-term dual users of both combustible cigarettes and e-cigarettes, and long-term users of both combustible cigarettes and NRT. Design: Cross-sectional study. Setting: United Kingdom. Participants: The following 5 groups were purposively recruited: combustible cigarette-only users, former smokers with long-term (≥6 months) e-cigarette-only or NRT-only use, and long-term dual combustible cigarette-e-cigarette or combustible cigarette-NRT users (n = 36 to 37 per group; total n = 181). Measurements: Sociodemographic and smoking characteristics were assessed. Participants provided urine and saliva samples and were analyzed for biomarkers of nicotine, tobacco-specific N-nitrosamines (TSNAs), and volatile organic compounds (VOCs). Results: After confounders were controlled for, no clear between-group differences in salivary or urinary biomarkers of nicotine intake were found. The e-cigarette-only and NRT-only users had significantly lower metabolite levels for TSNAs (including the carcinogenic metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]) and VOCs (including metabolites of the toxins acrolein; acrylamide; acrylonitrile; 1,3-butadiene; and ethylene oxide) than combustible cigarette-only, dual combustible cigarette-e-cigarette, or dual combustible cigarette-NRT users. The e-cigarette-only users had significantly lower NNAL levels than all other groups. Combustible cigarette-only, dual combustible cigarette-NRT, and dual combustible cigarette-e-cigarette users had largely similar levels of TSNA and VOC metabolites. Limitation: Cross-sectional design with self-selected sample. Conclusion: Former smokers with long-term e-cigarette-only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette-only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes. Primary funding source: Cancer Research UK.
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Concerns have been raised about the potential health effects of potential bystander exposure to exhaled aerosols from e-vapor products (EVPs). An exhaled breath collection system (EBS) was developed and analytical methods were verified for collection and analysis of exhaled breath from users of EVPs. Analytical methods were adapted and verified for collection of environmental air samples during EVP use in an exposure chamber. Analysis of constituents in exhaled breath focused on nicotine, propylene glycol, and glycerin (because these are reported as the major constituents in EVPs) and selected carbonyl compounds (acetaldehyde, acrolein, and formaldehyde). Analysis of environmental samples included nicotine, propylene glycol, glycerin, 12 volatile organic compounds (VOCs), 15 carbonyl compounds and 4 metals. The EBS and analytical methods used were found to be suitable for collection and analysis of the target constituents in exhaled breath. Environmental sampling for background levels of VOCs and carbonyl compounds found only acetone, acetaldehyde, benzene, ethylbenzene, formaldehyde, isoprene, methyl ethyl ketone, hexaldehyde, propionaldehyde, and toluene above the limit of quantification in some samples. None of the targeted metals were detected. Background levels of VOCs and carbonyl compounds were consistent with levels previously reported for ambient air.
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Objectives To investigate how the two main electronic (e-) cigarette solvents—propylene glycol (PG) and glycerol (GL)—modulate the formation of toxic volatile carbonyl compounds under precisely controlled temperatures in the absence of nicotine and flavor additives. Methods PG, GL, PG:GL = 1:1 (wt/wt) mixture, and two commercial e-cigarette liquids were vaporized in a stainless steel, tubular reactor in flowing air ranging up to 318°C to simulate e-cigarette vaping. Aerosols were collected and analyzed to quantify the amount of volatile carbonyls produced with each of the five e-liquids. Results Significant amounts of formaldehyde and acetaldehyde were detected at reactor temperatures ≥215°C for both PG and GL. Acrolein was observed only in e-liquids containing GL when reactor temperatures exceeded 270°C. At 318°C, 2.03±0.80 μg of formaldehyde, 2.35±0.87 μg of acetaldehyde, and a trace amount of acetone were generated per milligram of PG; at the same temperature, 21.1±3.80 μg of formaldehyde, 2.40±0.99 μg of acetaldehyde, and 0.80±0.50 μg of acrolein were detected per milligram of GL. Conclusions We developed a device-independent test method to investigate carbonyl emissions from different e-cigarette liquids under precisely controlled temperatures. PG and GL were identified to be the main sources of toxic carbonyl compounds from e-cigarette use. GL produced much more formaldehyde than PG. Besides formaldehyde and acetaldehyde, measurable amounts of acrolein were also detected at ≥270°C but only when GL was present in the e-liquid. At 215°C, the estimated daily exposure to formaldehyde from e-cigarettes, exceeded United States Environmental Protection Agency (USEPA) and California Office of Environmental Health Hazard Assessment (OEHHA) acceptable limits, which emphasized the need to further examine the potential cancer and non-cancer health risks associated with e-cigarette use.
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Introduction: ECIGs are currently under scrutiny concerning their safety, particularly in reference to the impact ECIG liquids (E-liquids) have on human health. One concern is that aerosolized E-liquids contain trace metals that could become trapped in respiratory tissues and induce pathology. Methods: To mimic this trapping, peristaltic pumps were used to generate and transport aerosol onto mixed cellulose ester (MCE) membranes where aluminum (Al), arsenic (As), cadmium (Cd), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn) were subsequently captured and quantified. The presence of trace metals on unexposed MCE membranes and on MCE membranes exposed to mainstream smoke served as control and comparison, respectively. The presence of these metals was also determined from the E-liquid before aerosolization and untouched by the ECIG device. All metals were quantified using ICP-MS. The ECIG core assembly was analyzed using scanning electron microscopy with elemental analysis capability. Results: The contents (μg) of Al, As, Cd, Cu, Fe, Mn, Ni, Pb, and Zn on control MCE membranes were 1.2 ± 0.2, 0.050 ± 0.002, 0.047 ± 0.003, 0.05 ± 0.01, 0.001 ± 0.001, 0.16 ± 0.04, 0.005 ± 0.003, 0.014 ± 0.006, and 0.09 ± 0.02, respectively. The contents of all trace metals on MCE membranes exposed to aerosol were similar to controls, except Ni which was significantly (p < 0.01) higher (0.024 ± 0.004 μg). In contrast, contents of Al, As, Fe, Mn, and Zn on MCE membranes exposed to smoke were significantly higher (p < 0.05) than controls. The contents of Al, As, Cu, Fe, and Mn on smoke-exposed MCE membranes were also significantly higher (p < 0.05) than their content on aerosol-exposed membranes. The contents per cigarette equivalent of metals in E-liquid before aerosolization were negligible compared to amounts of aerosolized E-liquid, except for Fe (0.002 μg before and 0.001 μg after). Elemental analysis of the core assembly reveals the presence of several of these trace metals, especially Al, Fe, Ni, and Zn. Conclusions: In general, from the single ECIG-device/E-liquid combination used, the amount of trace metals from ECIG-generated aerosol are lower than in traditional mainstream smoke, Only Ni in the ECIG-generated aerosol was higher than control. The most probable source of Ni in this aerosol is the core assembly.
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Objectives Classify and describe the policy approaches used by countries to regulate e-cigarettes. Methods National policies regulating e-cigarettes were identified by (1) conducting web searches on Ministry of Health websites, and (2) broad web searches. The mechanisms used to regulate e-cigarettes were classified as new/amended laws, or existing laws. The policy domains identified include restrictions or prohibitions on product: sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/promotion/sponsorship, trademarks, and regulation requiring: taxation, health warning labels and child-safety standards. The classification of the policy was reviewed by a country expert. Results The search identified 68 countries that regulate e-cigarettes: 22 countries regulate e-cigarettes using existing regulations; 25 countries enacted new policies to regulate e-cigarettes; 7 countries made amendments to existing legislation; 14 countries use a combination of new/amended and existing regulation. Common policies include a minimum-age-of-purchase, indoor-use (vape-free public places) bans and marketing restrictions. Few countries are applying a tax to e-cigarettes. Conclusions A range of regulatory approaches are being applied to e-cigarettes globally; many countries regulate e-cigarettes using legislation not written for e-cigarettes.
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The Tobacco Heating System (THS) 2.2, a candidate Modified Risk Tobacco Product (MRTP), is designed to heat tobacco without burning it. Tobacco is heated in order to reduce the formation of harmful and potentially harmful constituents (HPHC), and reduce the consequent exposure, compared with combustible cigarettes (CC). In this 5-day exposure, controlled, parallel-group, open-label clinical study, 160 smoking, healthy subjects were randomized to three groups and asked to: (1) switch from CCs to THS 2.2 (THS group; 80 participants); (2) continue to use their own non-menthol CC brand (CC group; 41 participants); or (3) to refrain from smoking (SA group; 39 participants). Biomarkers of exposure, except those associated with nicotine exposure, were significantly reduced in the THS group compared with the CC group, and approached the levels observed in the SA group. Increased product consumption and total puff volume were reported in the THS group. However, exposure to nicotine was similar to CC at the end of the confinement period. Reduction in urge-to-smoke was comparable between the THS and CC groups and THS 2.2 product was well tolerated.
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Smoking conventional cigarettes (CCs) exposes smokers to harmful and potentially harmful constituents (HPHCs). The Tobacco Heating System 2.2 (THS 2.2), a candidate modified risk tobacco product, was developed to reduce or eliminate the formation of HPHCs, while preserving as much as possible the taste, sensory experience, nicotine delivery profile and ritual characteristics of CC. This randomized, controlled, open-label study in confinement for 5 day exposure aimed to demonstrate the reduction in exposure to selected HPHCs, to assess nicotine uptake and subjective effects, in participants switching to THS 2.2 (n = 80) compared to participants continuing smoking CCs (n = 40) and abstaining from smoking (n = 40). The subjects were randomized according to sex and daily CC consumption. The levels of biomarkers of exposure to HPHCs were significantly reduced in participants switching to THS 2.2, compared to CC use. More importantly, the magnitude of exposure reduction observed was close to that which was seen in participants who abstained from smoking for 5 days, while nicotine uptake was maintained. Reduction in urge-to-smoke was comparable between THS and CC groups, however THS 2.2 was slightly less satisfactory than CCs. The new, alternative tobacco product THS 2.2 was well tolerated.
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Electronic cigarettes (e-cigarettes, ECIGs) were introduced into the market a decade ago as an alternative to tobacco smoking. Whether ECIGs are safe and whether they qualify as smoking cessation tool is currently unknown. Their use has markedly expanded in that period, despite the fact that potential toxic effects of the vapour created by the e-cigarette and the nicotine-containing cartridge fluid have been incompletely studied. Marketing targets diverse groups including older smokers but also young people. Whereas the adverse health effects of nicotine inhaled by users of ECIGs has been well documented, less is known about the other components. An increasing number of in vitro and in vivo studies demonstrate a range of adverse effects of both the vapour created by ECIGs as well as the nicotine-containing fluid. Importantly, these studies demonstrate that toxicity from ECIGs, although this may be less than that caused by tobacco products, not only arises from its nicotine content. Furthermore, there are no data on the long-term consequences of ECIG use. The wide range of ECIG products available to consumers and the lack of standardisation of toxicological approaches towards ECIG evaluation complicates the assessment of adverse health effects of their use. Here we review the current data on preclinical studies on ECIGs describing their effects in cell culture and animal models.
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Low levels of thermal degradation products such as carbonyls (formaldehyde, acetaldehyde, acrolein, crotonaldehyde) have been reported in e-cigarette aerosols. The collection and analysis of e-cigarette aerosol carbonyls are often adapted from methods developed for tobacco cigarette smoke. These methodologies are often not sensitive enough to detect low carbonyl levels in e-cigarette aerosols. One objective of this work was to develop and validate a rapid, selective and sensitive ultra-performance liquid chromatography with mass spectrometry method optimized for analysis of carbonyls in e-cigarette aerosols. Aerosols were trapped in 20-puff collections, 4-s durations, 55-mL volumes, 30-s intervals, square wave puff profiles. Collection apparatus involved a linear smoking machine with Cambridge filter pad followed by a glass impinger containing acidified 2,4-dinitrophenylhydrazine. This method showed limits of quantitation and detection of 0.016 and 0.003 µg puff⁻¹, respectively, and run time of 4 min. Six e-cigarettes were evaluated (five devices each). All contained measurable levels of carbonyls. Levels were mostly well below those in conventional cigarettes. However, for some e-cigarettes, formaldehyde levels were above those for tobacco cigarettes (highest at 14.1 µg puff⁻¹). Temperatures related to carbonyl yields in e-cigarette aerosols were explored to better understand carbonyl formation: formation of formaldehyde is low at temperatures below 350°C.
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This publication introduces a series of eight other publications describing the non-clinical assessment and initial clinical study of a candidate modified risk tobacco product (MRTP) – the Tobacco Heating System 2.2 (THS2.2). This paper presents background information on tobacco harm reduction, to complement the approaches of increasing smoking cessation and reducing smoking initiation to reduce the morbidity and mortality caused by cigarette smoking. THS2.2 heats tobacco without combustion, and the subsequent formation of harmful and potentially harmful constituents (HPHC) is greatly reduced compared with cigarette smoke. Assessment of the THS2.2 aerosol in vitro and in vivo reveals reduced toxicity and no new hazards. Additional mechanistic endpoints, measured as part of in vivo studies, confirmed reduced impact on smoking-related disease networks. The clinical study confirmed the reduced exposure to HPHCs in smokers switching to THS2.2, and the associated transcriptomic study confirmed the utility of a gene expression signature, consisting of only 11 genes tested in the blood transcriptome of subjects enrolled in the clinical study, as a complementary measure of exposure response. The potential of THS2.2 as an MRTP is demonstrated by the assessment and additional publications cited in this series.
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To review the evidence for the short term association between air pollution and stroke. Systematic review and meta-analysis of observational studies Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. Admission to hospital and mortality from stroke. From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM2·5. Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. PROSPERO-CRD42014009225. © Shah et al 2015.
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Tobacco smoke is a major risk to the health of its users and arsenic is among the components of smoke present at concentrations of toxicological concern. There are significant variations in human toxicity between inorganic and organic arsenic species and the aim of this study was to determine whether there are predictable relationships among major arsenic species in tobacco that could be useful for risk assessment. 14 samples of tobacco were studied spanning a wide range of concentrations in samples from different geographical regions, including certified reference materials and cigarette products. Inorganic and major organic arsenic species were extracted from powdered tobacco samples by nitric acid using microwave digestion. Concentrations of arsenic species in these extracts were determined using HPLC-ICPMS. The concentrations of total inorganic arsenic species range from 144 to 3914 μg kg(-1), while organic species dimethylarsinic acid (DMA) ranges from 21 to 176 μg As kg(-1), and monomethylarsonic acid (MA) ranges from 30 to 116 μg kg(-1). The percentage of species eluted compared to the total arsenic extracted ranges from 11.1 to 36.8% suggesting that some As species (possibly macro-molecules, strongly complexed or in organic forms) do not elute from the column. This low percentage of column-speciated arsenic is indicative that more complex forms of arsenic exist in the tobacco. All the analysed species correlate positively with total arsenic concentration over the whole compositional range and regression analysis indicates a consistent ratio of about 4:1 in favour of inorganic arsenic compared with MA + DMA. The dominance of inorganic arsenic species among those components analysed is a marked feature of the diverse range of tobaccos selected for study. Such consistency is important in the context of a WHO expert panel recommendation to regulate tobacco crops and products using total arsenic concentration. If implemented more research would be required to develop models that accurately predict the smoker's exposure to reduced inorganic arsenic species on the basis of leaf or product concentration and product design features.
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Leading commercial electronic cigarettes were tested to determine bulk composition. The e-cigarettes and conventional cigarettes were evaluated using machine-puffing to compare nicotine delivery and relative yields of chemical constituents. The e-liquids tested were found to contain humectants, glycerin and/or propylene glycol, (⩾75% content); water (<20%); nicotine (approximately 2%); and flavor (<10%). The aerosol collected mass (ACM) of the e-cigarette samples was similar in composition to the e-liquids. Aerosol nicotine for the e-cigarette samples was 85% lower than nicotine yield for the conventional cigarettes. Analysis of the smoke from conventional cigarettes showed that the mainstream cigarette smoke delivered approximately 1500 times more harmful and potentially harmful constituents (HPHCs) tested when compared to e-cigarette aerosol or to puffing room air. The deliveries of HPHCs tested for these e-cigarette products were similar to the study air blanks rather than to deliveries from conventional cigarettes; no significant contribution of cigarette smoke HPHCs from any of the compound classes tested was found for the e-cigarettes. Thus, the results of this study support previous researchers’ discussion of e-cigarette products’ potential for reduced exposure compared to cigarette smoke.
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Background: Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM2.5 and PM10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence. Objective: Our goal was to provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer. Methods: We conducted meta-analyses of studies examining the relationship of exposure to PM2.5 and PM10 with lung cancer incidence and mortality. In total, 18 studies met our inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m3 increase in exposure to PM. We used random-effects analyses to allow between-study variability to contribute to meta-estimates. Results: The meta-relative risk for lung cancer associated with PM2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as subanalyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM2.5 was greatest for former smokers [1.44 (95% CI: 1.04, 1.22)], followed by never-smokers [1.18 (95% CI: 1.00, 1.39)], and then current smokers [1.06 (95% CI: 0.97, 1.15)]. In addition, meta-estimates for adenocarcinoma associated with PM2.5 and PM10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively. Conclusion: The results of these analyses, and the decision of the IARC Working Group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources.
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Glycerin (VG) and propylene glycol (PG) are the most common nicotine solvents used in e-cigarettes (ECs). It has been shown that at high temperatures both VG and PG undergo decomposition to low molecular carbonyl compounds, including the carcinogens: formaldehyde and acetaldehyde. The aim of the study was to evaluate how various product characteristics, including nicotine solvent and battery output voltage, affect the levels of carbonyls in EC vapor. Twelve carbonyl compounds were measured in vapors from 10 commercially available nicotine solutions and from three control solutions composed of pure glycerin, pure propylene glycol, or a mixture of both solvents (50:50). EC battery output voltage was gradually modified from 3.2 to 4.8V. Carbonyl compounds were determined using HPLC/DAD method. Formaldehyde and acetaldehyde were found in 8 of 13 samples. The amounts of formaldehyde and acetaldehyde in vapors from lower voltage EC were on average 13- and 807-fold lower than in tobacco smoke, respectively. The highest levels of carbonyls were observed in vapors generated from PG-based solutions. Increasing voltage from 3.2 to 4.8V resulted in 4 to over 200 times increase in formaldehyde, acetaldehyde, and acetone levels. The levels of formaldehyde in vapors from high-voltage device were in the range of levels reported in tobacco smoke. Vapors from EC contain toxic and carcinogenic carbonyl compounds. Both solvent and battery output voltage significantly affect levels of carbonyl compounds in EC vapors. High-voltage EC may expose users to high levels of carbonyl compounds.
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