Systemic absorption of nicotine following acute secondhand exposure to electronic cigarette aerosol in a realistic social setting

Evidence suggests exposure of nicotine-containing e-cigarette aerosol to nonusers leads to systemic absorption of nicotine. However, no studies have examined acute secondhand exposures that occur in public settings. Here, we measured the serum, saliva and urine of nonusers pre- and post-exposure to nicotine via e-cigarette aerosol. Secondarily, we recorded factors affecting the exposure.Six nonusers of nicotine-containing products were exposed to secondhand aerosol from ad libitum e-cigarette use by three e-cigarette users for 2?h during two separate sessions (disposables, tank-style). Pre-exposure (baseline) and post-exposure peak levels (Cmax) of cotinine were measured in nonusers’ serum, saliva, and urine over a 6-hour follow-up, plus a saliva sample the following morning. We also measured solution consumption, nicotine concentration, and pH, along with use behavior.Baseline cotinine levels were higher than typical for the US population (median serum session one?=?0.089?ng/ml; session two?=?0.052?ng/ml). Systemic absorption of nicotine occurred in nonusers with baselines indicative of no/low tobacco exposure, but not in nonusers with elevated baselines. Median changes in cotinine for disposable exposure were 0.007?ng/ml serum, 0.033?ng/ml saliva, and 0.316?ng/mg creatinine in urine. For tank-style exposure they were 0.041?ng/ml serum, 0.060?ng/ml saliva, and 0.948?ng/mg creatinine in urine. Finally, we measured substantial differences in solution nicotine concentrations, pH, use behavior and consumption.Our data show that although exposures may vary considerably, nonusers can systemically absorb nicotine following acute exposure to secondhand e-cigarette aerosol. This can particularly affect sensitive subpopulations, such as children and women of reproductive age.     

Composition and chemical health hazards of the most common electronic cigarette liquids in nine European countries

Abstract

Background: The aim of the present study was to identify the composition and reported chemical health hazards of the most common electronic cigarette liquids (e-liquids) in nine European Union (EU) Member States (MS) prior to adoption of the Tobacco Product Directive (TPD).

Materials and methods: Within the Horizon2020, EUREST-PLUS study, 122 of the most commonly sold e-liquids in 9 EU MS were randomly selected and purchased. A quantitative and qualitative chemical analysis was performed using a previously validated based gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry method. The most commonly detected compounds were then divided according to the Danger Globally Harmonized System of Classification and Labelling of Chemicals (GHS) and Warning GHS codes.

Results: Within our qualitative analysis, 171 different compounds were detected. Discrepancies in measured versus reported nicotine concentration were identified. Forty-one (85.4%) of the most commonly detected compounds were registered with Warning GHS codes, 11 with Danger GHS codes and 9 with both codes. Of the total number of the detected compounds, 293 were attributable to fruits flavor, followed by tobacco flavor (204), nonalcoholic drinks (n?=?64), desserts–sweets (n?=?50), menthol – mint (n?=?42) and alcohol (n?=?39). Menthol which is classified as a strong irritant to skin and eye was the most frequently detected compound.

Conclusion: A large plethora of compounds with varying warning codes was identified in e-cigarette samples. The systematic monitoring and chemical evaluation of e-liquids are warranted, so as to ensure consumer protection.     

E-cigarette vape and lung ACE2 expression: Implications for coronavirus vulnerability

Evidence in humans suggests a correlation between nicotine smoking and severe respiratory symptoms with COVID-19 infection. In lung tissue, angiotensin-converting enzyme 2 (ACE2) appears to mechanistically underlie viral entry. Here, we investigated whether e-cigarette vapor inhalation alters ACE2 and nicotinic acetylcholine receptor (nAChR) expression in male and female mice. In male lung, nicotine vapor inhalation induced a significant increase in ACE2 mRNA and protein, but surprisingly, these differences were not found in females. Further, both vehicle and nicotine vapor inhalation downregulated α5 nAChR subunits in both sexes, while differences were not found in α7 nAChR subunit expression. Finally, blood ACE2 levels did not differ with exposure, indicating that blood sampling is not a sufficient indicator of lung ACE2 changes. Together, these data indicate a direct link between e-cigarette vaping and increased ACE2 expression in male lung tissue, which thereby reveals an underlying mechanism of increased vulnerability to coronavirus infection in individuals vaping nicotine.     

E-cigarette-associated Severe Pneumonia in Korea Using Data Linkage between the Korea National Health and Nutrition Examination Survey (KNHANES, 2013–2019) and the National Health Insurance Service (NHIS) Claims Database

BackgroundThis study aimed to investigate the association between e-cigarette (EC) use and development of acute severe pneumonia in the Korean population using a national database.MethodsWe conducted a retrospective analysis using linkage of data between the Korean National Health and Nutrition Examination Survey (KNHANES) and the National Health Insurance Service (NHIS) administrative claims database. The primary endpoint of this study was development of severe pneumonia requiring hospital admission according to EC use during the study period. The secondary endpoints were in-hospital mortality, intensive care unit (ICU) admission, ventilator care, and days of hospital stay.ResultsThe final analysis included 28,950 individuals, of which 578 (2.0%) were EC users. EC users were younger and more often male than non-EC users. The EC users showed higher level of education and household income and had fewer comorbidities. Severe pneumonia was noted in 37 of 28,372 non-EC users (0.13%), but there were no occurrences of severe pneumonia in EC users. The incidence of pneumonia occurrence was not different between the two groups (P = 1.000).ConclusionsSince e-cigarette or vaping use-associated lung injury (EVALI) is most likely included in acute severe pneumonia occurring within 3 months of EC use, it is considered that there might be no EVALI patients in Korea during the investigation period. A large-scale, prospective study is necessary to evaluate the association between EC use and acute lung injury.     

湖北省在校中学生电子烟使用现况与影响因素分析

目的 了解湖北省在校中学生电子烟使用现状并分析其影响因素,为进一步开展校园控烟工作提供科学依据。 方法 采用多阶段分层整群随机抽样法,2019年6至12月,对湖北省在校初中、高中、职业高中生共8414名学生进行问卷调查,问卷使用全球青少年烟草调查（GYTS）中国项目问卷。对问卷中电子烟使用情况、电子烟预期使用情况的差异采用率与〖XC小五号.EPSP〗检验进行分析,使用非条件logistic回归分析电子烟使用的影响因素。结果 湖北省在校中学生电子烟尝试使用率和现在使用率分别为8.2%和1.6%,有26.1%的中学生在使用电子烟后会使用传统卷烟。电子烟预期使用情况分析显示:使用过电子烟的中学生中,有59.7%会在朋友给电子烟时使用电子烟,未来12个月使用电子烟的概率（29.6%）显著高于未使用电子烟的中学生（1.7%）（P均<0.01）。Logistic回归分析显示:职业高中生电子烟使用风险高于初中生,OR（95%CI）为1.50（1.16~1.94）,女生使用电子烟的风险低于男生,OR（95%CI）为0.29（0.24~0.36）,一周零用钱数越高,电子烟使用风险越高,OR（95%CI）为1.34（1.20~1.51）,年级越高,电子烟使用风险越高OR值（95%CI）为1.22（1.09~1.36）。相对于从不吸烟者,戒烟和现在吸烟学生电子烟使用风险较高,OR值（95%CI）分别为11.91（9.7~14.62）和24.88（16.3~38.0）。 结论 湖北省中学生电子烟使用较普遍,电子烟使用是传统烟草成瘾的“入门效应”,性别、学校类型、零花钱数、吸烟行为是中学生学生电子烟使用的影响因素。     

Patterns of e-cigarette use and self-reported health outcomes among smokers and non-smokers in the United States: A preliminary assessment

Background: This preliminary assessment evaluates the patterns of e-cigarette use and self-reported health outcomes in the United States. Methods: Multinomial logistic regressions were (baseline wave 2013-2014) performed by using a nationally representative sample with self-reported health measures, including overall, physical, and mental health, and quality of life, as outcomes of interest. Measurements were based on “excellent,” “very good,” “good,” “fair,” and “poor” responses. Results: Among non-cigarette smokers, e-cigarette users had lower chance of reporting good mental health, compared with those non-users (RRR[Relative Risk Ratio] = 0.66). When the respondents used e-cigarette products containing nicotine, the risk for reporting poor mental health was higher (RRR = 1.87). Among cigarette smokers, more use of e-cigarette cartridges was associated with higher risk of mental health (RRR = 1.12). Poor quality of life was associated with regular e-cigarette use. If smokers used e-cigarette products with nicotine, the risk of reporting poor quality of life was lower than individuals who did not use such products (RRR = 0.49). Higher concentration of nicotine in e-cigarette cartridges was associated with higher risks of poor physical and poor overall health, and with lower chance of excellent mental health. Conclusions: Health practitioners should evaluate the benefits and harms of using e-cigarettes and the effects on human health.