Electronic cigarettes: what are they and what do they do?
ABSTRACT: Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
Project description:Electronic cigarettes (ECIGs) electrically heat and aerosolize a liquid containing propylene glycol (PG), vegetable glycerin (VG), flavorants, water, and nicotine. ECIG effects and proposed methods to regulate them are controversial. One regulatory focal point involves nicotine emissions. We describe a mathematical model that predicts ECIG nicotine emissions. The model computes the vaporization rate of individual species by numerically solving the unsteady species and energy conservation equations. To validate model predictions, yields of nicotine, total particulate matter, PG, and VG were measured while manipulating puff topography, electrical power, and liquid composition across 100 conditions. Nicotine flux, the rate at which nicotine is emitted per unit time, was the primary outcome. Across conditions, the measured and computed nicotine flux were highly correlated (r = 0.85, p<.0001). As predicted, device power, nicotine concentration, PG/VG ratio, and puff duration influenced nicotine flux (p<.05), while water content and puff velocity did not. Additional empirical investigation revealed that PG/VG liquids act as ideal solutions, that liquid vaporization accounts for more than 95% of ECIG aerosol mass emissions, and that as device power increases the aerosol composition shifts towards the less volatile components of the parent liquid. To the extent that ECIG regulations focus on nicotine emissions, mathematical models like this one can be used to predict ECIG nicotine emissions and to test the effects of proposed regulation of factors that influence nicotine flux.
Project description:Electronic nicotine delivery systems (ENDS), which includes e-cigarettes (ECIGs), are a rapidly-expanding class of products that heat a liquid (which may or may not contain nicotine) to produce an aerosol. The variation of ECIG components is extensive as are their effects on users. Epidemiological data show that while both adults and youth use ECIGs, use among youth has increased dramatically in recent years. Other epidemiological data show that women of reproductive age and some pregnant women are also using ECIGs. The goal of this article is to provide readers with background information about ECIGs, with a focus on recent findings about ECIG use in pregnancy and potential implications. Among pregnant women, correlates of ECIG use include current cigarette smoking, among other factors. Regarding pregnant women's perceptions of ECIG use in pregnancy, two themes emerge from the literature: many pregnant women perceive ECIGs to be safer than conventional cigarettes, and that ECIGs can aid with smoking cessation. In contrast to these perceptions, there is little concrete evidence that ECIGs help smokers quit. In addition, there are concerns about ECIG nicotine and other toxicant delivery. Nicotine is a toxicant of particular concern for pregnant women, as nicotine is known to harm a developing fetus. There are many limitations to existing research, and the literature is scant in this area. Further, new "pod mod"-style ECIGs such as JUUL present new challenges. Overall, with limited evidence of their effectiveness, and concerns about developmental toxicology, the authors do not recommend that pregnant women use ECIGs.
Project description:Electronic cigarettes (ECIGs) heat and vaporize a liquid mixture to produce an inhalable aerosol that can deliver nicotine to the user. The liquid mixture is typically composed of propylene glycol (PG) and vegetable glycerin (VG), in which are dissolved trace quantities of flavorants and, usually, nicotine. Due to their different chemical and thermodynamic properties, the proportions of PG and VG in the liquid solution may affect nicotine delivery and user sensory experience. In social media and popular culture, greater PG fraction is associated with greater "throat-hit", a sensation that has been attributed in cigarette smokers to increased presence of vapor-phase nicotine. VG, on the other hand, is associated with thicker and larger exhaled "clouds". In this study, we aim to investigate how PG/VG ratio influences variables that relate to nicotine delivery and plume visibility. Aerosols from varying PG/VG liquids were generated using a digitally controlled vaping instrument and a commercially available ECIG, and analyzed for nicotine content by GC-MS. Particle mass and number distribution were determined using a six-stage cascade impactor and a fast particle spectrometer (TSI EEPS), with tightly controlled dilution and sampling biases. A Mie theory model was used to compute the aerosol scattering coefficients in the visible spectrum. Decreasing the PG/VG ratio resulted in a decrease in total particulate matter (TPM) and nicotine yield (R2 > 0.9, p<.0001). Measured particle count median diameter ranged between 44-97nm, and was significantly smaller for PG liquids. Although the particle mass concentration was lower, aerosols produced using liquids that contained VG had an order of magnitude greater light scattering coefficients. These findings indicate that PG/VG ratio is a strong determinant of both nicotine delivery and user sensory experience.
Project description:INTRODUCTION:Electronic cigarettes (ECIGs) electrically heat and vaporize a liquid solution to produce an inhalable nicotine-containing aerosol. Normally the electrical heater is fed the liquid via an automatic wick system. Some ECIG users, however, elect to directly drip liquid onto an exposed heater coil, reportedly for greater vapor production and throat hit. Use of such "direct drip atomizers" (DDAs) may involve greater exposure to non-nicotine toxicants due to the potentially higher temperatures reached by the coil. In this study we examined nicotine and volatile aldehyde (VA) emissions from one type of DDA under various use scenarios, and measured heater temperature. METHODS:Aerosols were machine-generated from an NHALER 510 Atomizer powered by an eGo-T battery (Joyetech), using a common PG-based liquid and a fixed puffing regimen. Inter-drip interval, the number of puffs drawn between replenishing the liquid on the coil, was varied from 2-4 puffs/drip. Total particulate matter, nicotine, and VA yields were quantified. Heater temperature was monitored using an infrared camera. RESULTS:Depending on the condition, VA emissions, including formaldehyde, greatly exceeded values previously reported for conventional ECIGs and combustible cigarettes, both per puff and per unit of nicotine yield. Increasing the inter-drip interval resulted in greater VA emissions, and lower total particulate matter and nicotine yields. Maximum heater coil temperature ranged from 130°C to more than 350°C. CONCLUSIONS:Due to the higher temperatures attained, DDAs are inherently likely to produce high toxicant emissions. The diversity of ECIG use methods, including potential off-label methods, should be considered as ECIG regulatory efforts proceed.
Project description:BACKGROUND:Electronic cigarettes (ECIGs) are a class of tobacco products that produce different effects (e.g., nicotine delivery), depending on the device, liquid, and behavioral factors. However, the influence of the two primary ECIG liquid solvents, propylene glycol (PG) and vegetable glycerin (VG), on ECIG acute effects is unknown. METHODS:Thirty ECIG-experienced, ?12-h nicotine- abstinent participants completed four conditions consisting of two ECIG-use bouts (10 puffs, 30?s interpuff-interval) differing only by liquid PG:VG ratio (2PG:98VG, 20PG:80VG, 55PG:45VG, 100PG). Device power (7.3?W) and liquid nicotine concentration (18?mg/ml) remained constant. Nicotine delivery, subjective effects, heart rate (HR), and puff topography were assessed. RESULTS:In the 100PG condition, participants took shorter and smaller puffs but obtained significantly more nicotine relative to the two VG-based conditions. Total nicotine exposure (i.e., area under the curve) was also significantly higher during use of the two PG-based liquids. However, participants reported that the 100?PG liquid was significantly less "pleasant" and "satisfying" relative to the other liquids (all ps?<?.05). Increases in HR and decreases in abstinence symptoms (e.g., "craving") did not differ across conditions. CONCLUSIONS:PG:VG ratio influenced nicotine delivery, some subjective effects, and puff topography. Lower overall product satisfaction associated with the 100PG liquid suggests factors other than nicotine delivery (e.g., aerosol visibility) may play a role in maintaining ECIG use. Regulating ECIG acute effects such as nicotine delivery and subjective effects may require simultaneous attention to liquid PG:VG ratio as well as device, liquid, and behavioral factors known to influence these outcomes.
Project description:INTRODUCTION:JUUL is an electronic cigarette (ECIG) with a compact form factor. It is prefilled with a liquid that is advertised to contain a high concentration of nicotine salt. JUUL commands 50% of the US ECIG market share, and its wide popularity with underage users has triggered unprecedented actions by the US FDA. Apart from its nicotine salt-containing liquid and compact form, a salient advertised design feature is a control circuit that limits the heating coil temperature, presumably reducing unwanted toxicants. In this study, several tobacco-flavoured JUUL devices were reverse engineered, and their aerosol emissions were studied. METHODS:Total nicotine and its partitioning (freebase and protonated), propylene glycol/vegetable glycerin (PG/VG) ratio, and carbonyls were quantified by gas chromatography (GC) and high performance liquid chromatography (HPLC). The temperature control functionality of JUUL was investigated using a temperature-controlled bath in which the coil was submerged. RESULTS:The liquid nicotine concentration was found to be 69?mg/mL, and the liquid and aerosol PG/VG ratio was found to be 30/70. In 15 puffs, JUUL emitted 2.05 (0.08) mg of nicotine, overwhelmingly in the protonated form. Carbonyl yields were significantly lower than those reported for combustible cigarettes, but similar to other closed-system ECIG devices. The heating coil resistance was 1.6 (0.66) Ohm, while the maximum power delivered by the JUUL device was 8.1 W. The control circuit limited the peak operating temperature to approximately 215C. CONCLUSIONS:JUUL emits a high-nicotine concentration aerosol predominantly in the protonated form. JUUL's nicotine-normalised formaldehyde and total aldehyde yields are lower than other previously studied ECIGs and combustible cigarettes.
Project description:Popularity of electronic cigarettes (ECIGs) has increased tremendously among young people, in part due to flavoring additives in ECIG liquids. Pyrazines are an important class of these additives, and their presence in tobacco cigarettes has been correlated with increased acceptability of smoking among smokers and bystanders. Pyrazine use by the tobacco industry is therefore thought to encourage smoking. However, the extent of transfer of pyrazines present in the liquid to aerosols upon vaping remains unclear. We present a simple analytical method to quantify six pyrazine derivatives in liquids and aerosols of ECIGs that allows the isolation of pyrazines from interfering compounds, like nicotine. Standard pyrazine solutions and commercial ECIG samples of different brands and flavors were tested for their pyrazine content in the liquids and in the generated aerosols from these solutions. Testing on ECIG commercial liquids revealed a heterogeneous distribution in the levels and types of pyrazines, with acetyl and alkyl pyrazines present in more than 70% of the samples. This method confirmed that pyrazine additives are common in ECIG and that labels do not usually reflect the type and quantity of pyrazines in the liquid. Pyrazines were not correlated with the nicotine content or the brand of the liquid. The aerosols showed similar pyrazine profiles to their corresponding liquids. The efficiency of transfer of pyrazines into the particle phase was approximately 46%. Therefore, addition of pyrazines to ECIGs should be regulated, because they act synergistically with nicotine to increase product appeal, ease smoking initiation, and discourage cessation.
Project description:BACKGROUND:This study is a systematic evaluation of a novel tobacco product, electronic cigarettes (ECIGs) using a two-site, four-arm, 6-month, parallel-group randomized controlled trial (RCT) with a follow-up to 9 months. Virginia Commonwealth University is the primary site and Penn State University is the secondary site. This RCT design is important because it is informed by analytical work, clinical laboratory results, and qualitative/quantitative findings regarding the specific ECIG products used. METHODS:Participants (N?=?520) will be randomized across sites and must be healthy smokers of >9 cigarettes for at least one year, who have not had a quit attempt in the prior month, are not planning to quit in the next 6 months, and are interested in reducing cigarette intake. Participants will be randomized into one of four 24-week conditions: a cigarette substitute that does not produce an inhalable aerosol; or one of three ECIG conditions that differ by nicotine concentration 0, 8, or 36 mg/ml. Blocked randomization will be accomplished with a 1:1:1:1 ratio of condition assignments at each site. Specific aims are to: characterize ECIG influence on toxicants, biomarkers, health indicators, and disease risk; determine tobacco abstinence symptom and adverse event profile associated with real-world ECIG use; and examine the influence of ECIG use on conventional tobacco product use. Liquid nicotine concentration-related differences on these study outcomes are predicted. Participants and research staff in contact with participants will be blinded to the nicotine concentration in the ECIG conditions. DISCUSSION:Results from this study will inform knowledge concerning ECIG use as well as demonstrate a model that may be applied to other novel tobacco products. The model of using prior empirical testing of ECIG devices should be considered in other RCT evaluations. TRIAL REGISTRATION:TRN: NCT02342795 , registered December 16, 2014.
Project description:<h4>Introduction</h4>Available in hundreds of device designs and thousands of flavors, electronic cigarette (ECIG) may have differing toxicant emission characteristics. This study assesses nicotine and carbonyl yields in the most popular brands in the U.S. market. These products included disposable, prefilled cartridge, and tank-based ECIGs.<h4>Methods</h4>Twenty-seven ECIG products of 10 brands were procured and their power outputs were measured. The e-liquids were characterized for pH, nicotine concentration, propylene glycol/vegetable glycerin (PG/VG) ratio, and water content. Aerosols were generated using a puffing machine and nicotine and carbonyls were, respectively, quantified using gas chromatograph and high-performance liquid chromatography. A multiregression model was used to interpret the data.<h4>Results</h4>Nicotine yields varied from 0.27 to 2.91 mg/15 puffs, a range corresponding to the nicotine yield of less than 1 to more than 3 combustible cigarettes. Nicotine yield was highly correlated with ECIG type and brand, liquid nicotine concentration, and PG/VG ratio, and to a lower significance with electrical power, but not with pH and water content. Carbonyls, including the carcinogen formaldehyde, were detected in all ECIG aerosols, with total carbonyl concentrations ranging from 3.72 to 48.85 µg/15 puffs. Unlike nicotine, carbonyl concentrations were mainly correlated with power.<h4>Conclusion</h4>In 15 puffs, some ECIG devices emit nicotine quantities that exceed those of tobacco cigarettes. Nicotine emissions vary widely across products but carbonyl emissions showed little variations. In spite of that ECIG users are exposed to toxicologically significant levels of carbonyl compounds, especially formaldehyde. Regression analysis showed the importance of design and e-liquid characteristics as determinants of nicotine and carbonyl emissions.<h4>Implications</h4>Periodic surveying of characteristics of ECIG products available in the marketplace is valuable for understanding population-wide changes in ECIG use patterns over time.
Project description:Background: Smoking is the number one predictor for the development of periodontal disease. Consequently, electronic cigarette (ECIG) use has prompted investigations into the health-related risks induced by ECIG-generated aerosol on oral commensal bacteria as compared to cigarette smoke. Since E-liquid contains fewer constituents than smoke, we hypothesize that growth media containing E-liquid or aerosol has less impact on oral commensal streptococci than cigarette smoke. Methods: Eight-hour growth curves were generated for three strains of streptococci following exposure of growth media to nicotine alone (0.05, 0.1, 0.2 mg/mL), E-liquid ± nicotine (2.3, 4.7, 7.0 µL/mL), ECIG-generated aerosol ± nicotine (25, 50, 75 puffs), or cigarette smoke (2, 5, 10, 25, 50, 75 puffs). Nicotine and E-liquid were added to the media at concentrations equivalent to vaporized amounts of 25, 50, or 75 puffs. Absorbance readings were taken at 0, 2, 4, 6, and 8 h of bacterial growth. Results: Both E-liquid and aerosol (±nicotine) had little to no effect on eight-hour streptococcal growth. In contrast, five puffs of smoke inhibited streptococcal growth. Conclusions: Smoke-treated growth media, but not E-liquid or ECIG-generated aerosol, inhibits the growth of oral commensal streptococci. A possible implication is that aerosol may induce less periodontitis than smoke.