Sugar and Aldehyde Content in Flavored Electronic Cigarette Liquids

Fagan, Pebbles; Pokhrel, Pallav; Herzog, Thaddeus A.; Moolchan, Eric T.; Cassel, Kevin; Franke, Adrian A.; Li, Xingnan; Pagano, Ian; Trinidad, Dennis R.; Sakuma, Kazuhiko; Sterling, Kymberle L.; Jorgensen, Dorothy; Lynch, Tania; Kawamoto, Crissy T.; Guy, Mignonne C.; Lagua, Ian Joseph N.; Hanes, Sarah; Alexander, Linda; Clanton, Mark S.; Graham-Tutt, Camonia; Eissenberg, Thomas; Workgroup, Addictive Carcinogens

doi:10.1093/ntr/ntx234

Cited by 37 publications

(52 citation statements)

References 33 publications

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“…As mentioned earlier, recent studies have shown that these compounds degrade into aldehydes when heated, however, to a much lesser extent than certain flavourings. These studies have also found aldehydes in unheated e‐liquids 15 . One study conducted on rats determined that PG and VG aerosols showed limited biological effects and limited toxicity, whereas PG and VG with nicotine aerosols resulted in toxic lung and metabolic effects 67 …”

Section: Toxicological Effects Of E‐cigarettesmentioning

confidence: 98%

“…There are no medicinally licensed nicotine vaping products in the United Kingdom. In 2016, the FDA declared that ECs and flavoured e‐cigarette liquids are tobacco products and are therefore subject to regulation that governs their manufacturing, marketing and distribution 15 …”

Section: Laws and Levels Around The Worldmentioning

confidence: 99%

“…Although formaldehyde, acetaldehyde and acrolein are formed when the sugars in the e‐liquids break down due to heating, these compounds have been found in unheated e‐liquids. It is important to quantify levels of sugars (glucose, sucrose and fructose) in e‐liquids to determine how much formaldehyde, acetaldehyde and acrolein the user would potentially be exposed to as aldehydes are known to cause respiratory irritation 15,58 …”

Section: Other Ingredients and Compounds In E‐liquidsmentioning

confidence: 99%

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A review of nicotine‐containing electronic cigarettes—Trends in use, effects, contents, labelling accuracy and detection methods

Taylor

Dunn

Turfus

2021

Drug Testing and Analysis

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Electronic cigarettes (ECs) are thought to be less harmful than traditional combustible cigarettes and were originally intended to help smokers quit. Over the past two decades, they have especially gained popularity with the younger generation. To date, there are over 7000 unique e‐liquid flavours available and over 400 different e‐cigarette brands. The accuracy of nicotine strength labelling in e‐liquids was assessed in this work. Twenty‐three studies from around the world were chosen to assess the level and frequency of nicotine mislabelling in 545 e‐liquid products. Nicotine strengths were most commonly mislabelled by between 5% and 20%, with the majority testing lower than what the label indicated. Fifteen European e‐liquids that were assessed were labelled as 20 mg/ml or less, yet when tested, they contained more than 20 mg/ml of nicotine. One e‐liquid that was supposed to contain no nicotine in fact contained 23.91 mg/ml of nicotine. Furthermore, the difference between the medians of the available labelled and experimental nicotine concentrations was significant (p < 0.001, Wilcoxon signed rank test). Preliminary studies show that high nicotine levels delivered via aerosol increase the risk for nicotine poisoning and cause airway inflammation. Other EC ingredients, such as flavourings, contribute to EVALI and ‘popcorn lung’. There is evidence that certain flavourings, such as menthol, reinforce the effects of nicotine and modify drug absorption and metabolism. There is a global need for better quality control in EC products in order to make these safe for consumers.

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Section: Toxicological Effects Of E‐cigarettesmentioning

confidence: 98%

Section: Laws and Levels Around The Worldmentioning

confidence: 99%

Section: Other Ingredients and Compounds In E‐liquidsmentioning

confidence: 99%

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A review of nicotine‐containing electronic cigarettes—Trends in use, effects, contents, labelling accuracy and detection methods

Taylor

Dunn

Turfus

2021

Drug Testing and Analysis

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“…This suggests that other sources than PG and G contribute to a major extent to the formation of AA. Sugars and flavors were recently discussed as possible sources for carbonyl emissions in EC aerosols (Fagan et al 2018;Khlystov and Samburova 2016).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the potential vaping-related exposure to carbonyls and epoxides using stable isotope-labeled precursors in the e-liquid

Landmesser

Scherer

et al. 2021

Arch Toxicol

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The formation of carbonyls and epoxides in e-cigarette (EC) aerosol is possible due to heating of the liquid constituents. However, high background levels of these compounds have inhibited a clear assessment of exposure during use of ECs. An EC containing an e-liquid replaced with 10% of 13C-labeled propylene glycol and glycerol was used in a controlled use clinical study with 20 EC users. In addition, five smokers smoked cigarettes spiked with the described e-liquid. Seven carbonyls (formaldehyde, acetaldehyde, acrolein, acetone, crotonaldehyde, methacrolein, propionaldehyde) were measured in the aerosol and the mainstream smoke. Corresponding biomarkers of exposure were determined in the user’s urine samples. 13C-labeled formaldehyde, acetaldehyde and acrolein were found in EC aerosol, while all seven labeled carbonyls were detected in smoke. The labeled biomarkers of exposure to formaldehyde (13C-thiazolidine carboxylic acid and 13C-N-(1,3-thiazolidine-4-carbonyl)glycine), acrolein (13C3-3-hydroxypropylmercapturic acid) and glycidol (13C3-dihydroxypropylmercapturic acid) were present in the urine of vapers indicating an EC use-specific exposure to these toxicants. However, other sources than vaping contribute to a much higher extent by several orders of magnitude to the overall exposure of these toxicants. Comparing data for the native (unlabeled) and the labeled (exposure-specific) biomarkers revealed vaping as a minor source of user’s exposure to these toxicants while other carbonyls and epoxides were not detectable in the EC aerosol.

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“…While complete substitution of ECs for cigarettes has been associated with smoking cessation [6, 7], concomitant or “dual” use of ECs and cigarettes has not [8], and dual use is now the most common form of EC use [9]. Further, dual use has not been shown to reduce exposure to the harmful products of combustible cigarettes, including carcinogens [10–18]. The American Cancer Society, as a result, strongly discourages the dual use of EC and cigarettes [19].…”

Section: Introductionmentioning

confidence: 99%

Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

et al. 2019

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Background The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities. Methods In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days. Results About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them. Conclusions Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.

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Sugar and Aldehyde Content in Flavored Electronic Cigarette Liquids

Cited by 37 publications

References 33 publications

A review of nicotine‐containing electronic cigarettes—Trends in use, effects, contents, labelling accuracy and detection methods

A review of nicotine‐containing electronic cigarettes—Trends in use, effects, contents, labelling accuracy and detection methods

Assessment of the potential vaping-related exposure to carbonyls and epoxides using stable isotope-labeled precursors in the e-liquid

Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes

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