Where There's Smoke

Report on smoking trends and tobacco smoke exposure

E-Cigarettes and secondhand-thirdhand vapor emissions

In contrast to combustible tobacco products, e‑cigarettes do not produce sidestream emissions; aerosol is produced during the activation of the device. Aerosol is subsequently exhaled into the environment where nonusers may be exposed through inhalation, ingestion, or dermal contact.  It is not clear how much of the inhaled e‑cigarette aerosol is exhaled into the atmosphere where nonusers can be exposed. While some studies have used machines to produce e‑cigarette aerosols and have measured the pollutants[1]McAuley TR, Hopke PK, Zhao J, Babaian S. Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhal Toxicol. 2012;24(12):850-7[2]Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Secondhand exposure to vapors from electronic cigarettes. Nicotine Tob Res. 2014;16(6):655-62[3]Geiss O, Bianchi I, Barahona F, Barrero-Moreno J. Characterisation of mainstream and passive vapors emitted by selected electronic cigarettes. Int J Hyg Environ Health. 2015;218(1):169-80, others have measured the change in contaminants in a room or a test chamber after vaporizer use [4]Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette … Continue reading, or measure airborne nicotine in the homes of e-cigarette users[5]Ballbe M, Martinez-Sanchez JM, Sureda X, Fu M, Perez-Ortuno R, Pascual JA, et al. Cigarettes vs. e-cigarettes: Passive exposure at home measured using airborne marker and biomarkers. Environ Res. … Continue reading.

Vaporizers introduction and types

The concentration of e‑cigarette aerosol in each environment depends primarily on the strength or the number of e‑cigarettes used and the emission rate of the aerosol for that device. E‑cigarettes, however, are varied in their design and the liquids used. The specific product combination significantly affects the secondhand emissions[6]Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133-9. The number of puffs and depth of inhalation may be particularly relevant to the amount exhaled by the user. They may also affect e‑cigarette emissions[7]Husari A, Shihadeh A, Talih S, Hashem Y, El Sabban M, Zaatari G. Acute Exposure to Electronic and Combustible Cigarette Aerosols: Effects in an Animal Model and Human Alveolar Cells. Nicotine Tob … Continue reading.

E-cigarettes emit significant amounts of nicotine but do not emit significant amounts of carbon monoxide and volatile organic compounds[8]Op. cit. Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Nicotine Tob Res. 2014. Due to their design variations, the level of secondhand exposure to nicotine depends on the e-cigarette brand and use. While the emissions of nicotine from e-cigarettes tend to be significantly lower than those of tobacco cigarettes[9]Ibid. Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Nicotine Tob Res. 2014, vaping residue will travel between rooms. California researchers detected electronic cigarette aerosol chemicals in a multiple-tenant retail building in an adjacent business where they had deposited as an electronic cigarette exhaled aerosol residue. Nicotine and other alkaloids were detected after one day of exposure within the field site, and these chemicals generally increased as exposure times increased. TSNAs, which have been linked to carcinogenesis, were also detected in short-term and long-term exposed samples from the field site [10]Khachatoorian C JIP, Benowitz NL, et al. Electronic cigarette chemicals transfer from a vape shop to a nearby business in a multiple-tenant retail building. Tobacco Control. 2018;28:519-25.

Evidence is accumulating that youth who try e-cigarettes may go on to try cigarettes

Since their entrance into the marketplace, vaporizers have become the most commonly used tobacco product among U.S. youth [11]Op. Cit. Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al. Int J Hyg Environ Health. 2014.  According to the CDC, the use of e-cigarettes by high school students has jumped 78% since 2018 and by 48% among middle schoolers. The FDA and some states are responding with a variety of proposals to restrict youth access to flavored nicotine products, which the CDC blames for contributing to the surging popularity of vaping[12]Wilson KM, Klein, J. D., Blumkin, A. K., Gottlieb, M., & Winickoff, J. P. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics. 2011;127(1):85-2[13]Khachatoorian C JIP, Benowitz NL, et al. Electronic cigarette chemicals transfer from a vape shop to a nearby business in a multiple-tenant retail building. Tobacco Control. 2018;28:519-25.,Schober … Continue reading. The use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels (fractional concentration of exhaled nitric oxide) in e-cigarette consumers[14]Int J Hyg Environ Health. 2014;217(6):628-37. Ballbe M, Martinez-Sanchez JM, Sureda X, Fu M, Perez-Ortuno R, Pascual JA, et al. Cigarettes vs. e-cigarettes: Passive exposure at home measured … Continue reading. Allergists may check nitric oxide levels to see if patients show inflammation associated with allergic or eosinophilic asthma[15]The American Academy of Allergy, Asthma & Immunology. What is a FEMO Test? https://www.aaaai.org/conditions-and-treatments/library/asthma-library/feno-test#:~:text=The%20FeNO%20test%2C%20w. … Continue reading.

Teen use of tobacco products

According to results from the latest National Youth Tobacco Survey (NYTS), 1.73 million fewer middle and high school students are using tobacco products in 2020 compared to 2019. A decrease in youth use of e-cigarettes (1.80 million) accounted for a large portion of the decline in overall youth tobacco use. Additionally, from 2019 to 2020, teen use of combustible tobacco products, multiple tobacco products, cigars, and smokeless tobacco decreased significantly[16]Products, Center for Tobacco. “Get the Latest Facts on Teen Tobacco Use.” U.S. Food and Drug Administration, FDA, www.fda.gov/tobacco-products/youth-and-tobacco/get-latest-facts-teen-tobacco-use.

Youth e-cigarette sources

A 2017 International Tobacco Control Youth Tobacco and Vaping survey study showed that about 7.5% of respondents reported having purchased a vaping product in the past year. Among those who had vaped in the past year, 32.6% reported having purchased a vaping product in the past year. Purchasing prevalence was significantly higher among US respondents compared to those from Canada and England; purchase prevalence was also higher among Canadian adolescents than respondents from England. The most commonly reported purchase location for vaping products in all counties was vape shops. Among past 30-day vapers, 42.5% reported getting their vaping products only from social sources, 41.4% only from commercial sources, and 13.4% from both types of sources. Purchasing a vaping product in the past year was associated with being male, of legal age to buy tobacco and vaping products, and greater frequency of smoking and vaping in the past 30 days. [17]David Braak, K. Michael Cummings, Georges J. Nahhas, Jessica L. Reid, David Hammond, How are adolescents getting their vaping products? Findings from the international tobacco control (ITC) youth … Continue reading.

E-Cigarette restrictions

Most state and local smokefree laws were enacted before e-cigarettes were on the market, so while such laws do not explicitly mention e-cigarettes, one should not assume that their use is permitted. Existing smokefree laws are often interpreted to prohibit e-cigarette use in their smokefree provisions[18]Electronic Smoking Devices (ESDs) – Not Safe for Use in Smokefree Spaces: American Nonsmokers’ Rights Foundation; 2019. https://no-smoke.org/smokefree-threats/electronic-cigarettes/.

It should be noted that based on the PATH Study findings from Wave 4 of the study, e-cigarette users are less likely to have tobacco use rules within their homes.

As of October 2018, 789 U.S. municipalities and 12 states include electronic smoking devices as products that are prohibited from use in smokefree environments. Including electronic smoking devices is now a standard component of smokefree air laws. Cities and states choose to prohibit the use of ESDs in all smokefree venues (indoors and outdoors). Many communities include ESDs in smokefree workplace laws, such as Nome, AK; Paducah, KY; New Orleans, LA; Tupelo, MS; and Ft. Worth, TX[19]Electronic Smoking Devices (ESDs) & Smokefree Laws. American Nonsmokers’ Rights Foundation; 2019.

References

References
1 McAuley TR, Hopke PK, Zhao J, Babaian S. Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality. Inhal Toxicol. 2012;24(12):850-7
2 Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Secondhand exposure to vapors from electronic cigarettes. Nicotine Tob Res. 2014;16(6):655-62
3 Geiss O, Bianchi I, Barahona F, Barrero-Moreno J. Characterisation of mainstream and passive vapors emitted by selected electronic cigarettes. Int J Hyg Environ Health. 2015;218(1):169-80
4 Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al. Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers. Int J Hyg Environ Health. 2014;217(6):628-37
5 Ballbe M, Martinez-Sanchez JM, Sureda X, Fu M, Perez-Ortuno R, Pascual JA, et al. Cigarettes vs. e-cigarettes: Passive exposure at home measured using airborne marker and biomarkers. Environ Res. 2014;135:76-80
6 Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014;23(2):133-9
7 Husari A, Shihadeh A, Talih S, Hashem Y, El Sabban M, Zaatari G. Acute Exposure to Electronic and Combustible Cigarette Aerosols: Effects in an Animal Model and Human Alveolar Cells. Nicotine Tob Res. 2016;18(5):613-9
8 Op. cit. Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Nicotine Tob Res. 2014
9 Ibid. Czogala J, Goniewicz ML, Fidelus B, Zielinska-Danch W, Travers MJ, Sobczak A. Nicotine Tob Res. 2014
10 Khachatoorian C JIP, Benowitz NL, et al. Electronic cigarette chemicals transfer from a vape shop to a nearby business in a multiple-tenant retail building. Tobacco Control. 2018;28:519-25
11 Op. Cit. Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al. Int J Hyg Environ Health. 2014
12 Wilson KM, Klein, J. D., Blumkin, A. K., Gottlieb, M., & Winickoff, J. P. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics. 2011;127(1):85-2
13 Khachatoorian C JIP, Benowitz NL, et al. Electronic cigarette chemicals transfer from a vape shop to a nearby business in a multiple-tenant retail building. Tobacco Control. 2018;28:519-25.,Schober W, Szendrei K, Matzen W, Osiander-Fuchs H, Heitmann D, Schettgen T, et al
14 Int J Hyg Environ Health. 2014;217(6):628-37. Ballbe M, Martinez-Sanchez JM, Sureda X, Fu M, Perez-Ortuno R, Pascual JA, et al. Cigarettes vs. e-cigarettes: Passive exposure at home measured utilizing airborne marker and biomarkers. Environ Res. 2014;135:76-80
15 The American Academy of Allergy, Asthma & Immunology. What is a FEMO Test? https://www.aaaai.org/conditions-and-treatments/library/asthma-library/feno-test#:~:text=The%20FeNO%20test%2C%20w. Reviewed Sept 28, 2019
16 Products, Center for Tobacco. “Get the Latest Facts on Teen Tobacco Use.” U.S. Food and Drug Administration, FDA, www.fda.gov/tobacco-products/youth-and-tobacco/get-latest-facts-teen-tobacco-use
17 David Braak, K. Michael Cummings, Georges J. Nahhas, Jessica L. Reid, David Hammond, How are adolescents getting their vaping products? Findings from the international tobacco control (ITC) youth tobacco and vaping survey, Addictive Behaviors, Volume 105, 2020, 106345, ISSN 0306-4603, https://doi.org/10.1016/j.addbeh.2020.106345
18 Electronic Smoking Devices (ESDs) – Not Safe for Use in Smokefree Spaces: American Nonsmokers’ Rights Foundation; 2019. https://no-smoke.org/smokefree-threats/electronic-cigarettes/
19 Electronic Smoking Devices (ESDs) & Smokefree Laws. American Nonsmokers’ Rights Foundation; 2019