The Health Risks of Electronic Cigarette Use to Bystanders.

Wouter F Visser,Hans W J M Cremers,Walther N Klerx,Paul L Schwillens,Ramon Ramlal,Reinskje Talhout

doi:10.3390/ijerph16091525

Abstract

This works aimed to assess the health risks of e-cigarette use to bystanders. The exhaled breath of 17 volunteers was collected while they were vaping, and the levels of nicotine, propylene glycol, glycerol, formaldehyde, acetaldehyde, acrolein, tobacco-specific nitrosamines (TSNAs), and heavy metals were analyzed. Increased levels of nicotine, propylene glycol, TSNAs and copper were found in the exhaled breath of the volunteers. From these measurements, bystander exposure was estimated for two different scenarios: (1) A non-ventilated car with two e-cigarette users and (2) a ventilated office with one e-cigarette user. Our results show that bystanders may experience irritation of the respiratory tract as a result of exposure to propylene glycol and glycerol. Systemic effects of nicotine should also be expected if nicotine-containing e-liquid is used, including palpitations, and an increase of the systolic blood pressure. Furthermore, due to the presence of TSNAs in some e-liquids, an increased risk of tumors could not be excluded for the ‘car’ scenario. While e-cigarette use can clearly have effects on the health of bystanders, the risks depend on the rate of ventilation, dimensions of the room, and vaping behavior of the e-cigarette user. The presence of TSNAs in e-liquids can be avoided, which will prevent the most serious effect identified (increased risk of tumors).

Highlights

With the increased popularity of electronic cigarettes, concern about the health risks associated with these devices has grown
E-cigarette users meeting the following inclusion criteria were initially identified by Computer Assisted Web Interviewing (CAWI): (i) At least 18 years of age, (ii) daily e-cigarette use, with a nicotine-containing (>6 mg/mL) liquid (iii) no clinical diagnosis of diabetes or lung disease
The magnitude of the increased heart rate and increased systolic blood pressure are comparable to what may be expected from the intake of the amount of caffeine contained in 2 or 3 cups of coffee

Summary

Introduction

With the increased popularity of electronic cigarettes, concern about the health risks associated with these devices has grown. Most studies to date indicate that e-cigarettes are less harmful than tobacco cigarettes [1], but much uncertainty remains regarding the absolute health risks of e-cigarette use, especially with respect to long-term effects and the risks of inhaling flavor components and thermal decomposition products. The technical design of e-cigarettes and their operation continues to evolve rapidly, demanding continuous adaptation of research methods. Most e-cigarette health risk studies have focused on the risks to users. Little is still known regarding the risks of exposure to second-hand e-cigarette emissions, to bystanders. Different approaches have been described to estimate the exposure of bystanders, reviewed by Fernandez et al [2]

Methods

Results

Discussion

Conclusion