Before You Vape: High levels of Formaldehyde Hidden in E-Cigs

Formaldehyde, a known human carcinogen found in cigarette smoke, also dwells in the vaporized liquid of popular electronic or e-cigarettes, researchers said Wednesday.

E-cigarette sales are booming in the United States and many hoped so- called "vaping" would replace tobacco smoking and be a panacea for the nearly 160,000 lung cancer deaths associated with conventional cigarettes.

But according to an analysis published Wednesday in the New England Journal of Medicine, the exposure to formaldehyde from e-cigarettes, based on similar chronic use as tobacco, could be five to 15 times higher than from smoking cigarettes.

"It's way too early now from an epidemiological point of view to say how bad they are," said co-author James F. Pankow, professor of chemistry and engineering at Portland State University in Oregon. "But the bottom line is, there are toxins and some are more than in regular cigarettes. And if you are vaping, you probably shouldn't be using it at a high-voltage setting."

Pankow and his colleagues analyzed aerosolized e-liquid in "tank system" e-cigarettes to detect formaldehyde-releasing agents in "hidden" form at various voltages.

They found that vaping 3 milligrams of e-cigarette liquid at a high voltage can generate 14 milligrams of loosely affiliated or "hidden" formaldehyde. Researchers estimated a tobacco smoker would get .15 milligrams of formaldehyde per cigarette or 3 milligrams in a 20-pack.

Pankow told NBC News those numbers "may be conservative."

"We are not saying e-cigarettes are more hazardous than cigarettes," he said. "We are only looking at one chemical. … The jury is really out on how safe these drugs are."

There are more than 8,000 chemicals in tobacco smoke, so it's hard to pinpoint whether formaldehyde is the main culprit in cigarette-related cancers.

"A lot of people make the assumption that e-cigarettes are safe and they are perfectly fine after using for a year," said Pankow. "The hazards of e-cigarettes, if there are any, will be seen 10 to 15 years from now when they start to appear in chronic users."

E-cigarettes were first invented in China in 2003, but they started appearing in the United States around 2006. A five-pack of flavor cartridges costs about the same as a pack of cigarettes and starter kits can cost between $30 and $100.

A cartridge or tank contains a liquid of propylene glycol, glycerol, or both, as well as nicotine and flavoring. These chemicals are heated to the boiling point with a battery-operated atomizer, creating a smokeless vapor that is inhaled.

But formaldehyde-containing chemical compounds can be released during the "vaping" process as the liquid is heated. Pankow said some e-cigarettes can burn hotter than 1,000 degrees fahrenheit.

"The difference in e-cigarettes is the material that is heated and turns into hot gas as it cools is not tobacco, but two main chemicals," he said. "When it gets really hot, unwanted reactions occur."

Pankow said the same risks likely do not occur when vaping dry marijuana or hash oil, which typically does not use those chemicals. "But it's totally likely that some people dilute hash oil with propylene glycol and glycerol, which we know can form formaldehyde," he said.

Formaldehyde is a colorless, strong-smelling gas used in embalming fluid, building materials and some medicines and cosmetics. It can also be produced as a byproduct of cooking and smoking.

According to the American Cancer Society, exposure to formaldehyde has been shown to cause cancer in laboratory animals and has also been linked to some cancers in humans.

When gaseous formaldehyde, found in funeral homes and other occupational settings, is inhaled, it breaks down in the mouth, nose, throat, and airways. Exposure has been linked to throat and nasal cancers and leukemias.

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Vaping for teens has clear growth, but cloudy impact

BY JANET ZIMMERMAN / STAFF WRITER

Teenagers’ use of drugs, alcohol and tobacco declined in 2014, a new study shows, but their preference for electronic cigarettes and vaping has health officials fuming.

More than 16 percent of 10th and 12th graders and nearly 9 percent of eighth graders had used the battery-powered smokes in the previous 30 days, according to the University of Michigan’s annual Monitoring the Future study.

Researcher Lloyd Johnston was surprised by the finding in the annual survey of more than 40,000 teens. This was the first time in the report’s 39-year history that questions about e-cigarette use were posed.

“One of the functions of the study is to identify new and emerging problems and this clearly is one,” he said.

Alcohol consumption decreased to 41 percent, the lowest level since 1975. That caps a long-term decline in use since the high of 61 percent in 1997.

The drop coincided with increased age limits for buying alcohol in many states and anti-drunk driving campaigns, Johnston said.

Teen use of other drugs, including synthetic marijuana – known as K-2 and Spice – bath salts, marijuana and Ecstasy, were also down. Levels of heroin, crack, methamphetamine and cocaine use were unchanged.

Traditional cigarette smoking also was at its lowest level, 8 percent, compared to a peak of 28 percent in 1997. The cause, Johnston said, is higher cigarette prices, fear of the health risks and public disfavor.

But in its place are e-cigarettes and vape pens, which work by heating liquid nicotine into an inhalable mist that looks like smoke but doesn’t contain the tar or odor of regular cigarettes.

E-cigarette refill fluids, known as juice, come in flavors such as bubble gum and milk chocolate cream, which make the products attractive to younger teens, the researchers said.

POPULAR WITH TEENS

Adrian Hernandez, 18, of Riverside, said he started vaping when he was 16 as a way to reduce the amount of marijuana he was using for personal issues.

“I needed something to take the edge off. It was a replacement. It helped,” said the high school senior who has since gotten a prescription for medical marijuana.

Hernandez isn’t concerned about possible health problems associated with vaping, and said just about everything in life carries some risk.

“We might as well look at alcohol abuse and cigarette abuse,” he said. “Granted (vaping) has a negative side, but what product do we consume that doesn’t?”

Hernandez has noticed that more of his fellow teens ask him where to buy vapes than about marijuana, he said.

INDUSTRY DEFENDS VAPING

Gregory Conley, president of the Medford, N.J.-based American Vaping Association, which represents businesses, took issue with the survey findings and accusations that e-cigarettes could lead young people to smoke regular cigarettes.

An analysis of the data shows that only a small percentage of the teens using e-cigarettes had never smoked before. The poll focused on use in the last 30 days, which does not indicate regular or habitual use, he said.

“They have no evidence that e-cigarette usage goes beyond experimentation and into addiction or dependence on nicotine,” he said.

Conley also noted that the sweet and fruity flavors of the e-liquid refills are aimed at adults. The flavors help many smokers, including Conley, quit tobacco, and once that craving is gone, the taste of a burning cigarette loses its appeal, he said.

Sean Cadieux, 35, of Riverside, smoked a pack a day of traditional cigarettes for 10 years. He said he started using e-cigarettes about a year ago in an attempt to quit, and was surprised to find it worked.

Now he spends about $1 a day on cartridges for his vape pen, compared to the $6 a day he spent on cigarettes.

“It’s a cool thing to do. I don’t smell like an ashtray anymore and I don’t taste like an ashtray,” Cadieux said.

HEALTH RISKS UNKNOWN

Most of the 12th graders surveyed for Monitoring the Future didn’t think regular e-cigarette use was harmful.

“Part of the reason e-cigarettes are so popular among youth is they have a very low perceived health risk,” said Richard Miech, a research professor at the University of Michigan’s Institute for Social Research and one of the study’s authors.

The health impacts are not fully known, however, because there are no long-term studies, said Prue Talbot, director of the Stem Cell Center at UC Riverside.

“Electronic cigarette aerosol has fewer chemicals than smoke from tobacco- burning cigarettes, but that doesn’t mean electronic cigarettes are not dangerous. It only takes one nasty chemical to cause problems,” she said. “We really don’t know what will happen to someone who smokes these for 20 years.”

In her research, Talbot found that some refill fluids for the e-cigarettes, including the cinnamon flavor, killed human and mouse cells.

“There are over 8,000 flavors of refill fluids on the market and we know very little about them,” she said.

Talbot’s research also revealed inaccurate labeling of the nicotine concentration on refills. The concentrations varied as much as 89 percent from the labeled amount, her study showed.

The Centers for Disease Control and Prevention warned that nicotine is highly addictive and there is evidence that its adverse effects on adolescent brain development could result in lasting deficits in cognitive function.

Christian Nazareno, 22, of Grand Terrace, is the manager of E-Cig City 4 in Riverside, where “tons of kids” try to buy vape pens and juice but are turned away. Many customers are college students who took up vaping to kick a tobacco habit; they can opt for zero-nicotine fluid that gives them a satisfying cloud of vapor that looks like smoke, he said.

Contact the writer: jzimmerman@pe.com or 951-368-9586

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Teen access to e-cigarettes faces scrutiny

As smoking of electronic cigarettes among youths rises, Chapman University assistant professor Georgiana Bostean and her student team are studying the link between “vaping” and aggressive marketing of e-cigarettes to youth, including the proximity of smoke shops to schools.

The battery-operated penlike vape devices come in a rainbow of colors and designs and are commonly filled with a mix of liquid nicotine and a flavor called “juice,” with colorful names such as Cotton Candy Clouds and Insane Candy Cane. The liquid formula is heated by the device and the vapor (as opposed to smoke) is inhaled like a cigarette.

E-cigarettes essentially deliver nicotine – a stimulant – without the other ingredients that come in regular cigarettes, such as tar and carbon monoxide.

While researchers at UC Irvine and Georgetown University, among other universities, have found evidence that nicotine may have positive effects on an adult brain, the effect of vaping and liquid nicotine use on the overall health of young people is unknown.

E-cigarettes were initially marketed as a way to help smokers quit. But Bostean suggests that youthful marketing of e-cigarettes and the high number of unregulated specialty retailers may make young people more susceptible to e-cigarette use.

The Centers for Disease Control reported that cigarette smoking by youth is down, while e-cigarette use is up. The use of e-cigarettes by teenagers doubled between 2011 and 2012, according to the CDC. More than a quarter-million youth who had never smoked a cigarette used electronic cigarettes in 2013.

Another more recent report, by Monitoring the Future, also found that more students in in middle school and high school are vaping than smoking.

Marketing and local restrictions 

Locally, restrictions on the use of e-cigarettes vary. Seal Beach was the first Orange County city to regulate the sales of e-cigarettes and vaping. Ordinances adopted earlier this year treat e-cigarettes equally to traditional tobacco products.

Mission Viejo, Aliso Viejo, Buena Park, San Clemente, Laguna Niguel, Irvine and Costa Mesa are in line to follow suit.

Roughly one-third of Orange County 11th-graders have tried e-cigarettes, according to the 2013-14 California Healthy Kids Survey.

The downshift in cigarette smoking by teens has been due in part to the heavy restrictions applied to tobacco marketing by the U.S. Food and Drug Administration.

Since 1971, there has been a ban on TV and radio ads for cigarette and other tobacco products. Newer FDA regulations put tobacco products behind store counters.

Meanwhile, there are no regulations on vaping ads. E-cigarette brands VUSE, made by old-school cigarette maker R.J. Reynolds Tobacco Co.’s subsidiary R.J. Reynolds Vapor Co., and Lorillard Technologies Inc.’s blu eCigs both advertise on TV.

Advertising restrictions have not been applied to electronic cigarettes because the devices don’t contain tobacco, though the FDA has proposed extending its oversight to e-cigarettes.

So far, Bostean’s team has observed 22 e-cigarette retailers in Santa Ana to see whether there’s a link between proximity to schools and use of e-cigarettes. Research team leader Nate Vorapharuek, 21, said many of the locations are within a quarter-mile to a half-mile from schools.

There are marked differences in how traditional tobacco products are sold vs. e-cigarettes, Bostean said. For one, e-cigarettes are more visible inside the store and from the outside looking in. E-cigarettes are also more accessible.

“Many of the smoke shops were selling vape cigarettes on a counter, at eye level next to the candy,” Bostean said.

For the second half of the research, the researchers will observe Costa Mesa retailers.

Danger inside 

Because e-cigarettes, which have been around for a decade, are unregulated by the FDA, the nicotine levels in the liquids are at the discretion of the mixer, said student researcher Katie Henderson, 21.

Ingestion and even topical exposure to the concentrated liquid nicotine used in home-brewed mixes can be extremely dangerous, even lethal, said Lee Cantrell, San Diego division director of the California Poison Control System.

“Ten to 15 milligrams per kilogram of body weight could be potentially lethal,” Cantrell said.

Up to half of all the California exposure cases involving liquid nicotine are children – 140 on record this year alone, Cantrell said.

Bostean’s primary research goal is aimed at identifying social trends and marketing influences. Next year, she plans to have students do a chemical analysis of the liquid.

Contact the writer: Brittany Hanson / Staff Writer bhanson@ocregister.com

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