Part of Seminar 51: Electronic Cigarettes: An Emerging Issue for ASHRAE.   Introduction to e-cigarettes Components and potential health effects Current regulatory status AIHA white paper findings and recommendations ANSI/ASHRAE 62.1 and addend

Marcham, Cheri

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Embry-Riddle Aeronautical University

Publications 1-26-2016 AIHA White Paper Findings: Emissions, Exposures and Health Risks Cheri Marcham Embry-Riddle Aeronautical University, march617@erau.edu Follow this and additional works at: https://commons.erau.edu/publication  Part of the Public Health Education and Promotion Commons Scholarly Commons Citation Marcham, C. (2016). AIHA White Paper Findings: Emissions, Exposures and Health Risks. , (). Retrieved from https://commons.erau.edu/publication/536 This Presentation without Video is brought to you for free and open access by Scholarly Commons. It has been accepted for inclusion in Publications by an authorized administrator of Scholarly Commons. For more information, please contact commons@erau.edu. 2016 Winter ConferenceOrlando, FloridaCheri Marcham, PhD, CIH, CSP, CHMM, FAIHAEmbry Riddle Aeronautical Universitymarch617@erau.edu Seminar 51 - Electronic Cigarettes: An Emerging Issue for ASHRAEAIHA White Paper Findings: Emissions, Exposures and Health RisksLearning Objectives1. Describe the primary exposure concerns related to the use of e-cigarettes2. Characterize some of the known air contaminants typically released from vaping, and describe the remaining knowledge gaps3. Define the fundamental toxicological risks associated with vaping4. Summarize the ways in which current ASHRAE Standards deal with tobacco smoking and related electronic devicesASHRAE is a Registered Provider with The American Institute of Architects Continuing Education Systems.  Credit earned on completion of this program will be reported to ASHRAE Records for AIA members.  Certificates of Completion for non-AIA members are available on request.This program is registered with the AIA/ASHRAE for continuing professional education.  As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.  Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.AcknowledgementsCheryl L. Marcham, PhD, CIH, CSP, CHMM, FAIHAProject Team LeaderThe University of Oklahoma Health Sciences CenterTimothy Froehlig, CIHAmtrakEllen Gunderson, CIH, CSPUniversity of WashingtonVeronica StanleyJohns Hopkins UniversityJ. David Krause, PhD, MSPH, CIHGeosyntecJohn P. Springston Jr., MS, CIH, CSP *White Paper EditorTRC Environmental Corp.Mary O’Reilly, PhD, CIH, CPESchool of Public Health, SUNY at AlbanyWarren Friedman, PhD, CIH, FAIHAHUD Office of Lead Hazard Control and Healthy HomesPamela Williams, MS, ScDE Risk Sciences, LLPColorado School of Public HealthRalph A. Froehlich, CIH, CSP, QEPHelix Environmental Inc.Patrick Breysse, PhD, CIHBloomberg School of Public HealthAlan Rossner, PhD, CIH, CSP Clarkson UniversityDora Gosen, CSPCalifornia Institute of TechnologyMitch Bergner, CIHConestoga-Rovers & Associates* Also provided graphics for this presentationAcknowledgementsElectronic Cigarettes in the Indoor Environment External ReviewersDavid L. Johnson, PhD, CIHDepartment of Occupational and Environmental HealthThe University of Oklahoma Health Sciences CenterEvan L. Floyd, PhDDepartment of Occupational and Environmental HealthThe University of Oklahoma Health Sciences CenterDavid O. Carpenter, MDInstitute for Health and the EnvironmentUniversity at AlbanyGary Adamkiewicz, PhD, MPHDepartment of Environmental HealthHarvard School of Public HealthOutline/Agenda• Introduction to E-cigarettes• Components and Potential Health Effects• Current Regulatory Status• AIHA White Paper Findings and Recommendations• ANSI/ASHRAE 62.1 and Addenda Disclaimer• The information in this presentation was compiled from sources believed to be reliable for informational purposes only. Images of actual products are provided for example and explanatory purposes only, and do not constitute endorsement or disapproval of the use of the products depicted. Anatomy of an E-Cigarette• More than 460 different e-brands currently on the market.*• Over 7,700 unique e-cigarette flavors.*  * As of January 2014• China produces approximately 90 percent of the world’s e-cigarettes.• Chinese manufacturers are expected to ship more than 300 million e-cigarettes to the US and Europe this year.Statistics• E-cigarette sales in the U.S. were estimated at $2.2 billion in 2014.• Sales expected to grow nearly 25% per year through 2018.• In 2014, an estimated 2.5 million middle and high school students used e-cigarettes. • There is some recent evidence that e-cigarette use can be a gateway to conventional cigarette use initiation during early adolescence.Statistics• Propylene Glycol/ Vegetable Glycerin• Nicotine• FlavoringsPrimary Components• Used in theatrical fogoExposure may contribute to both acute and chronic health issues, such as asthma, wheezing, chest tightness, decreased lung function, respiratory irritation, and airway obstructionPropylene Glycol/Vegetable Glycerin• Pyrolysis/heating glycerin forms acrolein, formaldehyde and acetaldehyde in the vapors• A known degradation productof propylene glycol and glycerin• Found in vapor and in small amounts in some studies of some liquids• Higher airborne concentrations with higher voltage second and third generation units• Known human carcinogen Formaldehyde• Causes irritation to the nasal cavity, damage to the lining of the lungs and is thought to contribute to cardiovascular disease in cigarette smokers• Found in vapor only (formed as a result of heating process)17Acrolein• Health Effectso Addictive o Teratogenico Increases heart rate, respiratory rate, blood pressure, and level of alertness• E-Cig Labeling o Some cartridges labeled as containing no nicotine did, in fact, contain detectable levels of nicotine (8/6)o Concentration and delivery inconsistencies (1/3)• Nicotine found in the vapor, but lower than found emitted from conventional cigarettes (3/1)• Nicotine has been the cause of an increase in emergency calls to poison control centers and at least one child’s deathNicotineFlavorings• Fruit and Bubblegum – targeting youth• Other additives include drugs• Tadalifil (generic name for a drug used for erectile dysfunction)*• Rimonabant (generic name for a weight-loss aid that has been withdrawn from the market due to serious side effects)*• “Mary Jane”• Cocaine*FDA did order a warning letter to a company that advertised these Flavorings and AdditivesDiacetyl as a food additive is GRAS, but aerosolized exposures can cause bronchiolitis obliteransGenerally Recognized as Safe (GRAS)?Diacetyl Health Effects• Diacetyl and acetyl propionyl are GRAS but are associated with respiratory disease when inhaledo The risks associated with inhalation of acetyl propionyl may be as high as from diacetyl based on inhalation studies with rats• 159 samples purchased from 36 manufacturer and retailers in 7 countrieso Diacetyl and acetyl propionyl were found in 74.2% of samples o Even found in samples (in the liquid form) from manufacturers who clearly stated that these chemicals were not present• Authors estimated an average user’s consumption “would result in 490 times higher daily intake compared to the NIOSH limit” (based on 5 ppb for an 8-hour exposure)Diacetyl and Acetyl Propionyl• 51 flavors of e-liquid were evaluated – cherry, java, peach, pina colada, apple, etc. • Diacetyl detected in the vapor (not the liquid) of 39 of 51 • Even found in samples from two companies who clearly stated in writing that these chemicals were not present New Diacetyl Study (12/8/15)• No research on potential health effects of aerosolized vapor exposure• No research on pyrolization products of flavorings• Benzaldehyde has been detected in cherry flavoring• Methyl anthranilate was detected in grape flavoring• 1-hexanol was detected in apple flavoring• Manufacturing of many flavoring sources are outside the US (China) with limited quality controlFlavoring Concerns• Tobacco-Specific Nitrosamines (TSNAs)• Acetic Acid• BTEX• Isoprene• Diethylene Glycol (antifreeze) – one FDA study onlyAdditional Potential Exposures• Some TSNAs are known human carcinogens and are suspected to contribute to the cancer burden of smokers• Small amounts of TSNAs have been found in e-liquids and vapor• Residual nicotine from tobacco smoke has been shown to react with ambient nitrous acid to form TSNAs over timeoThird-hand exposure?Tobacco-Specific Nitrosamines (TSNAs)• Tin• Lead• Nickel• Zinc• Copper• Chromium• Silicon fibers• NanoparticlesAdditional Potential Exposures• Nicotine (teratogen and addictive)• Flavorings (nut and other allergies)• Formaldehyde (carcinogen)• Acrolein (listed as a Hazardous Air Pollutant by the EPA)• Acetaldehyde (possible human carcinogen)• Fine/Ultrafine Particles• Tin, Lead, Nickel, ChromiumSecond-Hand Exposure ConcernsCloud Chasing• Contenthttps://www.youtube.com/watch?v=ZgouBVNItQA• Mouth and throat irritation• Dry cough• Nausea• Dizziness• Changes in heart rhythm• Changes in blood pressureSome User-Reported Health EffectsEffects on the Immune System• Content• Johns Hopkins study exposed mice to e-cigarette vapor for two weeks in amounts that approximated human e-cig exposure, then exposed them to Streptococcus pneumoniae and influenza A virus.• E-cigarette vapor alone produced mild effects on the lungs, including inflammation and protein damage• E-cigarette exposure inhibited the ability of mice to clear bacteria from their lungs and the viral infection led to increased weight loss and death indicative of an impaired immune responseMiscellaneous Concerns• Lithium ion batteries• Many have no overcurrent or overcharge protection (overheating)• Incorrect chargers also lead to overheating• Smoke alarm concerns• Has been demonstrated that e-cigs have the potential to set off a smoke alarm, but appears to be dependent on the situation and type of alarm• Indoor use• Allowing e-cigs may confuse occupants as to whether smoking is allowed• For smokers, the observation of others smoking can increase cravingsState RegulationsCenters for Disease Control and Prevention. State Laws Prohibiting Sales to Minors and Indoor Use of Electronic Nicotine Delivery Systems - United States, November 2014. • The FDA currently regulates only e-cigarettes that are marketed for therapeutic purposes. • However, the FDA has proposed a rule extending its tobacco product authorities to cover additional products that meet the legal definition of a tobacco product, such as e-cigarettes• Final proposed rule sent to OMB October 19, 2015• OMB has 90 calendar days, but delays expectedFood and Drug Administration (FDA)• The World Health Organization (WHO) has recommended that consumers be strongly advised not to use electronic nicotine delivery systems, including e-cigarettes, until they are deemed safe and effective and of acceptable quality by a competent national regulatory body. WHO• NIOSH Current Intelligence Bulletin 67 published  April 2, 2015 recommends that employers “establish and maintain smoke-free workplaces that protect those in workplaces from involuntary, secondhand exposures to tobacco smoke and airborne emissions from e-cigarettes and other electronic nicotine delivery systems.”(emphasis added)NIOSH• ASHRAE Standard 62.1 contains requirements for ventilation of spaces that are free of environmental tobacco smoke (ETS).  • Also contains requirements for separation of an ETS-free area from any spaces containing ETS.• Addendum c to ANSI/ASHRAE Standard 62.1-2013 clarifies that the definition of ETS “includes smoke produced from the combustion of cannabis and controlled substances and the emissions produced by electronic smoking devices.” • “The existing requirements for separation of ETS-free spaces from ETS spaces remains unchanged.”ANSI/ASHRAE 62.1• “This addendum clarifies the intent of the standard that provisions of acceptable indoor air quality is incompatible with the presence of ETS, including cannabis smoke and e-cigarette emissions.”• “The ventilation rates determined in accordance with the provisions of the standard apply only to spaces where these emissions are not present that are adequately separated from spaces where they are present.”ANSI/ASHRAE 62.1• ETS-free areas at positive pressure to ETS areas• Solid walls, floors, ceiling, and doors with automatic closing mechanisms to separate ETS areas from ETS-free areas• No recirculation or transfer of air from ETS area to ETS-free area• Signage for ETS areasANSI/ASHRAE 62.1Recommendation:“E-cigarettes should be considered a source of volatile organic compounds (VOCs) and particulates in the indoor environment that have not been thoroughly characterized or evaluated for safety.”**Quoted by NIOSH in the 2015 Current Intelligence Bulletin 67 “Promoting Disease and Injury Through Workplace Tobacco Policies”AIHA White Paper: Electronic Cigarettes in the Indoor EnvironmentResearch on e-cigarettes should be conducted in at least the following areas:1. Health effects from inhaling e-cigarette ingredients that are reported to be generally recognized as safe (GRAS) via ingestion, but which have not yet been evaluated for inhalation toxicity, as well as their thermal degradation products; 2. Effects of second-hand emissions, third-hand exposures, and nicotine addiction from e-cigarettes;3. Understanding the dynamics of pre- and post-respiration aerosols and their fate in the environment; and4. Lifecycle and end-of-use issues.*AIHA White Paper: Electronic Cigarettes in the Indoor Environment• Some are single use or disposable• Lithium ion batteries• Nicotine (acute hazardous waste)• EPA: “unused (unsold, expired, or returned) nicotine-containing products, including patches, gums, lozenges, inhalers, nasal sprays, and e-cigarettes, are classified as P075 listed acute hazardous wastes when discarded.” • Some manufacturers offer recycling programs• There is at least one disposal company that is disassembling the components, recycling the batteries, metal, and plastic components that can be recycled, then disposing of the nicotine by incineration. Life Cycle IssuesRecommendation:Risk-based regulation of e-cigarettes should be adopted using reliable safety, health, and emissions data, due to concerns about primary and secondary exposure to vapors and fluids (e-juices) used to charge e-cigarettes.AIHA White Paper: Electronic Cigarettes in the Indoor EnvironmentFour areas of regulation relating to the safety of primary users and people exposed to second-hand vapors or e-juice products should be considered:1. All e-cigarette devices, whether they are used for therapeutic or recreational purposes, should be evaluated for potential physical and/or electrical hazards by a regulatory agency; 2. The health risks and economic consequences of accidental exposure to e-juices by children, adults and pets should be addressed, including proper labeling and child-resistant packaging requirements; AIHA White Paper: Electronic Cigarettes in the Indoor EnvironmentRisk-based regulation recommendations (cont.):3. All future e-juice components that may be used by consumers should be fully evaluated for any potential hazards (e.g., toxicity, flammability, safety hazards, secondary exposures, etc.) prior to introduction into the marketplace; and4. As e-cigarettes are a source of pollutants, their use in indoor environments should be restricted, consistent with current smoking bans, until, and unless, research documents that they will not significantly increase the risk of adverse health effects to occupants.AIHA White Paper: Electronic Cigarettes in the Indoor EnvironmentBibliography• AIHA White Paper: Electronic Cigarettes in the Indoor Environment https://www.aiha.org/government-affairs/Documents/Electronc%20Cig%20Document_Final.pdf• NIOSH Current Intelligence Bulletin 67: Promoting Health and Preventing Disease and Injury Through Workplace Tobacco Policies (NIOSH Publication No. 2015-113) http://www.cdc.gov/niosh/docs/2015-113/pdfs/fy15_cib-67_2015-113_v3.pdf• ANSI/ASHRAE Standard 62.1-2013: Ventilation for Acceptable Indoor Air Quality• ANSI/ASHRAE Addenda a, c, j, k, q, r, and s to ANSI/ASHRAE Standard 62.1-2013: Ventilation for Acceptable Indoor Air Qualityhttps://www.ashrae.org/File%20Library/docLib/StdsAddenda/62_1_2013_2015Supplement_20150203.pdfBibliography• Allen, J.G., Flanigan, S.S., LeBlanc, M., Vallarino, J., MacNaughton, P., Stewart, J.H., & Farsalinos, K. E., Kistler, K. A., Gilman, G., Voudris, V. (2015) Flavoring chemicals in e-cigarettes: Diacetyl, 2,3-pentanedione, and acetoin in a sample of 51 products, including fruit-, candy-, and cocktail-flavored e-cigarettes. Environmental Health Perspectives, doi: 10.1289/ehp.1510185• Barboza, D. (2014, December 13). China’s e-cigarette boom lacks oversight for safety. The New York Times. Retrieved from http://www.nytimes.com/2014/12/14/business/international/chinas-e-cigarette-boom-lacks-oversight-for-safety-.html?_r=0• Centers for Disease Control and Prevention. State Laws Prohibiting Sales to Minors and Indoor Use of Electronic Nicotine Delivery Systems — United States, November 2014. Morbidity and Mortality Weekly Report. December 12, 2014 / 63(49);1145-1150• Farsalinos, K. E., Kistler, K. A., Gilman, G., & Voudris, V. (2015) Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins. Nicotine & Tobacco Research, 168-174, doi: 10.1093/ntr/ntu176• Food and Drug Administration. (2010). Warning letter.  Retrieved from http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm225187.htmBibliography• Geiss, O., Bianchi, I., Barhona, F., & Barrero-Moreno, J. (2014). Characterisation of mainstream and passive vapours emitted by selected electronic cigarettes. International Journal of Hygiene and Environmental Health, 281, 169-180• Lauterbach, J.H. & Laugesen, M. (2012). Comparison of toxicant levels in mainstream aerosols generated by Ruyan® electronic nicotine delivery systems (ENDS) and conventional cigarette products. Toxicologist, 126, 1• Lauterbach, J.H., Laugesen, M., Ross, B.B., 2012. Suggested protocol for estimation of harmful and potentially harmful constituents in mainstream aerosols generated by electronic nicotine delivery systems (ENDS). Toxicologist, 126, 1• Leventhal, A.M., Strong, D.R., Kirkpatrick, M.G., Under, J. B., Sussman, S., Riggs, N.R., Stone, M.D., Khoddam, R., Sarnet, J.M. & Audrain-McGovern, J. (2015). Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA. doi:10.1001/jama.2015.8950• Sussan, T. E., Gajghate, S., Thimmulappa, R. K., Ma, J., Kim, J.-H., Sudini, K.,… Biswal, S. (2015). Exposure to electronic cigarettes impairs pulmonary anti-bacterial and anti-viral defenses in a mouse model. PLoS ONE PLOS ONE. doi :•DOI: 10.1371/journal.pone.0116861 • Zhu, S. (2014). Four hundred and sixty brands of e-cigarettes and counting: Implications for product regulation. Tobacco Control. doi:10.1136/tobaccocontrol-2014-051670Questions?Cheri Marcham, PhD, CIH, CSP, CHMM, FAIHAmarch617@erau.edu

AIHA White Paper Findings: Emissions, Exposures and Health Risks

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AIHA White Paper Findings: Emissions, Exposures and Health Risks

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