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Member Research & Reports

Member Research & Reports

UNC Faculty Members Study Awareness of Chemicals in Cigarette Smoke, Negative Health Effects of Flavored e-Cigarettes

Adults in the United States have little awareness of the chemical components of cigarette smoke, though many of them report having looked for information about the composition of tobacco products. In a study published in the journal BMC Public Health, researchers from the University of North Carolina at Chapel Hill suggest that the Food and Drug Administration (FDA) expand its messaging activities so that information about these chemicals reaches all segments of the U.S. population, especially those most vulnerable to tobacco product use and its associated health risks.

“The majority of the U.S. public wants easy access to information about the chemicals in cigarettes and other tobacco products,” said Dr. Marcella H. Boynton, assistant professor of health behavior at the UNC Gillings School of Global Public Health, member of UNC’s Lineberger Comprehensive Cancer Center, and first author of the paper. “Surprisingly, our results reveal that the groups one might presume to be the least psychologically motivated to look for this information – young adults and smokers – were actually more likely to say that they had previously searched for it.”

In a nationally representative telephone survey of 5,014 adults ages 18 years and over, more than a quarter of participants (27.5 percent) reported having looked for information on the different components of tobacco products and tobacco smoke, many of which are known to be poisonous or cause cancer. Of those adults, 37.2 percent were young adults (18-25 years of age) and 34.3 percent were smokers. Out of non-smokers and older adults, 26 percent reported having looked for information on tobacco chemicals.

With the exception of nicotine, however, most respondents were largely unaware of which chemicals are present in cigarette smoke. More than half of respondents (54.8 percent) indicated that they would like this information to be available on cigarette packs, while 28.7 percent would prefer to access the information online.

These results indicate that publication of tobacco chemical information is of interest to the public. According to the researchers, sharing this information could improve public health in the U.S., where tobacco use is the leading cause of preventable death and disease.

“By making tobacco chemical information available to the public and tobacco industry practices more transparent, those seeking this information may be less likely to start smoking and more likely to quit because they will be better informed about the toxic chemicals present in tobacco products,” Dr. Boynton explained.

{Photo: Dr. Marcella H. Boynton and Dr. Ilona Jaspers]

Another element of the study examined education campaigns conducted by the FDA, which are intended to increase the public’s awareness of the potential health harms of tobacco products. In 2009, the FDA was given the authority to regulate the tobacco industry with the passage of the Family Smoking Prevention and Tobacco Control Act. In May 2016, it expanded this authority to include additional tobacco products, such as e-cigarettes, hookahs and cigars.

Given the FDA’s role in communicating the harms of tobacco use, the investigators sought to understand how tobacco product users and non-users perceive the credibility of the FDA. Survey participants were asked whether they had ever heard of the FDA and whether they believed that the FDA could effectively regulate tobacco products.

The vast majority of U.S. adults surveyed (94.6 percent) reported having heard of the FDA, but awareness was lower among young adults, those with lower education and those living in poverty. A smaller majority of both smokers (66.6 percent) and non-smokers (65 percent) believed that the FDA could regulate tobacco products effectively.

The study was limited by its focus on the chemicals in tobacco for which the FDA has already signaled it will require manufacturers to provide information. Given the large number of chemicals in tobacco, future research into a wider range of chemicals is needed to better inform efforts to regulate tobacco use and communicate its risks. Such research could benefit the majority of U.S. smokers (more than 80 percent) who reported an intention to quit in this study. Additional research also is needed to monitor public response to FDA communications and changing patterns of tobacco use.

Dr. Ilona Jaspers, professor of environmental sciences and engineering at the UNC Gillings School, specializes in the effects of ambient air pollutants on respiratory immune dysfunction.

As deputy director of the Center for Environmental Medicine, Asthma and Lung Biology, she has established several models to determine adverse health effects induced by pollutant exposures. She collaborates extensively with investigators from UNC-Chapel Hill and the U.S. Environmental Protection Agency to conduct translational studies related to air pollution health effects.

In an October 2017 study in the journal Current Allergy and Asthma Reports, Dr. Jaspers describes that flavored liquids in e-cigarettes contain airway irritants and toxicants implicated in the beginning and worsening of lung diseases. That makes vaping particularly hard on young people with asthma, who use e-cigs more often (12.4 percent prevalence) than their non-asthmatic peers (10.2 percent prevalence). The flavorings often are listed as a primary reason young people start smoking e-cigarettes or switch from tobacco cigarettes.

Recent rodent studies show that prenatal nicotine exposures lead to epigenetic reprogramming, abnormal lung development and multigenerational transmission of asthmatic-like symptoms. When comparative studies of tobacco cigarettes and e-cigarettes are made, Dr. Jaspers says, the studies often focus on toxicants, such as formaldehyde, in the smoke, and on clinical results, such as cancer, bronchitis or chronic obstructive pulmonary disease (COPD). These studies disregard the toxicity of ingredients unique to flavored e-cigarettes, which likely induce respiratory problems not usually seen in smokers of tobacco cigarettes.

CNN called upon Dr. Jaspers’ expertise in a May 17 article about a teen who developed a condition called ‘wet lung’ after only three weeks of vaping. The article described a case study, led by Dr. Casey Sommerfeld, of the University of Pittsburgh Medical Center, and published May 17 in the journal Pediatrics, regarding an 18-year-old who suffered coughing, difficulty breathing and chest pains resulting from inhaling the heated, additive-filled vapor.

Unable to get enough oxygen into her blood, the young woman was placed on a respirator, which breathed for her until her lungs recovered. Chest tubes drained fluid from her lungs. She was diagnosed with hypersensitivity pneumonitis, also called ‘wet lung,’ a lung inflammation due to an allergic reaction to chemicals or dust. Chemicals in the e-cigarettes had caused inflammation that triggered her body to stage an immune response. The woman was treated with methylprednisolone, a drug that treats severe allergic reactions.

Dr. Jaspers said that Dr. Sommerfeld’s study “highlights the importance of potential adverse health effects associated with e-cigarette use” and shows that the negative health effects may manifest in several ways, potentially resulting in a number of serious lung conditions.

Dr. Jaspers said that the nicotine in vaping products is addictive and has potential health effects for the developing adolescent brain. The 2016 Surgeon General’s report noted a 900 percent increase in e-cigarette use by high school students between 2011 and 2015. The 2016 National Youth Tobacco Survey noted that 1.7 million high school students said they had used e-cigarettes in the previous 30 days.

“I hope we can find a way to reverse this trend,” Dr. Jaspers said.

Jaspers is also director of the UNC Curriculum in Toxicology, a professor of pediatrics, microbiology and immunology in the UNC School of Medicine and division head at the newly launched UNC Institute for Environmental Health Solutions.