Abstract Body (Do not enter title and authors here): Introduction
Massachusetts (MA) enacted statewide regulation on all flavored tobacco products in June 2020. Thereafter, electronic cigarettes (e-cigarettes) labeled ‘clear’ emerged on the market. We studied the acute hemodynamic impact along with chemical analysis of ‘clear’ e-cigarettes of these novel products.
Methods
In healthy young adults (age 18-45), we measured acute changes in blood pressure (BP) and heart rate (HR) following a 10-minute structured use of participants’ own e-cigarette, comparing ‘clear’ e-cigarette users with other flavored e-cigarette users and non-users. Chemical characterization and quantification of relevant flavorings and cooling agents (WS-3, WS-23) of 19 ‘clear’-labeled disposable e-cigarette liquids was carried out by gas chromatography/mass spectrometry.
Results
Our data was collected between 04/2019-05/2023 and includes 22 ‘clear’ e-cig users, 115 non-‘clear’ flavored users and 73 non-users (Figure A). After the ban, participants that used ‘clear’ labeled e-cigarettes increased from 0% to 21%. Baseline BP and HR were similar across all groups. With acute use the increase in diastolic BP, mean arterial pressure, and HR was higher in ‘clear’ e-cigarettes users compared to both non-‘clear’ flavored e-cigarette users and non-users (Figure B). The greater increase in HR in ‘clear’ users remained when restricting non-‘clear’ users to Juul users (products that do not contain synthetic coolants) (8.9±7.4 vs 4.5±7.9, P=0.03).
All (19/19) ‘clear’ e-liquids were found to contain synthetic cooling agents WS-23 and/or WS-3, most (18/19) contain menthol, with selected products also containing other flavorants (Figure C).
Conclusion
The presence of menthol and synthetic cooling agents alongside other flavorings in newly marketed ‘clear’ e-cigs is a direct violation of the MA flavored tobacco product regulation. Acute use of ‘clear’ e-cigarette led to greater hemodynamic effects compared to other flavored e-cigarettes and Juul, raising questions about the health effects of cooling agents. Monitoring novel products and their constituents to assess their health effects is needed to protect young adults.