News

Two new studies from the University of Rochester Medical Center (URMC) have uncovered an association between vaping and mental fog. Both adults and kids who vape were more likely to report difficulty concentrating, remembering, or making decisions than their non-vaping, non-smoking peers. It also appeared that kids were more likely to experience mental fog if they started vaping before the age of 14.

While other studies have found an association between vaping and mental impairment in animals, the URMC team is the first to draw this connection in people. Led by Dongmei Li, Ph.D., associate professor in the Clinical and Translational Science Institute at URMC, the team mined data from two major national surveys.

"Our studies add to growing evidence that vaping should not be considered a safe alternative to tobacco smoking," said study author Li.

The studies, published in the journals Tobacco Induced Diseases and Plos One, analyzed over 18,000 middle and high school student responses to the National Youth Tobacco Survey and more than 886,000 responses to the Behavioral Risk Factor Surveillance System phone survey from U.S. adults. Both surveys ask similar questions about smoking and vaping habits as well as issues with mental function.

Both studies show that people who smoke and vape -- regardless of age -- were most likely to report struggling with mental function. Behind that group, people who only vape or only smoke reported mental fog at similar rates, which were significantly higher than those reported by people who don't smoke or vape.

The youth study also found that students who reported starting to vape early -- between eight and 13 years of age -- were more likely to report difficulty concentrating, remembering, or making decisions than those who started vaping at 14 or older.

"With the recent rise in teen vaping, this is very concerning and suggests that we need to intervene even earlier," said Li. "Prevention programs that start in middle or high school might actually be too late."

Adolescence is a critical period for brain development, especially for higher-order mental function, which means tweens and teens may be more susceptible to nicotine-induced brain changes. While e-cigarettes lack many of the dangerous compounds found in tobacco cigarettes, they deliver the same amount - or possibly more - nicotine.

While the URMC studies clearly show an association between vaping and mental function, it's not clear which causes which. It is possible that nicotine exposure through vaping causes difficulty with mental function. But it is equally possible that people who report mental fog are simply more likely to smoke or vape -- possibly to self-medicate.

Li and her team say that further studies that follow kids and adults over time are needed to parse the cause and effect of vaping and mental fog.

In addition to Li, authors of the youth study include Catherine Xie, and Zidian Xie, Ph.D. For the adult study, Li was joined by co-authors Zidian Xie, Ph.D., Deborah J. Ossip, Ph.D. Irfan Rahman, Ph.D., and Richard J. O'Connor, Ph.D. Both studies were funded by the National Cancer Institute and the U.S. Food and Drug Administration's Center for Tobacco Products.

States with more vapers had larger numbers of daily coronavirus cases and deaths in the early weeks of the pandemic — with New York state as a hot spot, according to an analysis by the University of Rochester Medical Center.

Led by Dongmei Li, Ph.D., an expert in biostatistics at URMC, the study adds to growing national data that links vaping and the coronavirus. Although the current analysis does not provide a direct cause-and-effect between the two, it raises more concerns about vaping, which has also been linked to outbreaks of other illnesses and deaths from the chemicals in vaping products.

The journal Preventive Medicine Reportspublished Li's findings.

"As the country comes to grips with behaviors that may raise or lower risks of contracting COVID-19," Li said, "our study supports the possibility that vaping increases the risk."

Li and her team analyzed integrated population data in each U.S. state from the Centers for Disease Control and Prevention (CDC) 2018 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS annually surveys about 400,000 Americans on health habits and risks. For this project, researchers focused on vaping data. They also gathered coronavirus cases and deaths from CDC data and other reliable sources, and then used statistical models to examine the prevalence of e-cigarette use and coronavirus infections from Jan. 21, 2020 to April 25, 2020.

The study also found that less education played a role in the number of infections. States with a higher proportion of residents without a high school degree, for example, had higher coronavirus death rates.

What do vapers, smokers, and non-smokers with chronic conditions such as high blood pressure or diabetes have in common? They all are at higher risk for COVID-19.

The scientific explanation behind this is complex and not yet certain — but it may boil down to an enzyme known as ACE2, that lives on the surface of many cells in the lungs and serves as the entry point for the coronavirus.

Evidence shows that people with chronic inflammatory illnesses, vulnerable older adults, and those who smoke or vape, all have an abundance of ACE2 receptor proteins to serve as a gateway to the deadly virus.

A research team at the University of Rochester Medical Center, led by Irfan Rahman, Ph.D., published a series of studies during the pandemic that focus on the vital role of ACE2 — which is already at the center of many other scientific investigations — to shape a clearer picture of the critical cellular mechanisms that regulate the deadly virus and its link to vaping.

While Rochester investigators are working in lockstep with scientists around the world, Rahman's special interest is on the growing problem of young people who test positive and may be spreading coronavirus at alarming rates. Even some older children and teens who have higher levels of the ACE2 receptor seem to be more vulnerable to the virus.

"Our next step is to investigate whether ACE2 is normally low in young people, hence their relatively low infection and mortality rates from COVID-19, but to find out if ACE2 is increased by smoking or vaping rendering them more susceptible to the virus," said Rahman, Dean's Professor of Environmental Medicine, Medicine (Pulmonary), and Public Health Sciences. "This would be in contrast to older people with lung diseases such as COPD and pulmonary fibrosis, who we already know are at higher risk for severe viral illnesses and death."

Research at the University of Rochester Medical Center has found evidence of why COVID-19 is worse for people who smoke and vape than for the rest of the population.

Irfan Rahman, who runs a lab at URMC that studies the effects of tobacco products on the lungs, said people who smoke and vape often have elevated levels of receptors for an enzyme called ACE2.

Those receptors also allow the novel coronavirus to enter lung cells. More receptors means more viral load, which means more severe infections, Rahman said.

"It's pretty bad, actually," he said.

Rahman said early evidence from novel coronavirus infections showed that smokers were particularly at risk from COVID-19, but the mechanism behind the vulnerability was unclear.

Now, Rahman and other researchers said, a growing body of evidence shows inhaling nicotine increases the lungs' receptiveness to the virus and the lethality of the disease.

Other articles on this topic:

https://www.rochestercitynewspaper.com/rochester/why-smokers-and-vapers-are-more-susceptible-to-covid-19/Content?oid=11961338

https://www.wxxinews.org/post/urmc-research-uncovers-links-between-covid-19-and-vaping-smoking#:~:text=Irfan%20Rahman%2C%20a%20researcher%20at,gain%20entry%20to%20the%20lungs.&text=Those%20receptors%20also%20allow%20the%20novel%20coronavirus%20to%20enter%20lung%20cells.

https://www.wxxi.org/category/tags/covid-19

The Rahman lab has been highlighted in Nature journal for their work on discovery of exosomes in COPD. Read the article.

Chemical constituents involved in e-cigarette, or vaping product use-associated lung injury (EVALI)

Abstract

Background: The Centers for Disease Control (CDC) declared e-cigarette (e-cig), or vaping product use-associated lung injury (EVALI) a national outbreak due to the high incidence of emergency department admissions and deaths. Investigators have identified vitamin E acetate (VEA) as the plausible cause for EVALI, based on compounds found in bronchoalveolar lavage fluid. Objectives: We defined the chemical constituents present in e-cig cartridges associated with EVALI and compared constituents to medical-grade and cannabidiol (CBD) containing cartridges. Methods: We measured chemicals and elemental metals in e-liquid and vapor phases of e-cig counterfeit cartridges by Gas Chromatography (GC) and Mass Spectrometry (MS), EPA method TO-15 by GCMS, and ICP-MS analysis. Results: We have identified chemical constituents in e-cig vaping tetrahydrocannabinol (THC)-containing counterfeit cartridges compared to medical-grade and cannabidiol (CBD) containing cartridges. Apart from VEA and THC, other potential toxicants correlated with EVALI included solvent-derived hydrocarbons, silicon conjugated compounds, various terpenes, pesticides/plasticizers/polycaprolactones, and metals. These chemicals are known to cause symptoms, such as cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, fatigue, fever, or weight loss, all symptoms presenting in patients with EVALI. Conclusion: This study provides insights into understanding the chemical-induced disease mechanism of acute lung injury.

Electronic cigarettes have been around for over a decade, but that's a relatively short time in the world of science and medicine. So very little is known about the long term health effects, like what the flavors and propellants may be doing to the respiratory system.

But as research picks up on that, what's even more pressing right now, is understanding the vaping products people are getting on the streets that is making them sick and even causing deaths.

Pulmonary scientist Irfan Rahman has been studying the impact of electronic cigarettes on the lungs. We followed him to a vape shop in Rochester, NY. He often visits many of the stores surrounding his lab at the University of Rochester Medical Center.

Rahman's team has found and published research that shows the combination of nicotine, flavors and propellants in e-juices changes cells in the lungs. "Anything [that] goes in the lung, it has to be pure. It has to be fresh," said Rahman, "[the] lung is not meant for these chemicals."

There is a growing body of research like this, showing that while vaping may be less harmful to the body than smoking, it's not exactly safe because it may affect the lungs' ability to protect against foreign agents.

Dr. Ronald Crystal, chairman of Genetics at Weill Cornell Medicine did a small study with non-smokers, who have never vaped, and gave them electronic cigarettes with a very small amount of nicotine.

"There were biologic changes. And what's clear is that if you vape, then you are going to change the biology of the cells lining your airways. Of course, the important question is, does that lead to this disease?" said Crystal. "Nicotine itself probably changes the biology of the airway cells. But probably more concerning are the contaminants and that is the flavoring that goes into [the vaping liquid], the propellants that go into it."

https://www.ny1.com/nyc/all-boroughs/exploring-your-health/2019/12/20/as-vaping-related-illnesses-rise--researchers-search-for-answers

As the federal Food and Drug Administration announced an impending ban on certain types of e-cigarettes, researchers at the University of Rochester applauded the move, but they also said it should only be the start of more regulations.

"It's a great decision," said Irfan Rahman, who runs a lab at URMC that studies the liquids used in e-cigarettes to figure out exactly what they contain.

"It should be a gateway to banning other products," he continued.

The ban will cover only certain types of e-cigarettes. Starting next month, companies will not be allowed to sell flavored vaping cartridges that contain nicotine -- with exceptions for tobacco and menthol flavors.

The rules also carve out an exception for larger "open-tank" e-cigarettes where customers fill the reservoirs with vaping liquid themselves.

The FDA, which funds much of Rahman's research, said the ban is targeting the vaping products most often used by teenagers and young adults. Rahman agreed, noting that the ban covers the flavors he encounters regularly in his analysis of the substances young people are vaping, such as bubble gum, candy or mango. "There are so many of them," he said.

"They look like they are fruit juices, but they are not. They are chemicals which look they are safe, but they are not safe."

A new study reveals an elevated risk of self-reported chronic obstructive pulmonary disease (COPD) — the third leading cause of death associated with smoking — among people using e-cigarettes. People who vaped were at increased risk even if they had never smoked tobacco, which casts doubt on e-cigarette companies' claims that vaping is a safe alternative to smoking.

According to the study, people who vaped were at a 47-percent greater risk of self-reported COPD diagnosis as compared to people in the study who did not use tobacco products. Compared to ex-smokers, people who had quit smoking and switched to e-cigarettes were 27 percent more likely to report a COPD diagnosis.

The study, published by Nicotine and Tobacco Research, is based on 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) national survey data of nearly one million adults. Survey participants were asked whether they had ever been diagnosed with COPD by their health-care provider.

Authors of the study, which was funded in part by the University of Rochester Clinical and Translational Science Institute (UR CTSI), the National Cancer Institute and the Food and Drug Administration, are Zidian Xie, Ph.D., Deborah J Ossip, Ph.D., Irfan Rahman, Ph.D. and Dongmei Li, Ph.D.

"It is clear, based on the large sample size of this study, that there is a significant link between vaping and self-reported COPD diagnosis in adults, even among vapers who never smoked before," said lead study author Zidian Xie.

Senior study author Dongmei Li, an associate professor in the UR CTSI, added, "More long-term clinical research is needed to determine how e-cigarette use is related to COPD, but our findings are consistent with other recent studies showing that e-cigarette use is associated with respiratory issues."

"This study provides further evidence that vaping simply isn't safe," said Deborah Ossip, a tobacco research expert and professor of Public Health Sciences at the University of Rochester Medical Center. "We hope that people begin to heed this message, especially young people who think vaping is cool and who are enticed by the thousands of available flavors."

Recent statistics from the Center for Diseases Control and Prevention's National Youth Tobacco Survey demonstrated the popularity of vaping among young people in the U.S. About one of every 10 middle school students and one out of four high school students reported in 2019 that they used electronic cigarettes.

Dean's Professor of Environmental Medicine, Irfan Rahman, Ph.D., was awarded the prestigious Lifetime Achievement Award by the executive committee of the NCSCA-2019 at the 11th National Conference On Solid State Chemistry And Allied Areas (NCSCA-2019), December 20, 2019. Congratulations Dr. Rahman!