The adoption of healthy diets with low environmental impact has been widely promoted as an important climate change mitigation strategy. Typically, these diets are high in plant-sourced and low in ...animal-sourced and processed foods. Despite the fact that their environmental impacts vary, they are often referred to as 'sustainable diets'. Here we systematically review the available published evidence on the effect of 'sustainable diets' on environmental footprints and human health. Eight databases (OvidSP-Medline, OvidSP-Embase, EBSCO-GreenFILE, Web of Science Core Collection, Scopus, OvidSP-CAB-Abstracts, OvidSP-AGRIS, and OvidSP-Global Health) were searched to identify literature (published 1999-2019) reporting health effects and environmental footprints of 'sustainable diets'. Available evidence was mapped and pooled analysis was conducted by unique combinations of diet pattern, health and environmental outcome. Eighteen studies (412 measurements) met our inclusion criteria, distinguishing twelve non-mutually exclusive sustainable diet patterns, six environmental outcomes, and seven health outcomes. In 87% of measurements (n = 151) positive health outcomes were reported from 'sustainable diets' (average relative health improvement: 4.09% 95% CI −0.10-8.29) when comparing 'sustainable diets' to current/baseline consumption patterns. Greenhouse gas emissions associated with 'sustainable diets' were on average 25.8%95%CI −27.0 to −14.6 lower than current/baseline consumption patterns, with vegan diets reporting the largest reduction in GHG-emissions (−70.3% 95% CI: −90.2 to −50.4), however, water use was frequently reported to be higher than current/baseline diets. Multiple benefits for both health and the environment were reported in the majority (n = 31576%) of measurements. We identified consistent evidence of both positive health effects and reduced environmental footprints accruing from 'sustainable diets'. The notable exception of increased water use associated with 'sustainable diets' identifies that co-benefits are not universal and some trade-offs are likely. When carefully designed, evidence-based, and adapted to contextual factors, dietary change could play a pivotal role in climate change mitigation, sustainable food systems, and future population health.
Food systems contribute greatly to global climate change due to their substantial contributions to greenhouse gas emissions, water use, and resource allocation. In addition, current food systems fail ...to deliver healthy and sustainable foods for all, with obesity as well as undernourishment remaining a pertinent global issue. Mounting pressures such as population growth and urbanisation urge rapid and transformational adaptations in food systems to sustainably feed a growing population. Sustainable diets have been promoted as a potential climate change mitigation strategy, and are characterized by high plant based foods and reduced animal-sourced and processed foods. While the evidence base on the potential health and environmental impacts of shifts towards sustainable diets has been growing rapidly over the past decade, there has been no recent synthesis of the evidence surrounding the health and climate mitigation benefits of sustainable consumption patterns. This systematic review will synthesize the evidence of both empirical and modelling studies assessing the direct health outcomes (such as all-cause mortality and body mass index) as well as environmental impacts (greenhouse gas emissions, land use, water use etc.) of shifts towards sustainable diets. Eight literature databases will be searched to identify studies published between 1999-2019 that report both health and environmental outcomes of sustainable diets. Evidence will be mapped and subsequently analysed based on the comparability of results and reported outcomes.
Few studies to date have characterized daily exclusive e-cigarette users, device characteristics, and use behaviors. This study describes daily e-cigarette user characteristics, and assesses the ...association between user behaviors and demographics.
From 2015-2017, 100 daily exclusive e-cigarette users and 50 non-users were recruited in Maryland, USA. Sociodemographic characteristics, health status, e-cigarette/tobacco use behaviors, device characteristics, and reasons for e-cigarette use were collected by interview. Chi-squared tests (categorical variables), Student's t-test (continuous variables), and linear regressions were used to assess relationships between variables.
Most daily exclusive e-cigarette users were men, White, former smokers, used MODs/tanks, and vaped on average 365 puffs/day (SD: 720). A third of users first vaped within 5 minutes of waking in the morning, and 56% vaped throughout the day. E-liquid consumption ranged from 5-240 mL/week (median: 32.5), with nicotine concentration 0-24 mg/mL (median: 3). E-cigarette users were more likely to report wheezing/whistling and hypertension than controls, although the finding was not statistically significant after adjustment. Less than half planned to quit vaping.
Daily e-cigarette users between 2015-2017 most commonly vaped MOD/tank devices. Being male and of lower education was associated with higher usage. Daily users with no intention to quit may be at risk for increased exposure to emissions from e-cigarettes that include inorganic (metals) and organic (e.g. acrolein, formaldehyde) compounds with known toxic effects, particularly to the lung. Further research is needed to characterize the long-term health effects of daily e-cigarette use.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Electronic cigarettes (e-cigarettes) generate an aerosol by heating a solution (e-liquid) with a metallic coil. Whether metals are transferred from the coil to the aerosol is unknown.
Our goal was to ...investigate the transfer of metals from the heating coil to the e-liquid in the e-cigarette tank and the generated aerosol.
We sampled 56 e-cigarette devices from daily e-cigarette users and obtained samples from the refilling dispenser, aerosol, and remaining e-liquid in the tank. Aerosol liquid was collected via deposition of aerosol droplets in a series of conical pipette tips. Metals were reported as mass fractions (μg/kg) in liquids and converted to mass concentrations (mg/m
) for aerosols.
Median metal concentrations (μg/kg) were higher in samples from the aerosol and tank vs. the dispenser (all
<0.001): 16.3 and 31.2 vs. 10.9 for Al; 8.38 and 55.4 vs. <0.5 for Cr; 68.4 and 233 vs. 2.03 for Ni; 14.8 and 40.2 vs. 0.476 for Pb; and 515 and 426 vs. 13.1 for Zn. Mn, Fe, Cu, Sb, and Sn were detectable in most samples. Cd was detected in 0.0, 30.4, and 55.1% of the dispenser, aerosol, and tank samples respectively. Arsenic was detected in 10.7% of dispenser samples (median 26.7μg/kg) and these concentrations were similar in aerosol and tank samples. Aerosol mass concentrations (mg/m
) for the detected metals spanned several orders of magnitude and exceeded current health-based limits in close to 50% or more of the samples for Cr, Mn, Ni, and Pb.
Our findings indicate that e-cigarettes are a potential source of exposure to toxic metals (Cr, Ni, and Pb), and to metals that are toxic when inhaled (Mn and Zn). Markedly higher concentrations in the aerosol and tank samples versus the dispenser demonstrate that coil contact induced e-liquid contamination. https://doi.org/10.1289/EHP2175.
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CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
E-cigarette (vaping) conventions are public events promoting electronic cigarettes, in which indoor use of e-cigarettes is allowed. The large concentration of people using e-cigarettes and poor air ...ventilation can result in indoor air pollution. In order to estimate this worst-case exposure to e-cigarettes, we evaluated indoor air quality in a vaping convention in Maryland (MD), USA. Real-time concentrations of particulate matter (PM
) and real-time total volatile organic compounds (TVOCs), CO
and NO
concentrations were measured. Integrated samples of air nicotine and PM
concentrations were also collected. The number of attendees was estimated to range from 75 to 600 at any single observation time. The estimated 24-h time-weighted average (TWA) PM
was 1800 μg/m
, 12-fold higher than the EPA 24-h regulation (150 μg/m
). Median (range) indoor TVOCs concentration was 0.13 (0.04-0.3) ppm. PM
and TVOC concentrations were highly correlated with CO
concentrations, indicating the high number of people using e-cigarettes and poor indoor air quality. Air nicotine concentration was 125 μg/m
, equivalent to concentrations measured in bars and nightclubs. E-cigarette aerosol in a vaping convention that congregates many e-cigarette users is a major source of PM
, air nicotine and VOCs, impairing indoor air quality. These findings also raise occupational concerns for e-cigarette vendors and other venue staff workers.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
E-cigarette use is increasing in populations around the world. Recent evidence has shown that the aerosol produced by e-cigarettes can contain a variety of toxicants. Published studies characterizing ...toxicants in e-cigarette aerosol have relied on filters, impingers or sorbent tubes, which are methods that require diluting or extracting the sample in a solution during collection. We have developed a collection system that directly condenses e-cigarette aerosol samples for chemical and toxicological analyses. The collection system consists of several cut pipette tips connected with short pieces of tubing. The pipette tip-based collection system can be connected to a peristaltic pump, a vacuum pump, or directly to an e-cigarette user for the e-cigarette aerosol to flow through the system. The pipette tip-based system condenses the aerosol produced by the e-cigarette and collects a liquid sample that is ready for analysis without the need of intermediate extraction solutions. We tested a total of 20 e-cigarettes from 5 different brands commercially available in Maryland. The pipette tip-based collection system condensed between 0.23 and 0.53mL of post-vaped e-liquid after 150 puffs. The proposed method is highly adaptable, can be used during field work and in experimental settings, and allows collecting aerosol samples from a wide variety of e-cigarette devices, yielding a condensate of the likely exact substance that is being delivered to the lungs.
•E-cigarette toxicant evaluation is limited by difficulty to directly collect aerosol.•Methods used so far require using an extraction solution which could modify sample.•Our novel method for e-cigarette directly condenses the e-cigarette aerosol sample.•Our method is fast, inexpensive and highly adaptable to multiple e-cigarette devices.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Nickel (Ni) and chromium (Cr) are components of e-cigarette heating coils. Whether e-cigarettes increase metal internal dose, however, is unknown. We assessed the association of e-cigarette use ...patterns and of e-liquid and aerosol metal concentrations with Ni and Cr biomarker levels in e-cigarette users from Maryland.
We recruited 64 e-cigarette users from December 2015 to March 2016. We collected urine, saliva, and exhaled breath condensate (EBC), data on e-cigarette use, and samples from their e-cigarette device (dispenser e-liquid, aerosol, and tank e-liquid).
Median Ni and Cr levels were 0.73 and 0.39μg/g creatinine in urine, 2.25 and 1.53μg/L in saliva, and 1.25 and 0.29μg/L in EBC. In adjusted models, tertiles 2 and 3 of aerosol Ni concentrations were associated with 16% and 72% higher urine Ni and 202% and 321% higher saliva Ni compared to the lowest tertile. Tertile 3 of aerosol Cr levels were associated with 193% higher saliva Cr. An earlier time to first vape in the morning and more frequent coil change were associated with higher urine Ni. Tertile 2 of e-liquid consumption per week and voltage were associated with higher saliva Ni levels than tertile 1.
Positive associations of Ni and Cr aerosol concentrations with corresponding Ni and Cr biomarker levels indicate e-cigarette emissions increase metal internal dose. Increased e-cigarette use and consumption were also associated with higher Ni biomarker levels. Metal level standards are needed to prevent involuntary metal exposure among e-cigarette users.
•E-cigarette heating coils are commonly made of Ni and Cr, known carcinogens.•Ni and Cr levels were detected in aerosol samples from e-cigarette devices of users.•These levels in aerosol were positively associated with Ni and Cr biomarker levels.•Increased use and consumption were also associated with Ni biomarker levels.•Findings demonstrate e-cigarette use as a relevant source of toxic metal exposure.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract
Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the ...results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were
ex ante
formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.
With flavors such as "Captain Crunch Berries" and "Cookies and Cream," it may be no surprise that e-cigarette use is increasing most rapidly among middle school- and high school-aged youths.2,3 ...Research has shown an alarming rate of e-cigarette uptake among adolescents, with estimates of use tripling in just one year.4 Rather than promoting these devices as a tobacco cessation method, this culture may be encouraging nicotine addiction among youths.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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