title: The effects of alcohol-containing e-cigarettes on young adult smokers.
abstract: BACKGROUND
  The liquids (e-liquids) used in an electronic cigarette (e-cigarette) contain myriad chemicals without adequate human inhalation safety data. Furthermore, the absence of e-liquid labeling requirements poses a formidable challenge to understanding how e-liquid constituents may promote nicotine addiction and/or have independent or synergistic biological effects when combined with nicotine. Ethyl alcohol is such a constituent, but has received little scientific interest in this context.
  
  
  METHODS
  Using a randomized, double blind, crossover design, acute changes in subjective drug effects, motor performance and biochemical measures of alcohol and nicotine intake were evaluated after directed and ad lib puffing from two commercially available e-liquids containing nicotine (8 mg/ml), vanilla flavor and either 23.5% (high) or 0.4% (trace) alcohol.
  
  
  RESULTS
  While no differences in subjective drug effects were observed between alcohol conditions, performance on the Purdue Pegboard Dexterity Test (PPDT) improved under the trace, but not under the 23.5% alcohol condition. Although plasma alcohol levels remained undetectable during testing, urine ethyl glucuronide (EtG), an alcohol metabolite, became measurable in three participants after puffing from the 23.5% alcohol e-cigarette.
  
  
  CONCLUSIONS
  Brief use of a widely available type of e-cigarette containing an e-liquid purchased from an internet vendor can negatively impact psychomotor performance and in some instances, produce detectable levels of a urine alcohol metabolite. Given the widespread and unregulated use of e-cigarettes, especially by youth and other vulnerable populations, further studies are needed to evaluate both the acute safety and long-term health risks of using alcohol-containing e-cigarettes.
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States. Electronic address: gerald.valentine@yale.edu.
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Valentine
authors.affiliation: Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, United States.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Jatlow
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States.
authors.forename: Marcedes
authors.initials: M
authors.lastname: Coffman
authors.affiliation: Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, United States.
authors.forename: Haleh
authors.initials: H
authors.lastname: Nadim
authors.affiliation: Yale University School of Public Health, Department of Biostatistics, New Haven, CT, United States.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, New Haven, CT, United States; VA Connecticut Healthcare System, West Haven, CT, United States.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004338:Drug Combinations; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects*; D000431:Ethanol / Q000009:adverse effects* / Q000097:blood; D005260:Female; D005965:Glucuronates / Q000652:urine; D006801:Humans; D008297:Male; D011597:Psychomotor Performance / Q000187:drug effects*; D055815:Young Adult
chemical_list: D004338:Drug Combinations; D005965:Glucuronates; C093924:ethyl glucuronide; D000431:Ethanol
keywords: Alcohol; Alcohol inhalation; Nicotine; Vaping; e-Cigarettes; e-Liquid