A new study from Johns Hopkins University found thousands of unknown chemicals in aerosols from e-cigarettes, including caffeine and chemicals associated with combustion.

Published in the journal Chemical Research in Toxicology the research tested the tobacco flavor of four different brands of e-liquids and their aerosols, including Juul, Blu, Mi-Salt and Vuse. The team confirmed six compounds in the e-liquids and aerosols, including a toxic flame retardant, but the researchers found thousands of chemicals that they couldn’t identify, study co-author and John Hopkins assistant professor Ana Rule said.

“We don’t even know what they are,” Rule said. “They’re not even in the normal list of chemicals that we can quantify or name in the lab, and these are going directly into the lungs of people that are vaping.”

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One of the confirmed chemicals found in the e-liquids and aerosols was caffeine. The research team was unsure whether caffeine was intentionally used to increase the level of addiction. Nicotine is already extremely addictive, Rule said, so the addition of caffeine for addictive purposes would likely be unnecessary.

Researchers also detected condensed-hydrocarbon-like compounds in the aerosols, which Rule said are only found as a result of combustion. The FDA categorizes vapes and e-cigarettes as noncombustible tobacco products.

Vape products are typically tested for chemicals contained in cigarette products, but for this study, researchers used a mass spectrometer to perform a non-targeted analysis normally used to identify chemicals in food, urine and blood.

According to the study, the number of chemicals in most vapes and e-cigarettes increases from the liquid to the aerosol stage. Applying heat to the e-liquid transforms it generates new chemicals, Rule said.

Most studies from the FDA focus on e-liquids, Rule said, but more research should be done on the unknown chemicals in the aerosols.

Vape and e-cigarette products list four main ingredients — nicotine, propylene glycol or vegetable glycerin, flavorings and other chemicals. The list of other chemicals doesn’t have to be disclosed because it’s protected as proprietary information, Rule said.

Informing young adults about the thousands of non-disclosed chemicals in vaping products could make them think twice about picking up the habit, Rule said.

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University of Wisconsin assistant professor of pediatrics and medicine Brian Williams said these findings should be a wake-up call for adolescents, young adults and policy-makers.

“I think the key takeaway — and one that I hope college students take away from this — is that e-cigarettes are not safe,” Williams said. “They contain dangerous chemicals, they put you at risk for lifelong nicotine addiction and put you at risk for harm down the road with use.”

Williams hopes that continued research into e-cigarettes and their toxin profile will lead to policy changes. While some regulations on e-cigarette marketing have been put in place, like raising the purchase age for tobacco to 21, Williams said more is needed, like limiting marketing towards young people.

Results from the Johns Hopkins study were released Oct. 5. A week later, the FDA allowed Vuse Solo to market tobacco-flavored e-cigarettes.

Vuse Solo also asked to market flavored products other than tabacco-flavored, but the FDA denied the request because youth and young adults often first start vaping with non-tobacco-flavored products, according to the FDA’s press release.

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Rule said she hopes the results from the study will be used to inform policy and regulations, especially in the FDA’s decisions to approve or deny new vaping products and marketing.

Young people are at the most risk for dangerous side effects from the unknown chemicals in vape products.

The chemicals in vapes and e-cigarettes target the brain, Rule said, which is still developing in young adults. Additionally, starting a nicotine addiction from a young age leads to a longer exposure time and more detrimental effects.

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E-cigarettes were originally marketed as a harmless and safe device, Williams said. Young adults and college students were targeted in advertising campaigns. According to a 2018 survey by the Centers for Disease Control and Prevention, adults aged 18–24 vaped more than any other group of adults.

Young adults who previously wouldn’t have used a nicotine product began to use e-cigarettes and this puts younger generations at risk for nicotine addiction, Williams said.

While e-cigarettes and vapes have the potential to benefit older adults trying to quit smoking, Rule said they are extremely harmful to young adults.

“The tobacco industry has been highlighting and focusing almost exclusively on the risk reduction to smokers,” Rule said. “More emphasis needs to be put on the risk increase for non-smokers. If you were not a smoker and started vaping, you’re increasing your risk.”