{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:16:28Z","timestamp":1790007388803,"version":"4.0.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">After Massachusetts enacted regulation on flavored tobacco products in 2020, electronic cigarettes (e\u2010cigarettes) labeled \u201cclear\u201d emerged in the state. We studied their acute hemodynamic impact and chemical composition.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">In participants (age 18\u201345\u2009years) in the Cardiovascular Injury due to Tobacco Products 2.0 study (Boston, MA), we measured changes in blood pressure and heart rate following a structured use of participants' own e\u2010cigarettes. We compared \u201cclear\u201d e\u2010cigarette users (N=23) with non\u2010\u201cclear\u201d flavored e\u2010cigarette users (N=111) and nonusers (N=73). We used gas chromatograph coupled with mass spectroscopy to characterize and quantify the presence of synthetic cooling agents (WS\u20103, WS\u201023), menthol, and nicotine, and other flavorants in 19 \u201cclear\u201d e\u2010cigarettes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">All \u201cclear\u201d e\u2010liquids contained the synthetic cooling agents WS\u201023 and\/or WS\u20103, 18\/19 contained menthol, and 12\/19 products contained other flavorants. JUUL e\u2010liquids did not contain synthetic coolants. Baseline blood pressure and heart rate measures were similar between \u201cclear\u201d and non\u2010\u201cclear\u201d flavored e\u2010cigarette users. Following acute use, \u201cclear\u201d e\u2010cigarettes resulted in a greater increase in blood pressure and heart rate compared to both non\u2010\u201cclear\u201d flavored e\u2010cigarette use and nonuse, which remained largely consistent in multivariable models. For sensitivity analysis of comparing \u201cclear\u201d users to the subgroup of JUUL non\u2010\u201cclear\u201d flavored users, the directions of associations were similar.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The presence of synthetic cooling agents along with traditional flavorants in \u201cclear\u201d e\u2010cigarette products available in the Massachusetts marketplace undermines the efficacy of the flavor ban. The potential that \u201cclear\u201d e\u2010cigarettes induced more pronounced hemodynamic effects necessitates further study of the health impact of these products and synthetic cooling agents.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1101\/2024.04.18.24305863v1\">https:\/\/www.medrxiv.org\/content\/10.1101\/2024.04.18.24305863v1<\/jats:ext-link>\n              , medRxiv.\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1101\/2024.04.18.24305863\">10.1101\/2024.04.18.24305863<\/jats:ext-link>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.036106","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T12:01:48Z","timestamp":1755000108000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Cardiovascular Health Effects and Synthetic Cooling Agents in E\u2010Cigarettes Labeled as \u201cClear\u201d Marketed in Massachusetts After the Tobacco Product Flavoring Ban"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4771-791X","authenticated-orcid":false,"given":"Erika T.","family":"Minetti","sequence":"first","affiliation":[{"name":"Boston University Chobanian and Avedisian School of Medicine","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3443-9794","authenticated-orcid":false,"given":"Hanno C.","family":"Erythropel","sequence":"additional","affiliation":[{"name":"Yale University","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Keith","sequence":"additional","affiliation":[{"name":"University of Louisville School of Medicine","place":["Louisville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9436-9575","authenticated-orcid":false,"given":"Danielle R.","family":"Davis","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5392-312X","authenticated-orcid":false,"given":"Julie B.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Yale University","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchitra","family":"Krishnan\u2010Sarin","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-5589","authenticated-orcid":false,"given":"Naomi M.","family":"Hamburg","sequence":"additional","affiliation":[{"name":"Boston University Chobanian and Avedisian School of Medicine","place":["Boston"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2016-053174"},{"key":"e_1_3_1_3_2","unstructured":"FDA . 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