WATER PIPE, e-CIGARETTES „THE HEALTHIER SMOKING ??? https://is.muni.cz/www/2422/um > Gregory N. Connolly: wTHE 20th CENTURY WAS THE CIGARETTE CENTURY. wNOW, THE 21st CENTURY IS ABOUT MULTIPLE TOBACCO PRODUCTS. wTHEY ARE CHEAP, FLAWORED. wAND SOME OF THEM YOU CAN USE ANYWHERE WATER PIPE wWaterpipe, Narghile, Arghile, Shisha, Hookah, Goza, Hubble – Bubble wHISTORY: in ASIA, NORTH. AFRICA wMIDDLE EAST wWIDE SPREAD ON NORTH HEMISPHERE : young, university students wSmoking by cca 100 MILLIONS PEOPLE PREVALENCE of USERS wUSA ……………….…. 12-15 % wESTONIA …………. 25 % wLIBANON …………… 25 % wSYRIE ……………….. 25.5 % wPAKISTAN …………. 50 % wTURKISH ………….. 40 % wCZECH REP. ……….. 37 % (70 % up to 25 y) ČR – MEDICAL STUDENTS (GHPSS 2011/12) w 3rd ČR 6th LFMU wNo of respondents 706 220 wHave tried (%) 79.3 82.2 wDuring last month 19.2 5.9 wAt home 9.8 6.8 wIn tea house 33.8 36.1 wIn friends´home 34.5 38.4 FILLING wVERY DIFFERENT; most often w30 % TOBACCO (Ma´assel): MELASA, SUGAR, HONEY, FRUIT wTumbal, Urak wCHARCOAL (source of CO, benzin, PAU) wDEEPER INHALATION TYPES of SMOKING wINDIVIDUAL: 30 – 60 min, > 100 (až 170) puffs; inspiration 2.6 sec; 2.8 x/min => 530 ml of air w 3 mg nicotin, 800 mg tar, 145 mg CO, w 242 mg dust particles wIN GROUP: common mouthpiece – infection w IS IT SAFFER THAN CIGARETTES? wWATER FILTR ABSORBES : w- Formaldehyd ………..64.7 % -Acetaldehyd ……….. 74.6 % -Aceton …………….. 80.1 % -Acrolein ……………71.6 % -Propionaldehyd …… 64.5 % -Butylaldehyd ……… 58.2 % BUT!!! TOXICOLOGY wMATTER WP : CIG. RATE w PAH 8 – 45 w FORMALDEHYD 6 – 9 w ALDEHYDES 2 – 14 w TAR 8 – 53 w NICOTIN 1 – 5 w CO 6 – 15 w ARSEN 1 – 4 w CHROMIUM 19 – 333 w LEAD 80 – 200 wNITROSAMINES, PRIM. AROM. AMINES, ACROLEIN, RESPIR.DUST TOXICOL. - FENOLS wProduction temperat. 350-600o C; w3 – 1000 times more than from cigarette wEFFECTS: wToxic (cardiovascular) wPromotion of cancer wPromotion of lung cancer metastases wGenotoxic activity MARKERS of EXPOSURE wNicotin serum from 1.1 - > 60.3 ng/ml w saliva from 1.1 - > 624.7 ng/ml wCotinin urine from 73.6 - > 249 mg/l/day wPAH, NNAL in urine wChromosomal aberation, sister chromatids exchange higher than in cigarette smokers wDose-response relationships HEALTH CONSEQUENCES wADDICTION (behavioural, physical) wLUNG CANCER………………OR 2 - 6 wHEAD/NECK CANCER……... OR 4 - 5 wMOUTH DYSPLASIA ……… OR 8.33 wOESOPHAGEAL CANCER ….OR 1.85 wPARODONTITIS ……………. OR 3 - 5 HEALTH-continue wMetabolic sy. ….………..OR 3.21 wHypertriglyceridemia …. OR 1.63 w< HDL ………………… OR 1.75 wHyperglykemia………… OR 1.82 wHypertension..………… OR 1.95 wAbdominal obesity .. ….. OR 1.93 wAc.cardiovaskular response as for cigarettes HEALTH -continue wRespiratory d., coron.d. ……..….OR 2.3 wDry sucs after tooth extraction…. RR 3 wInfertility ………………………..OR 2.5 wComplication of gravidity wLow birthweight …….. ………. OR 2.12 wOxidative stress CASUISTIC wAC. POISONING by CO (man, 19y) WITH HEARTH SYNCOPE and VISUS DISORDERS wCOHb 32.7 % wINVERZE WAVE T (ECG) wAlso in another studies levels of COHb in water pipes smokers are high (20-30 %) DEPENDENCE wLIBANON „WATERPIPE DEPENDENCE SCALE“ w wBUYING THE WATER PIPE FOR DOMESTIC USE – IS IT THE FIRST MARKER OF DEPENDENCE (?) C:\Documents and Settings\prof. Hrubá\Plocha\Kavárny prach CO.jpg NOTICES wRESULTS FROM STUDIES ARE DIFFERENT – INFLUENCED BY w- BURNING MIXTURES w- EXCHANGING OF WATER w- WAYS and FREQUENCY of SMOKING C:\Documents and Settings\prof. Hrubá\Plocha\KOUŘ.OBR\Vodní dýmka na cigaretu.jpg HOOKAH STEAM STONES wPorous stones with glycerine wBurning in water pipe wSources of smoke from propandiol/ glycerol wEmisions from charcoat (CO, PAH) ADVERTISING w„SAFE SMOKING“ wTOBACCO LAW FREE wLIKE SWEETS, CHEWING GUMS wEXPORT FROM GERMANY, UK, wYOUNG ARE VERY INTERESTED E-CIGARETTES wElectronic Nicotine Delivery Systems w1993 China, like clasic cigarette (pipe, cigar) wContemporarly cca 200 sorts wWidespead: 2012 sold 3,5 mil. pieces w (a)SMOKING CESSATION w (b)SMOKING ON PUBLIC PLACES http://safesmoke.com.au/images/schematic.jpg TECHNIC PARAMETERS wCONTAIN: nicotine, propylenglykol / glycerin, additives (menthol, chocolade, fruits) wSelf- filling by smokers ! (liquid) wTEMPERATURE cca 60o C w (classic cigarette 600 - 900o C ) w PRODUCTION wSMALL MANUFACTURES, LOW STANDARD wREAL LEVELS ARE DIFFERENT FROM DECLARATED LEVELS (FDA´s measurements) w95 % are produced in China NEW INTEREST by wBIG TOBACCO, including wALTRIA (Philip Morrise: Regulatory Toxicology and Pharmacology) wADVERTISING similar as for classic cigarettes: wsofisticated, freedom, individualism, … C:\Documents and Settings\prof. Hrubá\Plocha\reklama e-cigareta.jpg DISTRIBUTION wInternational Tobacco Control Four-Country Survey 2013: wKNOWN: 46.6% (US 73, UK 54, Ca 40, Au 20) wHAVE TRIED: 7.6% wREGULAR USERS: 2.9% w wIn ČR (2010) have tried 6.7% over 15 y wSOCIAL TRENDS: young, higher income REASONS FOR USING w 75.4% REDUCTION OF SMOKING w 85.1% SMOKING CESSATION w 79.8% BELIEVED ABOUT SAFETY w NICOTINE wVolume 5, 10, 20 ml wNicotine concentr. 0 – 20 mg/ml wEven the smallest cartridge (5ml) can contain 100 mg nicotine wLetal dosis 10 mg (children), w 30-60 mg (adults) C:\Documents and Settings\prof. Hrubá\Plocha\Ecig-nové.JPG C:\Documents and Settings\prof. Hrubá\Plocha\Distribuce nikotinu.JPG RESPIRABLE PARTICLES wCONVENTIONAL C. w4 x 109 /cm3 w wE-CIGARETTES: w4.39 x 109 /cm3 wCORRELATTE WITH NICOTINE CONC., and LENGHT OF PUFF OTHER CHEMICALS (aerosol) wDI-ETYLEN GLYKOL wPARTICLES of Ag, Fe, Ni, Al, Sn, Si wNANOPARTICLES Sn, Cr, Ni wCONCENTRATIONS OF THESE CHEMICALS ARE HIGHER THAN IN CLASSIC CIGARETTES MORE OTHER CHEMICALS wNITROSAMINES wACETALDEHYD, ACETON wFORMALDEHYD wCHLORINATED POLYCYKLIC H. wPOLYCYCLIC AROMATIC H. FOR PASSIVE SMOKERS wINDOOR ETS -Levels of ammonia lower by 41 % -Particular matters lower by 80 – 90 % -CO as in non-smoking environment -Nicotine as in non-smoking environment FOR USERS: •EFFECTS FOR SMOKING CESSATION - CONTROVERSIAL •NICOTINE CAN PRODUCE DIFFERENT PHYSIOLOG., TOXICOLOG. and ADDICTIVE EFFECTS wAC. HEART and LUNG RESPONSE as classic cigarettes wCHR. EFFECTS – NOT KNOWN wDEVELOPMENT OF DEPENDENCE IN VITRO wEXTRACTS FROM DIFFERENT e-CIG. PRODUCED CYTOTOXIC EFFECTS ON CARDIOMYOBLASTS, wSIMILARLY AS CLASSIC CIGARETTES w wFarsalinoc et al., Int J Environ Res Publ Health 2013; 10 (10) SIDE EFFECTS wHEADACHE, wNAUSEA wIRRITATION (mouth, bronchi) wDRY MOUTH wLIPOID PNEUMONIE (aspiration of glycerinu) 3 ON-LINE SOURCES w405 DIFFERENT SYMPTOMS -78 POSITIVE -326 NEGATIVE -1 NEUTRAL - wHua M et al. J Medical Internet Research, 2013; www.jmir.org20134e59 USERS´ COMMENTS: wLESS TOXIC wSMELL-FREE wFREEDOM wNO ASH wNO FIRE wSOURCE of NICOTINE wLOWER „CRAVING“ wBAD QUALITY wSHORT LIFE of BATERIE wTOO EXPENSIVE wBAD TASTE wLOW INFORMATIONS wBACK TO CIGARETTES E-CIGARETTES for CESSATION wUSING E-CIGARET: - -Longer time -Short time -No using w2.758 clients of 6 „quit lines“ - w7 Months ABSTINENCE: -21.7 % -16.6 % -31.3 % wVickerman KA et al., Tobacco Research 2013; May 8 - wAnother tobacco product, not treatment drug wDanger of poissoning (alimentar, transdermal) wSupport the behavioral dependence wFurther research of effects is necessary wNot legal in Canada, Australia wLegal in USA, UK wNot permitted for smoking on public places, and wFor sale to minors SPECIALISTS´ STATEMENT: CONCLUSSION 1 wWATER PIPES and E-CIGARETTES ARE PERCIEVED AS SAFE SMOKING wIT IS NECESSARY TO CONFIRM or REFUSE IT by SERIOUS RESEARCH wUSING DECREASES COMMON EFFORT TO REDUCE NICOTINE/ TOBBACO INTAKE CONCLUSION 2 wNICOTINE IS: wCOMPLEETE CARCINOGEN (due to its genotoxic metabolit NNK; direct epigenetic influence on promotion, proliferation and expanzion) wHUMAN TERRATOGEN (brain development, programming) wPOTENT ADDICTION DRUG Reklama DĚKUJI ZA POZORNOST