WATER PIPE e-CIGARETTES THE HEALTHIER SMOKING

WATER PIPE, e-CIGARETTES „THE HEALTHIER SMOKING ? ? ? https: //is. muni. cz/www/2422/um

Gregory N. Connolly: w THE 20 th CENTURY WAS THE CIGARETTE CENTURY. w NOW, THE 21 st CENTURY IS ABOUT MULTIPLE TOBACCO PRODUCTS. w THEY ARE CHEAP, FLAWORED. w AND SOME OF THEM YOU CAN USE ANYWHERE

WATER PIPE w Waterpipe, Narghile, Arghile, Shisha, Hookah, Goza, Hubble – Bubble w HISTORY: in ASIA, NORTH. AFRICA w MIDDLE EAST w WIDE SPREAD ON NORTH HEMISPHERE : young, university students w Smoking by cca 100 MILLIONS PEOPLE

PREVALENCE of USERS w USA ………………. …. 12 -15 % w ESTONIA …………. 25 % w LIBANON …………… 25 % w SYRIE ………………. . 25. 5 % w PAKISTAN …………. 50 % w TURKISH …………. . 40 % w CZECH REP. ………. . 37 % (70 % up to 25 y)

ČR – MEDICAL STUDENTS (GHPSS 2011/12) w No of respondents Have tried (%) During last month At home In tea house In friends´home 3 rd ČR 706 79. 3 19. 2 9. 8 33. 8 34. 5 6 th LFMU 220 82. 2 5. 9 6. 8 36. 1 38. 4

FILLING w VERY DIFFERENT; most often w 30 % TOBACCO (Ma´assel): MELASA, SUGAR, HONEY, FRUIT w Tumbal, Urak w CHARCOAL (source of CO, benzin, PAU) w DEEPER INHALATION

TYPES of SMOKING w INDIVIDUAL: 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, 242 mg dust particles w IN GROUP: common mouthpiece – infection

IS IT SAFFER THAN CIGARETTES? WATER FILTR ABSORBES : - Formaldehyd ………. . 64. 7 % - Acetaldehyd ………. . 74. 6 % Aceton ……………. . 80. 1 % Acrolein …………… 71. 6 % Propionaldehyd …… 64. 5 % Butylaldehyd ……… 58. 2 %

BUT!!! TOXICOLOGY w MATTER PAH FORMALDEHYDES TAR NICOTIN CO ARSEN CHROMIUM LEAD WP : CIG. RATE 8 – 45 6– 9 2 – 14 8 – 53 1– 5 6 – 15 1– 4 19 – 333 80 – 200 NITROSAMINES, PRIM. AROM. AMINES, ACROLEIN, RESPIR. DUST

TOXICOL. - FENOLS w Production temperat. 350 -600 o C; w 3 – 1000 times more than from cigarette w EFFECTS: w Toxic (cardiovascular) w Promotion of cancer w Promotion of lung cancer metastases w Genotoxic activity

MARKERS of EXPOSURE w Nicotin serum from 1. 1 - > 60. 3 ng/ml saliva from 1. 1 - > 624. 7 ng/ml Cotinin urine from 73. 6 - > 249 mg/l/day PAH, NNAL in urine Chromosomal aberation, sister chromatids exchange higher than in cigarette smokers Dose-response relationships

HEALTH CONSEQUENCES w ADDICTION (behavioural, physical) w LUNG CANCER………………OR 2 - 6 w HEAD/NECK CANCER……. . . OR 4 - 5 w MOUTH DYSPLASIA ……… OR 8. 33 w OESOPHAGEAL CANCER …. OR 1. 85 w PARODONTITIS ……………. OR 3 - 5

HEALTH-continue w Metabolic sy. …. ………. . OR 3. 21 w Hypertriglyceridemia …. OR 1. 63 w < HDL ………………… OR 1. 75 w Hyperglykemia………… OR 1. 82 w Hypertension. . ………… OR 1. 95 w Abdominal obesity. . …. . OR 1. 93 w Ac. cardiovaskular response as for cigarettes

HEALT -continue Respiratory d. , coron. d. ……. . …. OR 2. 3 w Dry sucs after tooth extraction…. RR 3 w Infertility ……………. . OR 2. 5 w Complication of gravidity w Low birthweight ……. . ………. OR 2. 12 w Oxidative stress

CASUISTIC w AC. POISONING by CO (man, 19 y) WITH HEARTH SYNCOPE and VISUS DISORDERS w COHb 32. 7 % w INVERZE WAVE T (ECG) w Also in another studies levels of COHb in water pipes smokers are high (20 -30 %)

DEPENDENCE w LIBANON „WATERPIPE DEPENDENCE SCALE“ w BUYING THE WATER PIPE FOR DOMESTIC USE (? )

NOTICES w RESULTS FROM STUDIES ARE DIFFERENT – INFLUENCED BY - BURNING MIXTURES - EXCHANGING OF WATER - WAYS and FREQUENCY of SMOKING

HOOKAH STEAM STONES w Porous stones with glycerine w Burning in water pipe w Sources of smoke from propandiol/ glycerol w Emisions from charcoat (CO, PAH)

ADVERTISING w „SAFE SMOKING“ w TOBACCO LAW FREE w LIKE SWEETS, CHEWING GUMS w EXPORT FROM GERMANY, UK, w YOUNG ARE VERY INTERESTED

E-CIGARETTES w Electronic Nicotine Delivery Systems w 1993 China, like clasic cigarette (pipe, cigar) w Contemporarly cca 200 sorts w Widespead: 2012 sold 3, 5 mil. pieces w (a)SMOKING CESSATION w (b)SMOKING ON PUBLIC PLACES

TECHNIC PARAMETERS w CONTAIN: nicotine, propylenglykol / glycerin, additives (menthol, chocolade, fruits) w Self- filling by smokers ! (liquid) w TEMPERATURE cca 60 o C w (classic cigarette 600 - 900 o C )

PRODUCTION w SMALL MANUFACTURES, LOW STANDARD w REAL LEVELS ARE DIFFERENT FROM DECLARATED LEVELS (FDA´s measurements)

NEW INTEREST by w BIG TOBACCO, including w ALTRIA (Philip Morrise: Regulatory Toxicology and Pharmacology) w ADVERTISING similar as for classic cigarettes: sofisticated, freedom, individualism, …

DISTRIBUTION w International Tobacco Control Four-Country Survey 2013: w KNOWN: 46. 6% (US 73, UK 54, Ca 40, Au 20) w HAVE TRIED: 7. 6% w REGULAR USERS: 2. 9% w In ČR (2010) have tried 6. 7% over 15 y w SOCIAL TRENDS: young, higher income

REASONS FOR USING w 75. 4% REDUCTION OF SMOKING w 85. 1% SMOKING CESSATION w 79. 8% BELIEVED ABOUT SAFETY

NICOTINE w Volume 5, 10, 20 ml w Nicotine concentr. 0 – 20 mg/ml w Even the smallest cartridge (5 ml) can contain 100 mg nicotine w Letal dosis 10 mg (children), 30 -60 mg (adults)

OTHER CHEMICALS (aerosol) w DI-ETYLEN GLYKOL w PARTICLES of Ag, Fe, Ni, Al, Sn, Si w NANOPARTICLES Sn, Cr, Ni w CONCENTRATIONS OF THESE CHEMICALS ARE HIGHER THAN IN CLASSIC CIGARETTES

MORE OTHER CHEMICALS w NITROSAMINES w ACETALDEHYD, ACETON w FORMALDEHYD w CHLORINATED POLYCYKLIC H. w POLYCYCLIC AROMATIC H.

FOR PASSIVE SMOKERS w INDOOR 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 w AC. HEART and LUNG RESPONSE as classic cigarettes w CHR. EFFECTS – NOT KNOWN w DEVELOPMENT OF DEPENDENCE

SIDE EFFECTS w HEADACHE, w NAUSEA w IRRITATION (mouth, bronchi) w DRY MOUTH w LIPOID PNEUMONIE (aspiration of glycerinu)

3 ON-LINE SOURCES w 405 DIFFERENT SYMPTOMS - 78 POSITIVE - 326 NEGATIVE - 1 NEUTRAL Hua M et al. J Medical Internet Research, 2013; www. jmir. org 20134 e 59

USERS´ COMMENTS: w w w LESS TOXIC SMELL-FREEDOM NO ASH NO FIRE SOURCE of NICOTINE w LOWER „CRAVING“ w BAD QUALITY w SHORT LIFE of BATERIE w TOO EXPENSIVE w BAD TASTE w LOW INFORMATIONS w BACK TO CIGARETTES

E-CIGARETTES for CESSATION w USING E-CIGARET: - Longer time - Short time - No using 2. 758 clients of 6 „quit lines“ w 7 Months ABSTINENCE: - 21. 7 % - 16. 6 % - 31. 3 % Vickerman KA et al. , Tobacco Research 2013; May 8

STATEMENTS of SPECIALISTS w w w w Another tobacco product, not treatment drug Danger of poissoning (alimentar, transdermal) Support the behavioral dependence Further research of effects is necessary Not legal in Canada, Australia Legal in USA, UK Not permitted for smoking on public places, and For sale to minors

CONCLUSSION 1 w WATER PIPES and E-CIGARETTES ARE PERCIEVED AS SAFE SMOKING w IT IS NECESSARY TO CONFIRM or REFUSE IT by SERIOUS RESEARCH w USING DECREASES COMMON EFFORT TO REDUCE NICOTINE/ TOBBACO INTAKE

CONCLUSION 2 w NICOTINE IS: w COMPLEETE CARCINOGEN (genotoxic metabolit NNK, epigenetic influence on promotion, proliferation and expanzion) w HUMAN TERRATOGEN (brain development, programming) w POTENT ADDICTION DRUG

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