Misinformation on environmental vapor in peer reviewed literature:

a scientific critique

Pro Vapeo México A.C.&Institute for Nuclear Sciences National University of Mexico

Roberto A Sussman

CONFLICTS OF INTEREST

ABSOLUTELY NONE WHATSOEVER

This is the extended version of the material I presented orally in the Paralel

Session 5: Beliefs and practices: new evidence on real world use of electronic

cigarettes. Friday 14 June 2019

Contents

Environmental e-cigarette & tobacco cigarette emissions

Distorted risk communication

Experimental results

Context: comparison with other pollutants

Why is this important?

AEROSOLS

Suspended “particles” [particulate phase]in a gaseous medium [gas phase]

Tobacco smoke and e-cigarette “vapor” are both aerosolsbut are VERY DIFFERENT AEROSOLS

Environmental vapor & tobacco cigarette emissions

Main Stream smoke

Side Stream smoke Side Stream smoke (not absorbed)2/3 of TAR (tobacco aerosol residue) 3/4 of nicotine. Most of gas phase compounds.

Main Stream vapor

Smoker absorbs most inhaled smoke

Vaper absorbes most inhaled vaporwhat is released is very diluted

There is no Side Stream Vapor

TOBACCO SMOKE vs E-CIG “VAPOR”

COMBUSTION: High temperatures: tip of cigarette at 900 C while burning, 450-600 C smouldering between puffs

ATOMIZATION: Low temperatures ~ 200 C

Tobacco smoke: Highly complex chemistry

E-cigarette vapor Simple chemistry

PARTICLES: Solid and liquid droplets (visible smoke) TAR (Tobacco Aerosol Residue). GAS PHASE: ~ 7000 detected compounds

PARTICLES: liquid droplets (visible cloud). GAS PHASE ~ 100-300 detected compounds (flavorings)

Experimental results on environmental emissions

Quick summary of gas & “particle” (droplets) phases

SOURCE: A.A. Ruprecht et al, 2017. Environmental pollution and emission factors of electronic cigarettes, heat not burn tobacco products & conventional cigarettes. Aerosol Science & Technology 51(6): 674-684 http://dx.doi.org/10.1080/02786826.2017.1300231

Black Carbon

Droplets

Gas: aldehydes

CIGARETTE E-CIG IQOS

GAS PHASE

Propylene Glycol, Glycerol Nicotine, everything else = NOISE (appears in minute concentrations comparable to background controls)

Polycyclic Aromatic Hydrocarbons Volatile Organic CompoundsNicotine, Many organic compounds (also inorganic)

E-cigarette “vapor”

Tobacco smoke

SOURCE: J Liu et al, 2017. Determination of selected chemical levels in room air and surfaces after the use of cartridge and tank based E-vapor products or conventional cigarettes. Int. J. Environ. Res. Public Health 2017, 14, 969; doi:10.3390/ijerph14090969

E-cigarette 4 hour sessions ALDEHYDES, PAH’s & metals at near background levels

In blue (Ecig), negiligible levels; in red(smoking) significant emmisions

Particulate phase:

“Particles” are liquid droplets made of Propylene Glycol, Glycerol and humectants (visible cloud)

They evaporate & disperse in ~ 1 minute per puff

Particles can be solid or liquid droplets of high chemical complexity (TAR = Tobacco Aerosol Residue)

They do not evaporate, but slowly disperse by air circulations, fall by gravity and deposit in walls

E-CIGARETTE

TOBACCO CIGARETTE

SOURCE: A Avino et al, 2018. Second-hand aerosol from tobacco and electronic cigarettes: Evaluation of the smoker emission rates and doses and lunf cancer risk of passive smokers and vapers. Science of the Total Environment, 642:137-147; https://doi.org/10.1016/j.scitotenv.2018.06.059

SOURCE: Z Tongke et al, 2017. Charactoristics of secondhand electronic cigarette aerosols from active human use. Aerosol Science and Technology, 51(12):1368-1376; https://doi.org/10.1080/02786826.2017.1355548

Difference can be seen in time evolution of particle numbers concentration

E-cigarette vapor

Aging by oxydizing reactions

Evaporation

E-cigarette aerosol have VERY SIMPLE CHEMISTRY Time evolution of “particle” size distribution AGING

Tobacco smoke

E-cigarette vapor

Palm Oil Cooking

Olive Oil Cooking

SOURCE: Tengyu Lui et al Atmos. Chem. Phys., 18, 11363–11374, 2018 https://

doi.org/10.5194/acp-18-11363-2018 SOURCE: Avino et al Science of the Total Environment, 642:137-147; https://doi.org/10.1016/j.scitotenv.2018.06.059

Time evolution of particle numbers AGING 60

50

40

30

20

10

0

Con

cent

ratio

n (µ

g m

-3)

543210-1-2-3Time since lights on (h)

Measured OA SOA POA Reconstructed OA First order loss

(a) Palm oil

50

40

30

20

10

0

Con

cent

ratio

n (µ

g m

-3)

-4 -3 -2 -1 0 1 2 3 4Time since lights on (h)

Measured OA SOA POA Reconstructed OA First order loss

(b) Olive oil

Secondary Organic Aerosol

Primary Organic Aerosol

E-cigarette vapor

Tobacco smokePhotochemical Aging

SOURCE: Avino et al Science of the Total Environment, 642:137-147; https://doi.org/10.1016/j.scitotenv.2018.06.059

SOURCE: Tengyu Lui et al Atmos. Chem. Phys., 18, 11363–11374, 2018 https://

doi.org/10.5194/acp-18-11363-2018

Aging by oxydizing reactions

Evaporation

Comparison with cooking aerosol

There is an ongoing debate on risks & benefits of e-cigarettes

Emphasize risks over benefits.Extreme precautionary approach (can be a form of

distorted risk communication)

Emphasize benefits over risks (deemed to be residual in comparison to smoking)

USA APPROACH

UK APPROACH

UK USA

ENVIRONMENTALEMISSIONS

Source: Fairchild A M. and Bayer R.D., Stabile L., The E-cigarette debate, what counts as evidence?, Am J Public Health. 2019 Jul;109(7):1000-1006. doi: 10.2105/AJPH.2019.305107

The issue of environmenal emissions in this debate is discussed in this article:

Distorted risk communication in the literature

• NO EXPERIMENTAL results in well designed studies have been found that give reasons for health concern

• YET: most studies conclude the exposure to environmental e-cig emissions is risky and dangerous

Emblematic Example (there are many)

• LEGISLATIVE INTERVENTIONS TO FORBID E-CIGARETTE USAGE IN PUBLIC PLACES AND INDOOR ENVIRONMENTS.

• EDUCATIONAL INTERVENTIONS TO INCREASE AWARENESS ON THE THREATS OF THE USE OF E-CIGS.

• DISCOURAGE E-CIG HOME USAGE TO PROTECT CHILDREN,

• URGENT TO PROMOTE HEALTHY LIFESTYLES.

Protano et al, Int. J. Environ. Res. Public Health 2018, 15, 2172; doi:10.3390/ijerph15102172

Conclusions of this study on e-cigarette vapor emissions

What did these authors find that us so worrying?

All they did was to show that recent high power E-Cigarettes produce more “particles” (droplets) in the nanometer scale

BEWARE, E-CIGARETTE AEROSOL DROPLETS ARE DANGEROUS !!!!!!!!!

Are they really ????

but their message is:

The same group of authors looked at household sub-micron particles sourcesManigrasso et al, Science of the Total Environment 598 (2017) 1015–1026 http://dx.doi.org/10.1016/j.scitotenv.2017.02.048

Emissions reach 5 X 10 particles/cm3 6

Combustion: particles liquid oil dropletsCooking Organic Aerosol Gas phase has PAH & VOC’s & Fatty Acids

Maintain these values (photochemical aging)

Compare with e-cigarette(same that was cause of alarm)

Emissions reach 1.5 X 10 particles/cm3

But only at peaks, returns to background values < 4000 particles/cm3 after each puff

NO Combustion: particles made of propylene glycol, glycerol and humectants

5

Meat grilling

Citronella Candle

Compare with e-cigarette(same that was cause of alarm)

Emissions reach 5 X 10 particles/cm3 5

Combustion: particles made of hydrocarbons Gas phase has PAH & VOC’s

Emissions reach 1.5 X 10 particles/cm3 5

But only at peaks, returns to background values < 4000 particles/cm3 after each puff

NO Combustion: particles made of propylene glycol, glycerol and humectants

Maintain these values as long as it burns (blue)

Sub-micron particles from a burning Citronella Candle

Vacuum Cleaner

Emissions reach 5 X 10 particles/cm3 5

Solid Particles dust and metalGas phase has PAH & VOC’s

Maintain these values (aging)

Compare with e-cigarette(same that was cause of alarm)

Emissions reach 1.5 X 10 particles/cm3

But only at peaks, returns to background values < 4000 particles/cm3 after each puff

NO Combustion: particles made of propylene glycol, glycerol and humectants

Sub-micron particles from a vacuum cleaner

5

Sub-micron particle numbers & gas phase emissions from grilling in a gas stove (max power) different types of foods

Concentrationµg/cm3

Particles#/cm 3

Source: Buonano G., Morawska L., Stabile L., Particle emission factors during cooking activities, Atmospheric Environment 43 (2009) 3235–3242

Concentrations of gase phase compounds & particle numbers orders of magnitude larger than in e-cigarette emissions

If the number count & lung deposition of submicron “particles” make environmental e-cigarette emissions

so dangeous then emissions from

ARE EVEN MORE DANGEROUS !!!!!!!!!(Their particles are chemically hazardous)

• Candle lightning

• Vaccum cleaners

• Meat grilling

If HARSH INTERVENTIONS are needed to protect the public from e-cigarette submicron “particles” then …

We need even harsher interventions to protect the public from

Is this what the authors are recommending ?

• Candle lightning

• Vaccum cleaners

• Meat grilling

Control such emissions through the use of exhaust ventilation

Improving domestic electric appliances.

Dust emissions from vacuum cleaners can be mitigated by improving the filtration efficiency.

Prevent susceptible sub-populations of risks of respiratory diseases and oxidative stress.

NO, The authors’ conclusions & recommendations are NOT alarmist, just plain old fashioned “common sense”

Why plain “common sense” cannot be applied to e-cigarettes?After all its “particles” (droplets) are not cause of concern

GOTCHA

Formaldehyde vs safety thresholds

Occupational Safety and Health Administration (OSHA)

Office of Environmental Health Hazard AssessmentCalifornia Environmental Protection Agency (OEHHA)

8-h time weighted average permissible exposure limit

Tobacco smoke

E-cigarette vapor

E-cigarette vs tobacco cigarette This is what I have shown you that comes from the

science

There is no scientific justification to regard environmental e-cigarette emissions as hazardous to bystanders

CONCLUSIONS: RISK COMMUNICATION

Health professionals communicating risks along an extremely precautionary approach that is not based on

facts brought by solid scientific practice are violating the very basics of Public Health ethics

Therefore

Standard Thresholds of Occupational Safety are not sufficiently protective of vulnerable populations (children, pregnant women, elderly, etc)

But exposures from environmental e-cigarette emissions are so much BELOW these thresholds that it is EXTREMELY unlikely that these emissions would affect vulnerable individuals

IN FACT: Occupational safety thresholds are appropriate to regulate voluntary exposure for healthy adults in designated indoor spaces.

CONCLUSIONS: SAFETY THRESHOLDS

This is what comes from the science. To claim otherwise is politics and ideology.

Protecting them Does not require prohibition of vaping here