During the webinar - UCSF · 2016-06-27 · • This webinar is being recorded and will be...
Transcript of During the webinar - UCSF · 2016-06-27 · • This webinar is being recorded and will be...
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Thirdhand Cigarette Smoke: A Persistent Environmental Contaminant
Thursday, June 23, 2016 2pm ET (120 minutes)
Welcome Please stand by. We will begin shortly.
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Disclosure
Dr. Suzaynn Schick and Catherine Saucedo have disclosed no financial interest/arrangement or affiliation with any commercial companies who have provided products or services relating to their presentation or commercial support for this continuing medical education activity.
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Moderator
Catherine Saucedo • Deputy Director,
Smoking Cessation Leadership Center, University of California, San Francisco
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Thank you to our funders
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Housekeeping
• All participants will be in listen only mode.
• Please make sure your speakers are on and adjust the volume accordingly.
• If you do not have speakers, please request the dial-in via the chat box.
• This webinar is being recorded and will be available on SCLC’s website, along with the slides.
• Use the chat box to send questions at any time for the presenters.
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American Association for Respiratory Care (AARC)
• Free Continuing Respiratory Care Education credit (CRCEs) are available to Respiratory Therapists who attend this live webinar
• Instructions on how to claim credit will be included in our post-webinar email
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Suzaynn Schick, PhD • Assistant Professor,
School of Medicine, University of California, San Francisco
Today’s Speaker
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Thirdhand Cigarette Smoke: A Persistent Environmental
Contaminant Suzaynn F. Schick, PhD
University of California, San Francisco
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Thanks
• Lab Staff – Kelly Pratt, Adam Whitlatch, Abel Huang
• UCSF – John Balmes, Neal Benowitz, Peyton Jacob, Chris Havel,
Lisa Yu, Pura Tech • Lawrence Berkeley Lab
– Lara Gundel, Mohamad Sleiman, Hugo Destaillats • UC Tobacco-Related Disease Research Program
– Grant #s 12FT-0114, 21 ST-011, 20PT-0184 and 24RT-0039
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SHS
THS
Indoor Surfaces
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What is Thirdhand cigarette smoke? The 3 R’s
Chemicals in cigarette smoke that: • Remain on surfaces and in dust • Re-emit back into the gas phase • React with other chemicals in the
environment to make new chemicals
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Chemical Exposure Routes Respiratory
Ingestion
Dermal 12
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What is smoke? •Gases • Particles and droplets of oils and
waxes (Tar) • 10% of secondhand smoke is tar
Thirdhand Smoke starts with Tar
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Remain
• Tar chemicals stick to surfaces before they can be removed by ventilation
• Walls, carpet, dust, people…
• Tar absorbs into porous materials • Tar contains nicotine and many toxins and
carcinogens • Nitrosamines • Polycyclic aromatic hydrocarbons
• Persistence increases exposure time
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Re-Emit • Combustion forces tar chemicals (normally
solids or liquids) into the air • Tar cools, condenses and sticks to surfaces • Once on a surface, each chemical reaches
equilibrium • Fraction in the air depends on the chemical
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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Acetone Nicotine NNK
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React
• Where there are chemicals, there are chemical reactions
• Which reactions do we know about? – Nicotine + nitrous acid = NNK
» Carcinogen
– Nicotine + ozone = formaldehyde » Carcinogen
– Tar + ozone = ultrafine particles » Can cause heart and lung disease
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Truth Initiative Tobacco Documents Library
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Thirdhand Smoke Studies at Philip Morris
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Nicotine persisted in surfaces (after smoking ended)
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NNK persisted in surfaces (after smoking ended)
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Thirdhand Smoke at Philip Morris
• Remains – Aging decreases concentration of particles and
nicotine in air – Adding carpet and cloth to room increased losses – Chemicals persisted on/in surfaces after 50-110 days
of constant ventilation with clean air • Re-Emits
– After ventilation with clean air overnight, the air still contained lots of nicotine
• Reacts – Nicotine reacts to form NNK
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Thirdhand Smoke Studies at UCSF
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Secondhand Smoke at UCSF
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Smoke from cigarette smoking machine is diluted with filtered air, aged 30 minutes, then delivered to the study participant
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Respiratory exposure
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Thirdhand Smoke Emits Particles
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Normal particle output
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0.4
0.6
0.8
1
1.2
9:30 9:45 10:00 10:15 10:30 10:45 11:00
mg/
m3
Time
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Something coming out before start the smoking machine
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“Secondary” particles from Thirdhand Smoke
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9:30 9:45 10:00 10:15 10:30 10:45 11:00
mg/
m3
Time
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Secondhand Smoke Generation Mode
Thirdhand Smoke Deposition Mode
Thirdhand Smoke Exposure Mode
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Secondhand and Thirdhand Smoke particles differ
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Thirdhand Smoke Emits Volatile Chemicals
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Paper exposed to smoke emits volatile chemicals
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Respiratory
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Respiratory Exposure to Thirdhand Smoke In Human Participants
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Study design and sample collection
Day 1 Day 2
Pre Post Before Bed
First AM
Next Day
3 hours
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Cotinine is a biomarker of nicotine exposure
• Metabolite of Nicotine • Biomarker of smoking and exposure to
Secondhand Smoke and Thirdhand Smoke • Half-life of 16 hours
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Breathing Thirdhand Smoke increases cotinine
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2
2.5
3
0 3.5 10 20 22
ng/m
l
Hours
THS
Clean Air median
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Health effects of Thirdhand Smoke exposure in mice
• Smoke cages (curtain, carpet, cloth swatches inside)
• Mice live in cages for 6 months • Depilate backs weekly
• Nair on mice…
• Change cages weekly • Control mice live in separate room in
unsmoked cages 48
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Health effects in mice
• Induces type II diabetes • Causes hyperactivity • Speeds up blood clotting • Slows wound healing/changes skin structure • Damages liver/elevates blood lipids • Increases oxidative stress • Slows growth
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Non-obese type II diabetes
• 49% of exposed mice showed these effects
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Hyperactivity
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Faster blood clotting
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Charting the Unknown: Data from Marijuana and E-
Cigarettes
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Similarities between tobacco and marijuana smoke
• Leaf contains high concentrations of oils and waxes
• Nicotine and THC both survive combustion • It doesn’t matter what you burn: Combustion
creates complex, toxic aerosols
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Toxins in Sidestream
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Health Effects Tobacco Marijuana weight (mg) 788 769 puffs 13 15 tar (mg) Multiple 24 50 CO (mg) Inhibits respiration 62 54 Ammonia (mg) Irritant 5.6 14.3 Nicotine (mg) Addictive 5 0 NOx (mg) Inflame lung 1.2 2.3 Formaldehyde (μg) Carcinogen 886 383 Acrolein (μg) Cardiotoxin 437 566 HCN (μg) Toxin 84 685 Benzo (a) pyrene (ng) Carcinogen 91 101 NNK (ng) Carcinogen 92 0
Moir et al., 2008
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Terpenes, cannabis and particle formation
• Terpenes are odorant, bioactive chemicals found in cannabis, tobacco and e-liquids
• Limonene, Pinene, Linalool, Myrcene and others
• Secreted by plant glands that make THC • Used to reduce viscosity of hash oil in vape
pens • React to form ultrafine particles in air
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Thirdhand Smoke is a persistent environmental contaminant
• Remains – Chemicals stick to surfaces – Weeks and months of ventilation do not remove
Thirdhand Smoke
• Re-Emits – Nicotine, formaldehyde, acetonitrile, acetone and
other volatile chemicals
• Reacts – Nicotine reacts to form NNK – THS reacts to form particles 57
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E-Cigarette Toxins
• THS potential unknown • Aerosol contains smaller particles
– Median diameter for cigarettes: 110-340 nm – Median diameter for e-cigarettes: 5-50 nm – E-cigarette particles evaporate faster
• Nicotine – No sidestream but, more spills and leaks
• Flavorings: benzaldehyde (cherry), cinnamonaldehyde …
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Summary I • 10% of the smoke of every cigarette persists in
the environment • Thirdhand smoke is toxic and carcinogenic • Thirdhand smoke on surfaces emits constant
low levels of particles and chemicals
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Summary II
• Breathing thirdhand smoke causes detectable increases in the levels of nicotine in the body
• Thirdhand smoke may have health effects • Marijuana smoke probably creates THS too • E-cigarettes probably also create THS
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Conclusions
• Living in spaces where people have smoked increases exposure to toxins and carcinogens
• The concentrations are lower, but the exposure
is continuous and persistent • Smoking bans in housing, workplaces, hotels and
rental cars will reduce thirdhand smoke exposure
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Questions and Answers
• Submit questions via the chat box
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CME/CEUs of up to 1.5 credits are available to all attendees of this live session. Instructions will be emailed after the webinar.
Contact SCLC for technical assistance
Visit us online • http://smokingcessationleadership.ucsf.edu
Call us toll-free • 1-877-509-3786
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American Association for Respiratory Care (AARC)
• Free Continuing Respiratory Care Education credit (CRCEs) are available to Respiratory Therapists who attend this live webinar
• Instructions on how to claim credit will be included in our post-webinar email
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2016 Tips Campaign
www.cdc.gov/tips
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Free CME/CE credit
Select recorded webinars are eligible for free CME/CE credit. For more information, visit: smokingcessationleadership.ucsf.edu/webinars/cme
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CME/CEU Statement
Accreditation: The University of California, San Francisco (UCSF) School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. UCSF designates this live activity for a maximum of 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the webinar activity. Nurse Practitioners and Registered Nurses: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 CreditTM issued by organizations accredited by the ACCME. Physician Assistants: The National Commission on Certification of Physician Assistants (NCCPA) states that the AMA PRA Category 1 CreditsTM are acceptable for continuing medical education requirements for recertification. California Pharmacists: The California Board of Pharmacy accepts as continuing professional education those courses that meet the standard of relevance to pharmacy practice and have been approved for AMA PRA category 1 creditTM. If you are a pharmacist in another state, you should check with your state board for approval of this credit. Social Workers: This course meets the qualifications for 1.5 hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences. If you a social worker in another state, you should check with your state board for approval of this credit.