Comparative Indoor Pollution from Glo, Iqos, and Juul, Using Traditional Combustion Cigarettes as Benchmark: Evidence from the Randomized SUR-VAPES AIR Trial.

Mariangela Peruzzi,Elena Cavarretta,Roberto Carnevale,Francesco Versaci,Carmela Protano,Sebastiano Sciarretta,Giacomo Frati,Pasquale Avino,Fabio Miraldi,Vittoria Cammalleri,Matteo Vitali,Giuseppe Biondi-Zoccai

doi:10.3390/ijerph17176029

Abstract

Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are appealing alternatives to combustion cigarettes. Limited between- and within-device comparative data are available on MRP. We aimed at comparing indoor particulate matter (PM) emissions measured in a randomized trial enforcing standardized smoking sessions, testing different devices and flavors of MRP, using traditional combustion cigarettes (TCC) as benchmark. Overall, MRP yielded significantly lower levels of indoor PM in comparison to TCC (with median PM levels during smoking for MRP < 100 μg/m3, and for TCC > 1000 μg/m3). Despite this, significant differences among MRP were found, with Iqos appearing associated with a significantly lower burden of emissions for all the monitored fractions of PM, including total PM (all p < 0.05). Precisely, during use, PM ≤1 µm (PM1) emissions were 28 (16; 28) μg/m3 for Glo, 25 (15; 57) μg/m3 for Iqos, and 73 (15; 559) μg/m3 for Juul (p < 0.001 for Glo vs. Iqos, p < 0.001 for Glo vs. Juul, and p = 0.045 for Iqos vs. Juul). Exploratory within-MRP analyses suggested significant differences between flavors, favoring, for instance, Ultramarine for Glo, Bronze for Iqos, and Mango for Juul, even if results varied substantially according to individual smoker. In conclusion, leading MRP have significantly less intense and persistent effects on indoor pollution in comparison to TCC. Yet, when focusing solely on MRP, between-product and between-flavor differences appear, with quantitative estimates suggesting lower polluting effects with Iqos. These results, if confirmed externally, could be used to individualize product and flavor choice to minimize the untoward effects of EVC and HNBC on indoor pollution.

Highlights

Smoking of traditional combustion cigarettes (TCC) is associated with major burdens of mortality, morbidity, and cost [1,2]
The use of heat-not-burn cigarettes (HNBC) has rapidly increased worldwide, among young individuals [7]. Whether these novel modified risk products (MRP) may prove as reduced risk products (RRP) remains still uncertain, despite several reports suggesting that both electronic vaping cigarettes (EVC) and HNBC may prove less detrimental than TCC in several dimensions [8,9]
The 7 subjects recruited for the experiments were smokers of traditional cigarettes that converted to dual smoking

Summary

Introduction

Smoking of traditional combustion cigarettes (TCC) is associated with major burdens of mortality, morbidity, and cost [1,2]. The use of HNBC has rapidly increased worldwide, among young individuals [7] Whether these novel modified risk products (MRP) may prove as reduced risk products (RRP) remains still uncertain, despite several reports suggesting that both EVC and HNBC may prove less detrimental than TCC in several dimensions [8,9]. While EVC would theoretically appear less toxic than HNBC given the vaporization methods, the possible presence of volatile toxic agents may undermine such purported benefits [10,16] This might hold even truer when specific flavors are used, given the potential to increase exponentially the release of potentially hazardous agents, putting some individuals at risk who could be more susceptible than others [17]. We hereby aim at providing a more poignant comparison of aggregate MRP, as well as different flavors of each MRP type, in order to expand and confirm prior findings, while capitalizing on modern state-of-the-art statistical modeling tools [26,27]

Design and Experiment

Analysis

Result

Discussion

Findings

Conclusions