Waterpipe Tobacco and Cigarette Smoking. Direct Comparison of Toxicant Exposure

Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
American journal of preventive medicine (Impact Factor: 4.28). 12/2009; 37(6):518-23. DOI: 10.1016/j.amepre.2009.07.014
Source: PubMed

ABSTRACT Waterpipe (hookah, shisha) tobacco smoking has spread worldwide. Many waterpipe smokers believe that, relative to cigarettes, waterpipes are associated with lower smoke toxicant levels and fewer health risks. For physicians to address these beliefs credibly, waterpipe use and cigarette smoking must be compared directly.
The purpose of this study is to provide the first controlled, direct laboratory comparison of the toxicant exposure associated with waterpipe tobacco and cigarette smoking.
Participants (N=31; M=21.4 years, SD=2.3) reporting monthly waterpipe use (M=5.2 uses/month, SD=4.0) and weekly cigarette smoking (M=9.9 cigarettes/day, SD=6.4) completed a crossover study in which they each smoked a waterpipe for a maximum of 45 minutes, or a single cigarette. Outcome measures included expired-air carbon monoxide (CO) 5 minutes after session's end, and blood carboxyhemoglobin (COHb), plasma nicotine, heart rate, and puff topography. Data were collected in 2008-2009 and analyzed in 2009.
On average, CO increased by 23.9 ppm for waterpipe use (SD=19.8) and 2.7 ppm for cigarette smoking (SD=1.8), while peak waterpipe COHb levels (M=3.9%, SD=2.5) were three times those observed for cigarette smoking (M=1.3%, SD=0.5; p's<0.001). Peak nicotine levels did not differ (waterpipe M=10.2 ng/mL, SD=7.0; cigarette M=10.6 ng/mL, SD=7.7). Significant heart rate increases relative to pre-smoking were observed at 5, 10, 15, 20, 25, and 35 minutes during the cigarette session and at 5-minute intervals during the waterpipe session (p's<0.001). Mean total puff volume was 48.6 L for waterpipe use as compared to 1.0 L for cigarette smoking (p<0.001).
Relative to cigarette smoking, waterpipe use is associated with greater CO, similar nicotine, and dramatically more smoke exposure. Physicians should consider advising their patients that waterpipe tobacco smoking exposes them to some of the same toxicants as cigarette smoking and therefore the two tobacco-smoking methods likely share some of the same health risks.

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    • "* Manual work includes occupations: farmer and laborer; non-manual work includes occupations: office worker and businessman. ** 1 hookah session = 2 cigarettes (Eissenberg and Shihadeh, 2009). of tobacco were less likely to be continuously abstinent compared to those who were younger in age and smoked less. Participants having one or more smokers at their workplace were less likely to achieve continuous abstinence than those without smokers at their workplace. "
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    ABSTRACT: Background Smoking cessation services are rarely found within health services in low income countries. Given the interactions between Tuberculosis (TB) and tobacco, including cessation support within TB programs offers a promising cost-effective solution. We conducted secondary analysis of data from a cluster randomized controlled trial of smoking cessation in health centers in Pakistan to identify predictors of continuous and short-term abstinence in smokers suspected of TB using cigarettes or hookah. Methods Predictor variables of those continuously abstinent at 5 and 25 weeks post quit-date (continuous abstinence) and those abstinent only at 5 weeks (short-term abstinence) were compared with those who continued smoking and with each other. Self-reported abstinence at both time points was confirmed biochemically. Results Data obtained from 1955 trial participants were analyzed. The factors that predicted continued smoking when compared to continuous abstinence were: being older RR 0.97 (0.95 to 0.98), smoking higher quantities of tobacco RR 0.975 (0.97 to 0.98) and sharing a workplace with other smokers RR 0.88 (0.77 to 0.99). Those with a confirmed TB diagnosis were more likely to remain continuously abstinent than those without RR 1.27 (1.10–1.47). Conclusions Those diagnosed with TB are more likely to be abstinent than those diagnosed with other respiratory conditions. Beyond this, predictors of continued smoking in Pakistan are similar to those in high income contexts. Taking advantage of the ‘teachable moment’ that a TB diagnosis provides is an efficient means for resource-poor TB programs in low income settings to increase tobacco cessation and improve health outcomes.
    Drug and alcohol dependence 08/2015; DOI:10.1016/j.drugalcdep.2015.08.002 · 3.28 Impact Factor
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    • "High CO levels among waterpipe-serving employees may be explained by chronic secondhand smoke exposure during shifts, but also by the fact that they are required to ignite the waterpipe in small rooms and take puffs from it soon after ignition to test for product quality. Among laboratory studies of waterpipe smokers, it appears that the increase in COHb is greatest within the first five minutes of smoking than at any other time of a standard 45 minutes session (Eissenberg and Shihadeh, 2009). Furthermore, the number of smoke particles in smoke aerosol produced during the early minutes after ignition appear to be greater than at any other time of smoking (Monn et al., 2007). "
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    Asian Pacific journal of cancer prevention: APJCP 01/2015; 16(2). DOI:10.7314/APJCP.2015.16.2.621 · 2.51 Impact Factor
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    • "Smokers and nonsmokers in the vicinity are exposed to significant toxic emissions arising from the tobacco mixture as well as the burning charcoal (Maziak et al., 2008; Monzer et al., 2008). Despite the evidence that WTS potentially carries similar health risks as cigarettes and is associated with nicotine dependence (Akl et al., 2010; Cobb et al., 2011; Eissenberg and Shihadeh, 2009; Maziak et al., 2008, 2009; Monzer et al., 2008; Neergaard et al., 2007), the general perception among water pipe smokers is that it is less harmful than cigarettes (Maziak et al., 2004a; Roskin and Aveyard, 2009). "
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    ABSTRACT: To report prevalence and correlates of waterpipe tobacco smoking (WTS) use among U.S. adults. Data were from the 2009-2010 National Adult Tobacco Survey, a nationally representative sample of U.S. adults. Estimates of WTS ever and current use were reported overall, and by sex, age, race/ethnicity, educational attainment, annual household income, sexual orientation, and cigarette smoking status. State-level prevalence rates of WTS ever were reported using choropleth thematic maps for the overall population and by sex. The national prevalence of WTS ever was 9.8% and 1.5% for current use. WTS ever was more prevalent among those who are male (13.4%), 18-24 years old (28.4%) compared to older adults, non-Hispanic White (9.8%) compared to non-Hispanic Black, with some college education (12.4%) compared to no high school diploma, and reporting sexual minority status (21.1%) compared to heterosexuals. States with highest prevalence included DC(17.3%), NV(15.8%), and CA(15.5%). WTS is now common among young adults in the US and high in regions where cigarette smoking prevalence is lowest and smoke-free policies have a longer history. To reduce its use, WTS should be included in smoke-free regulations and state and federal regulators should consider policy development in other areas, including taxes, labeling, and distribution. Copyright © 2014. Published by Elsevier Inc.
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