Article

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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    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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    • "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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