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: 4.53). 12/2009; 37(6):518-23. DOI: 10.1016/j.amepre.2009.07.014
Source: PubMed


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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    • "For example, there is research that suggests one hookah session could be the equivalent of toxicant exposure of smoking 1 to 50 cigarettes [6]. Furthermore, Eissenberg et al. [11] found that hookah produced a significantly higher carbon monoxide exposure while delivering the same amount of nicotine in a laboratory-controlled experiment compared to cigarettes. Assessments of the harm potential of e-cigarettes are also limited. "
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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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    • "To assess the magnitude and implication of this addictive behavior , there is a need to understand dependence patterns of waterpipe smokers and identify those at high risk of becoming addicted. Waterpipe smoking delivers the same or higher doses of nicotine compared with cigarette smoking (Cobb et al., 2011; Eissenberg and Shihadeh, 2009), with daily users exposed to considerably higher levels (Maziak et al., 2011). While waterpipe smoking is mainly an intermittent tobacco use method, smoking frequency increases with prolonged use (Asfar et al., 2005). "
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