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Comparative Study
. 2009 Dec;37(6):518-23.
doi: 10.1016/j.amepre.2009.07.014.

Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure

Thomas Eissenberg  1 , Alan Shihadeh
Affiliations
Comparative Study

Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure

Thomas Eissenberg et al. Am J Prev Med. 2009 Dec.

Abstract

Background: 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.

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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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Figures

Figure 1
Figure 1
Waterpipe with modified hose assembly and topography measurement hardware. The waterpipe consists of a “head” in which sweetened and flavored tobacco is placed, a body that holds the head atop a conduit, a bowl that is half filled with water that submerges the bottom of the conduit, and a hose that emerges from the bowl above the waterline and that terminates in a mouthpiece. The tobacco in the head is heated with charcoal (often separated from the tobacco by a piece of perforated aluminum foil) and when the user sucks on the mouthpiece, charcoal-heated air passes through the tobacco, and tobacco and charcoal smoke travel through the conduit, water, hose, and mouthpiece, and then into the user’s mouth and lungs. The hose attached to this waterpipe has been modified by the insertion of a flow sensor that is used to measure puff topography (see text for details).
Figure 2
Figure 2
Mean (+/− 1 SEM) carboxyhemoglobin (top panel) and plasma nicotine (bottom panel) data from 31 participants who smoked tobacco using a waterpipe (triangles) or cigarette (squares) in a laboratory session. While both waterpipe and cigarette smoking were ad libitum, the waterpipe was available for 45 minutes while the cigarette was consumed in approximately 5 minutes. Filled symbols indicate a significant difference from baseline (time 0) and asterisks (*) indicate a significant difference between conditions at that time point (ps < 0.001).
See this image and copyright information in PMC

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References

    1. WHO. Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators. Geneva, Switzerland: Author; 2005. TobReg Advisory Note. - PMC - PubMed
    1. Pärna K, Usin J, Ringmets I. Cigarette and waterpipe smoking among adolescents in Estonia: HBSC survey results, 1994–2006. BMC Public Health. 2008;8:392. - PMC - PubMed
    1. Baska T, Pudule I, Tilgale N, Warren CW, Lee J, Lea V, Jones NR. Smoking tobacco in waterpipes among adolescents in Europe: the case of Latvia and Slovakia. Tob Control. 2008;17(6):432. - PubMed
    1. El-Roueiheb Z, Tamim H, Kanj M, Jabbour S, Alayan I, Musharrafieh U. Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003–2004. Nicotine Tob Res. 2008;10(2):309–14. - PubMed
    1. Weglicki LS, Templin TN, Rice VH, Jamil H, Hammad A. Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth. Am J Prev Med. 2008;35(4):334–9. - PMC - PubMed

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