Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking

Awareness and use of non-conventional tobacco products among U.S. students, 2012

BACKGROUND

Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth.

PURPOSE

This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics.

METHODS

Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip).

RESULTS

Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products.

CONCLUSIONS

Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth.

Hookah use among college students: prevalence, drug use, and mental health

BACKGROUND

There is consistent evidence that hookah use is as, if not more, harmful than cigarette use. Yet, hookah users underestimate the potential deleterious effects of hookah use. This study examined the rates of hookah use and associated demographic characteristics in a sample of undergraduates at a small Northeastern university. This study also examined the relationships between hookah use and other substance use, mental health problems, and perceived levels of stress.

METHODS

Data were drawn from the Spring 2009 American Health Association-National College Health Assessment (ACHA-NCHA) at one small, Northeastern university (N=1799). The relationships between hookah use and other substance use, mental health problems, and perceived stress levels were examined using logistic regression analyses.

RESULTS

Hookah use (in the past month) was reported among 14.1% (253/1799) of this sample of undergraduates. Hookah users were more likely to use other substances, including cigarettes, cannabis, alcohol, cocaine, and amphetamines. The strongest associations emerged between hookah use and alcohol and cigarette use. There were no significant associations found between hookah use and any mental health problems or perceived stress levels.

CONCLUSIONS

Hookah users are significantly more likely to use other substances, including alcohol, cigarettes, cannabis, cocaine, and amphetamines compared with non-hookah users. In contrast to cigarette smoking, hookah use does not appear to be associated with mental health problems or perceived stress levels in this sample of undergraduates. Further investigation into the prevalence and correlates of hookah use is needed in representative population samples.

Children's exposure to secondhand and thirdhand smoke carcinogens and toxicants in homes of hookah smokers

INTRODUCTION

We examined homes of hookah-only smokers and nonsmokers for levels of indoor air nicotine (a marker of secondhand smoke) and indoor surface nicotine (a marker of thirdhand smoke), child uptake of nicotine, the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and the toxicant acrolein by analyzing their corresponding metabolites cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and NNAL-glucuronides (total NNAL) and 3-hydroxypropylmercapturic acid.

METHODS

Data were collected at 3 home visits during a 7-day study period from a convenience sample of 24 households with a child 5 years or younger. Three child urine samples and 2 air and surface samples from the living room and the child bedroom were taken in homes of nonsmokers (n = 5) and hookah-only smokers (n = 19) comprised of daily hookah smokers (n = 8) and weekly/monthly hookah smokers (n = 11).

RESULTS

Nicotine levels in indoor air and on surfaces in the child bedrooms in homes of daily hookah smokers were significantly higher than in homes of nonsmokers. Uptake of nicotine, NNK, and acrolein in children living in daily hookah smoker homes was significantly higher than in children living in nonsmoker homes. Uptake of nicotine and NNK in children living in weekly/monthly hookah smoker homes was significantly higher than in children living in nonsmoker homes.

CONCLUSIONS

Our data provide the first evidence for uptake of nicotine, the tobacco-specific lung carcinogen NNK, and the ciliatoxic and cardiotoxic agent acrolein in children living in homes of hookah smokers. Our findings suggest that daily and occasional hookah use in homes present a serious, emerging threat to children's long-term health.

Young adult waterpipe smokers: Smoking behaviors and associated subjective and physiological effects

INTRODUCTION

The purpose of this pilot study was to investigate smoking behaviors and subjective and physiological effects of nicotine on young adult occasional waterpipe smokers.

METHODS

This study utilized a repeated-measures design that included one repeated factor for condition (nicotine and non-nicotine). For each participant, the sequencing of the repeated factor was assigned using random allocation. The two nicotine conditions were nicotine (0.75 g) and non-nicotine (0 g placebo) tobacco. Over the course of two weeks, twenty-two participants completed subjective (Acute Subjective Effects of Nicotine) and physiological (blood pressure, heart rate, and CO level) measures. Additional measures (QSU and MNWS-R) were used to assess for withdrawal symptoms.

SAMPLE

The participants (n=22) were young adults (23 ± 3.1years); 71% smoked waterpipe once a month in the past year and 29% smoked waterpipe 1-2 times per week. In addition, 60% reported sharing their waterpipe with friends while smoking. None of the participants reported using any other forms of tobacco products.

RESULTS

Under the nicotine condition, participants tended to smoke longer (i.e. smoking duration, p=0.004), take more puffs (p=0.03), take shorter puffs (p=0.03), and inhale less volume with each puff (p=0.02). The repeated measures analysis of the factor headrush revealed an effect of the nicotine condition (F=9.69, p<0.001, partial η(2)=0.31) and time (F=8.17, p=0.02, partial η(2)=0.30). Heart rate increased significantly across the nicotine condition (F=7.92, p=0.01, partial η(2)=0.31) and over time (F=12.64, p=0.01, partial η(2)=0.41).

CONCLUSIONS

This study demonstrates how differences between nicotine and non-nicotine waterpipe smoking are associated with changes in smoking behaviors, experiencing a headrush and an increase in heart rate.

Nicotine and carcinogen exposure after water pipe smoking in hookah bars

BACKGROUND

Water pipe tobacco smoking is spreading globally and is increasingly becoming popular in the United States, particularly among young people. Although many perceive water pipe smoking to be relatively safe, clinical experimental studies indicate significant exposures to tobacco smoke carcinogens following water pipe use. We investigated biomarkers of nicotine intake and carcinogen exposure from water pipe smoking in the naturalistic setting of hookah bars.

METHODS

Fifty-five experienced water pipe users were studied before and after smoking water pipe in their customary way in a hookah bar. Urine samples were analyzed for nicotine, cotinine, the tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and mercapturic acid metabolites of volatile organic compounds (VOC).

RESULTS

We found an average 73-fold increase in nicotine, 4-fold increase in cotinine, 2-fold increase in NNAL, and 14% to 91% increase in VOC mercapturic acid metabolites immediately following water pipe smoking. We saw moderate to high correlations between changes in tobacco-specific biomarkers (nicotine, cotinine, and NNAL) and several mercapturic acid metabolites of VOCs.

CONCLUSION

Water pipe smoking in a hookah bar is associated with significant nicotine intake and carcinogen exposure.

IMPACT

Given the significant intake of nicotine and carcinogens, chronic water pipe use could place users at increased risk of cancer and other chronic diseases. Cancer Epidemiol Biomarkers Prev; 23(6); 1055-66. ©2014 AACR.

Smoking among dental students at King Saud University: Consumption patterns and risk factors

OBJECTIVE

To assess smoking prevalence among dental students at King Saud University (KSU) and to determine possible risk factors of tobacco use.

METHODS

A self-addressed invitation letter was sent to all dental students (males and females) at KSU requesting participation in this study. Data on smoking habits, associated risk factors, and demographic factors, such as age, marital status, residency status, the student's year of study, and grade point average, were collected by an electronic self-administered questionnaire sent via email. Data were analyzed using SPSS. Significant differences between different groups were assessed with a Pearson Chi-Square test at α = 0.05. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) and to determine the effect of different risk factors on students' smoking habits.

RESULTS

Of the 600 registered dental students, 400 students responded (230 males, 170 females), representing a response rate of 67%. More male than female students were current smokers (27.6% vs. 2.4%, p < 0.001). Most smokers used shisha tobacco only (N = 35, 51.5%), followed by both shisha tobacco and cigarettes (N = 17, 25%), or cigarettes only (N = 16, 23.5%). Male students were about 4 times more likely to be smokers if all or most of their friends were smokers compared to students who had some friends who smoked (OR = 3.9, 95% CI = 1.9-7.7). A high proportion of current smokers (47.8%) reported stress as the main reason for smoking. Twenty-six percent of dental students (N = 87) who are currently nonsmokers reported that they have used tobacco at some point in their lives. Over two thirds of sampled students (63%) believed that public tobacco usage is not well addressed in the current college curriculum.

CONCLUSION

Approximately one in every four male dental students at KSU is a smoker. Having friends who are smokers was the most important risk factor associated with smoking. There is a general belief among dental students that public tobacco use is not well addressed in the dental college curriculum.

Determinants of gastroesophageal reflux disease, including hookah smoking and opium use- a cross-sectional analysis of 50,000 individuals

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common cause of discomfort and morbidity worldwide. However, information on determinants of GERD from large-scale studies in low- to medium-income countries is limited. We investigated the factors associated with different measures of GERD symptoms, including frequency, patient-perceived severity, and onset time.

METHODS

We performed a cross-sectional analysis of the baseline data from a population-based cohort study of ∼ 50,000 individuals in in Golestan Province, Iran. GERD symptoms in this study included regurgitation and/or heartburn.

RESULTS

Approximately 20% of participants reported at least weekly symptoms. Daily symptoms were less commonly reported by men, those of Turkmen ethnicity, and nass chewers. On the other hand, age, body mass index, alcohol drinking, cigarette smoking, opium use, lower socioeconomic status, and lower physical activity were associated with daily symptoms. Most of these factors showed similar associations with severe symptoms. Women with higher BMI and waist to hip ratio were more likely to report frequent and severe GERD symptoms. Hookah smoking (OR 1.34, 95% CI 1.02-1.75) and opium use (OR 1.70, 95% CI 1.55-1.87) were associated with severe symptoms, whereas nass chewing had an inverse association (OR 0.87, 95% CI 0.76-0.99). After exclusion of cigarette smokers, hookah smoking was still positively associated and nass chewing was inversely associated with GERD symptoms (all frequencies combined).

CONCLUSION

GERD is common in this population. The associations of hookah and opium use and inverse association of nass use with GERD symptoms are reported for the first time. Further studies are required to investigate the nature of these associations. Other determinants of GERD were mostly comparable to those reported elsewhere.

When water does not clear the smut from the smoke

Water-pipe (shisha) smoking is increasingly popular among young people in Europe and North America. The proponents claim that smoking water-pipe is much 'cleaner' than cigarettes. Although, a recent analysis of toxicant yields during 1-2 h water-pipe smoking resulted comparable to 100-200 cigarettes. We report a case of a 25-year-old patient with elevated haemoglobin, impaired concentration and reduced physical performance. Molecular investigations for JAK2 mutations and BCR-ABL fusion transcripts were negative and the arterial blood gas analysis revealed an elevated carboxyhaemoglobin of 6.1%. In a follow-up visit, the patient disclosed excessive shisha smoking. Secondary polycythaemia was diagnosed caused by chronic carbon monoxide poisoning. After cessation of shisha smoking all blood values returned to normal ranges within 6 weeks. Owing to the increasing popularity of water-pipe smoking and the anticipated health risks, our report should help to enhance awareness and advocate more information in tobacco prevention programmes on its potential toxicities.

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

BACKGROUND

In the past decade, waterpipe smoking-also known as hookah, shisha, narghileh-has increased among youth. The scarcity of rigorous studies linking waterpipe smoking to smoking-related diseases has hindered policy and regulatory efforts to confront the waterpipe epidemic. This study compares systemic carcinogen exposure between independent groups of exclusive waterpipe smokers, cigarette smokers and non-smokers.

METHODS

This study was conducted at the Syrian Center for Tobacco Studies (SCTS) in Aleppo, Syria, between 2010 and 2011. First morning urinary samples were collected from three groups of subjects; exclusive daily waterpipe smokers (n=24), exclusive daily cigarette smokers (n=23), and non-smokers (n=28). These samples were analysed for carcinogenic tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (NNAL) using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

Our results show that waterpipe smokers are exposed to about 5-10 times greater NNAL than non-smokers. Mean (95% CI) free and total NNAL was 0.7 (0.3 to 1. 4) and 3.9 (1.6 to 9.5) pg/mL urine for non-smokers, 8.4 (4.8 to 14.8) and 33.0 (21.6 to 50.6) pg/mL urine for waterpipe smokers, and 10.7 (5.0 to 22.6) and 46.8 (27.6 to 79.3) pg/mL urine for cigarette smokers (p<0.001 for all comparisons). Daily waterpipe smokers were less exposed to NNAL than daily cigarette smokers, although the difference did not reach statistical significance for all measurements.

CONCLUSIONS

These results provide the clearest indication to date about systemic exposure to harmful carcinogens associated with long-term waterpipe smoking. Such evidence can support policy and regulatory efforts designed to confront the emerging global waterpipe epidemic, as well as drive interventions aimed at increasing the public awareness about the cancer risk associated with waterpipe smoking.