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Bakker-'t Hart IME, Bakker F, Pennings JLA, Weibolt N, Eising S, Talhout R. Flavours and flavourings in waterpipe products: a comparison between tobacco, herbal molasses and steam stones. Tob Control 2023; 32:627-634. [PMID: 35241500 PMCID: PMC10447401 DOI: 10.1136/tobaccocontrol-2021-056955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
ObjectivesFlavoured products are especially appealing to youth and contribute to the onset of waterpipe smoking and continued use of waterpipe tobacco. The goal of database and chemical analysis was to provide a clear overview of commonly used flavours and flavourings in tobacco and related waterpipe products, that is, herbal molasses and steam stones. METHODS In 2019, 249 waterpipe tobacco products were registered in the European Common Entry Gate by manufacturers to be marketed in The Netherlands. Flavour categories were assigned to the registered products based on their brand names and product descriptions. Nicotine and eleven 1111 flavourings were identified and quantified in waterpipe tobacco (n=8), herbal molasses (n=7) and steam stones (n=4) by extraction and gas chromatography-mass spectrometry (GC-MS) analysis. RESULTS Flavour categories could be assigned to 237 of 249 registered waterpipe tobacco products. Eight flavour main categories and 48 unique subcategories were identified and presented in a flavour wheel. All registered waterpipe tobacco products were flavoured, and the majority (78%) was fruit flavoured. Herbal molasses contained similar median flavouring levels, and steam stones contained lower median levels compared with waterpipe tobacco. Flavourings in waterpipe products were almost exclusively fruity and sweet, often in combination with menthol/mint flavourings. CONCLUSIONS This study is the first to present a waterpipe tobacco flavour wheel, providing a quick overview of waterpipe tobacco flavours and thereby aiding communication among experts around the globe. GC-MS analysis revealed that the most prevalent flavourings are present in similar levels in herbal and tobacco waterpipe products. Banning flavourings in all waterpipe products would be a good strategy to reduce waterpipe smoking among youth.
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Affiliation(s)
- Ingrid M E Bakker-'t Hart
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Frank Bakker
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Naömi Weibolt
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Selma Eising
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Utrecht, The Netherlands
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Hussein T. Indoor Exposure and Regional Inhaled Deposited Dose Rate during Smoking and Incense Stick Burning-The Jordanian Case as an Example for Eastern Mediterranean Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:587. [PMID: 36612906 PMCID: PMC9819828 DOI: 10.3390/ijerph20010587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Tobacco smoking and incense burning are commonly used in Jordanian microenvironments. While smoking in Jordan is prohibited inside closed spaces, incense burning remains uncontrolled. In this study, particle size distributions (diameter 0.01-25 µm) were measured and inhaled deposited dose rates were calculated during typical smoking and incense stick-burning scenarios inside a closed room, and the exposure was summarized in terms of number and mass concentrations of submicron (PNSub) and fine particles (PM2.5). During cigarette smoking and incense stick-burning scenarios, the particle number concentrations exceeded 3 × 105 cm-3. They exceeded 5 × 105 cm-3 during shisha smoking. The emission rates were 1.9 × 1010, 6.8 × 1010, and 1.7 × 1010 particles/s, respectively, for incense, cigarettes, and shisha. That corresponded to about 7, 80, and 120 µg/s, respectively. Males received higher dose rates than females, with about 75% and 55% in the pulmonary/alveolar during walking and standing, respectively. The total dose rates were in the order of 1012-1013 #/h (103-104 µg/h), respectively, for PNSub and PM2.5. The above reported concentrations, emissions rates, and dose rates are considered seriously high, recalling the fact that aerosols emitted during such scenarios consist of a vast range of toxicant compounds.
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Affiliation(s)
- Tareq Hussein
- Environmental and Atmospheric Research Laboratory (EARL), Department of Physics, School of Science, The University of Jordan, Amman 11942, Jordan;
- Institute for Atmospheric and Earth System Research (INAR/Physics), University of Helsinki, FI-00014 Helsinki, Finland
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E Culbreth R, J Brandenberger K, Battey-Muse CM, Gardenhire DS. 2021 Year in Review: E-Cigarettes, Hookah Use, and Vaping Lung Injuries During the COVID-19 Pandemic. Respir Care 2022; 67:709-714. [PMID: 35606003 PMCID: PMC9994204 DOI: 10.4187/respcare.09919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electronic cigarettes (e-cigarettes) and hookah smoking have gained tremendous popularity over the past decade. With the constantly evolving e-cigarette market and potential impact of the COVID-19 pandemic on users of these tobacco products, research is needed to assess the prevalence and safety of these devices as well as potential public health implications and cessation tools. For this year in review, PubMed was searched from January 2021-December 14, 2021, for articles related to e-cigarettes, vaping-related lung injury, and hookah smoking. Relevant articles addressing the objectives were included in this review. This review focused primarily on articles based on United States populations. Gray literature and nonpublished articles were not included in this review. The 2020 pandemic resulted in a decline in e-cigarette usage among youth (potentially due to the COVID-19 pandemic); however, recent research in 2021 suggests that e-cigarette usage is increasing again among youth. Conflicting evidence exists for e-cigarettes and the risk of COVID-19 infection, but biological plausibility suggests that e-cigarette users are more susceptible to COVID-19 infection and more severe COVID-19 infection compared to non-e-cigarette users. Hookah smoking has remained stable across the past several years and remains a primarily social activity among youth. New e-cigarette devices are constantly emerging, resulting in an increased demand to understand the safety of these devices. Additionally, hookah smoking continues to be a concerning public health issue with the increase in hookah bars and venues coupled with lack of policy regulations for hookah smoking.
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Affiliation(s)
- Rachel E Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia.
| | - Kyle J Brandenberger
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Corinne M Battey-Muse
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Douglas S Gardenhire
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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Richardson A, Krivokhizhina T, Lorkiewicz P, D’Souza S, Bhatnagar A, Srivastava S, Conklin DJ. Effects of electronic cigarette flavorants on human platelet aggregation ex vivo. Toxicol Rep 2022; 9:814-820. [PMID: 36518374 PMCID: PMC9742839 DOI: 10.1016/j.toxrep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/11/2023] Open
Abstract
Because little is known about the effects of individual flavorants in electronic cigarette (e-cig) fluids on human platelet aggregation, we tested for the direct effects of 15 common e-cig flavorants on adenosine diphosphate (ADP)-induced human platelet aggregation ex vivo. To better understand a potential mechanism of action of flavorants, we quantified 2 phases of aggregation. Human platelet-rich plasma (PRP) was obtained from whole blood of healthy volunteers and used in a platelet aggregometry assay. PRP was incubated with 1 of 15 different flavorant compounds (e.g., benzyl alcohol, eugenol, citronellol, menthol, menthone, diacetyl, maltol, limonene, methylbutyric acid, isoamyl acetate, acetylpyridine, eucalyptol, 2,5-dimethylpyrazine, cinnamaldehyde, and vanillin) at 100 µM for 5 min at 37 °C prior to addition of ADP (10 µM). Subsequent ADP-induced platelet aggregation was tracked for 5 min using an aggregometer. Aggregation curves were analyzed for flavorant-induced effects on total (%) aggregation, Phase 1 and Phase 2 components, and compared with their ADP-only control via One-Way ANOVA. Notably, eugenol significantly inhibited total aggregation; an effect due solely to inhibition of Phase 2. No other flavor tested had any effect on total or phase-specific ADP-induced platelet aggregation. These results indicate that parent flavorant compounds commonly found in e-cig liquids neither activate nor inhibit ADP-induced human platelet aggregation. However, as flavorants are chemically altered during heating of e-cig, thermally-derived products of flavorants (e.g., flavor acetals) also will need to be tested for effects on platelet activation.
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Key Words
- AA, arachidonic acid
- ADP, adenosine diphosphate
- CVD, cardiovascular disease
- E-cig, electronic cigarette
- ENDS,, electronic nicotine delivery systems
- Electronic cigarettes
- Electronic nicotine delivery systems
- Eugenol
- Flavorants
- GRAS, generally regarded as safe
- NO, nitric oxide
- P1,, phase 1 aggregation
- P2,, phase 2 aggregation
- PAF, platelet activating factor
- PG, propylene glycol
- PPP,, platelet-poor plasma
- PRP,, platelet-rich plasma
- ROS, reactive oxygen species
- Thrombosis
- Tobacco
- TxA2, thromboxane A2
- VG, vegetable glycerol
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Affiliation(s)
- Andre Richardson
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA
| | - Tatiana Krivokhizhina
- Christina Lee Brown Envirome Institute, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA
| | - Pawel Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA,Department of Chemistry, University of Louisville, USA
| | - Stanley D’Souza
- Department of Physiology, School of Medicine, University of Louisville, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA,Division of Environmental Medicine, Department of Medicine, University of Louisville, USA
| | - Sanjay Srivastava
- Christina Lee Brown Envirome Institute, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA,Division of Environmental Medicine, Department of Medicine, University of Louisville, USA
| | - Daniel J. Conklin
- Christina Lee Brown Envirome Institute, University of Louisville, USA,Diabetes & Obesity Center, University of Louisville, USA,Division of Environmental Medicine, Department of Medicine, University of Louisville, USA,Correspondence to: Diabetes and Obesity Center, University of Louisville, 580 S. Preston Street, Rm., 404E, Louisville, KY, USA.
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Karey E, Reed T, Katsigeorgis M, Farrell K, Hess J, Gibbon G, Weitzman M, Gordon T. Exhalation of alternative tobacco product aerosols differs from cigarette smoke-and may lead to alternative health risks. Tob Use Insights 2022; 15:1179173X221078200. [PMID: 35250322 PMCID: PMC8891836 DOI: 10.1177/1179173x221078200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Variation in alternative tobacco product (ATP) constituents, heating potential, and consumer behaviors have made it difficult to characterize their health risks. To date, most toxicity studies of ATPs have used established cigarette endpoints to inform study design. Furthermore, to assess where ATPs fall on the tobacco harm continuum, with cigarettes representing maximum potential risk, studies have tended to compare the relative biological responses to ATPs against those due to cigarettes. OBJECTIVES 1) To characterize the exhalation profiles of two popular ATPs: electronic cigarettes (e-cigarettes) and hookah waterpipes (hookah) and 2) to determine if ATP exhalation patterns were representative of cigarette exhalation patterns. METHODS Exhalation patterns were recorded (mouth only, nose only, or both mouth and nose) among individuals observed in the New York City tri-state area using a recognizable tobacco product (cigarette, e-cigarette, or hookah). Cigarette smokers and e-cigarette vapers were observed on city streets; water-pipe smokers were observed inside Manhattan hookah bars. RESULTS E-cigarette vapers practiced exclusive nasal exhalation at far higher rates than did cigarette smokers (19.5% vs 4.9%). Among vapers, e-cigarette device type was also significantly associated with exhalation profile. Overall, cigarette smokers exhaled from their nose approximately half to one-third as often as ATP users (hookah and e-cigarettes, respectively). CONCLUSIONS Nasal exhalation of tobacco emissions appears to be a shared characteristic across several types of ATPs. It is therefore plausible that ATP-specific consumer behaviors may foster unique upper respiratory health consequences that have not been observed in smokers. Thus, product-specific behaviors should inform the prioritization of biological endpoints used in studies evaluating ATP toxicity and health effects.
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Affiliation(s)
- Emma Karey
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Taylor Reed
- Department of Social Welfare, University of California at Los Angeles, Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Maria Katsigeorgis
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Kayla Farrell
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jade Hess
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Grace Gibbon
- Department of Social Welfare, University of California at Los Angeles, Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Michael Weitzman
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
- New York University College of Global Public Health, New York, NY, USA
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
- New York University College of Global Public Health, New York, NY, USA
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Holt JM, Mayer-Helm B, Gafner J, Zierlinger M, Hirn C, Paschke T, Eilenberger G, Kuba M, Pummer S, Charriere M. Investigating the transfer rate of waterpipe additives to smoke as an integral part of toxicological risk assessments. Toxicol Rep 2022; 9:945-950. [PMID: 35875255 PMCID: PMC9301603 DOI: 10.1016/j.toxrep.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/08/2022] Open
Abstract
Waterpipe, also known as hookah, narghile or narghila, shisha or hubbly bubbly, is a tobacco-smoking device. Waterpipe tobacco is heated and consumed by a process of inhaling tobacco smoke, that bubbles through water before being inhaled. To date, limited studies have examined the transfer of waterpipe additives from tobacco to smoke. This study was designed to investigate the filtration ability of water in the waterpipe’s bowl to define exposure to additives in waterpipe smoke, which is an essential requirement to perform toxicological risk assessments of waterpipe additives. Within this study, a standard smoking protocol (ISO 22486) was used to evaluate the transfer of > 40 additives from experimental and commercially available samples. These results are the first to provide such an extensive dataset of information showing transfer rates varying between 6% and 61% depending on the additive. Various physicochemical parameters of the additives including water solubility, partition coefficient, molecular weight, boiling point, and vapor pressure were also evaluated to seek to identify any correlation to transfer rate that may be later used to predict transfer. The amount of additive transfer from waterpipe tobacco to the smoke was found to be moderately correlated to vapor pressure (Pearson correlation coefficient = 0.33) with subsequent multivariate analysis using step-wise selection indicating 39% of the transfer rate variance can be explained collectively by the additive boiling point, molecular weight, vapor pressure and water solubility. These findings underscore the complexity of additive transfer and highlight the necessity of exposure assessment for meaningful waterpipe additive risk assessments. Additive transfer evaluated using ISO 22486 plus charcoal to reflect consumer use First provision of extensive results showing varying transfer rates between 6–61%. 39% of the transfer rate variance explained by four physiochemical properties. Findings underscore the complexity of additive transfer for waterpipe. Results show the necessity of exposure assessment for additive risk assessments.
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Sutfin EL, Lazard AJ, Soule EK, Kimes CM, King J, Jenson D, Ross JC. Health Claims, Marketing Appeals, and Warnings on Popular Brands of Waterpipe Tobacco Packaging Sold in the United States. Nicotine Tob Res 2021; 23:1183-1190. [PMID: 33406241 DOI: 10.1093/ntr/ntab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Waterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging. AIMS AND METHODS Using data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014-October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March-April 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package. RESULTS Over half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor "natural" (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including "fresh," "premium," "quality," and "pure." All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were "well-made" (57%), "enjoyable" (55%), and "patriotic" (47%). CONCLUSIONS Prohibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm. IMPLICATIONS Tobacco packaging is used to convey health-related messages, both explicitly and implicitly; however, information about WT packaging is virtually nonexistent. We conducted a content analysis of WT packaging from the 10 most popular US brands. Over half (54%) of packages had prohibited MRTP claims and over a quarter (26%) included one or more descriptors that may be perceived as implying reduced harm. Use of imagery, including smoking cues, was common. The widespread use of prohibited MRTP claims, other descriptors, and imagery on WT packaging may contribute to misperceptions of reduced harm.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Caroline M Kimes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Desmond Jenson
- Mitchell Hamline School of Law, Public Health Law Center, Saint Paul, MN, USA
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