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Le NT, Phan CV, Pham YTH, Le PH, Dao HV, Nguyen LC, Yuan JM, Luu HN. Waterpipe Tobacco Smoking and Risk of Cancer Mortality. JAMA Oncol 2024:2821031. [PMID: 38990578 PMCID: PMC11240226 DOI: 10.1001/jamaoncol.2024.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/06/2024] [Indexed: 07/12/2024]
Abstract
Importance There has been an increasing trend of using noncigarette products, including waterpipe tobacco (WTP), worldwide. While cigarette smoking is a well-established risk factor for numerous cancers, little is known about the association between WTP smoking and cancer mortality. Objective To assess the association between WTP smoking and risk of cancer mortality in Vietnam. Design, Setting, and Participants This cohort study was based on data from the Hanoi Prospective Cohort Study, an ongoing study with a median (range) follow-up of 11.0 (0.1-11.6) years for participants aged 15 years or older in Northern Vietnam from 2007 through 2019. Data were analyzed from June 1 to September 1, 2023. Exposures Tobacco smoking and WTP smoking statuses. Main Outcomes and Measures Overall and site-specific cancer mortality. Cox proportional regression models were used to calculate the hazard ratio (HR) and 95% CIs for the associations between WTP smoking alone, cigarette smoking alone, and dual WTP and cigarette smoking and the risk of cancer death. Results A total of 554 cancer deaths were identified among the 39 401 study participants (mean [SD] age, 40.4 [18.8] years; 20 616 females [52.3%]). In multivariable models, compared with never smokers, ever smokers had a significantly increased risk of cancer mortality (HR, 1.87; 95% CI, 1.48-2.35). Exclusive WTP smokers had the highest risk of cancer mortality compared with never smokers (HR, 2.66; 95% CI, 2.07-3.43). Risk of cancer mortality was higher for dual smokers of WTP and cigarettes (HR, 2.06; 95% CI, 1.53-2.76) than for exclusive cigarette smokers (HR, 1.86; 95% CI, 1.41-2.45). As most smokers (95.6% [8897 of 9312]) were male, these patterns were more apparent in male participants. Compared with never smokers, exclusive WTP smoking among males was associated with an elevated risk of death from liver cancer (HR, 3.92; 95% CI, 2.25-6.85), lung cancer (HR, 3.49; 95% CI, 2.08-5.88), nasopharyngeal carcinoma (HR, 2.79; 95% CI, 1.27-6.12), and stomach cancer (HR, 4.11; 95% CI, 2.04-8.27). For exclusive WTP smokers, the risk of cancer mortality was highest among those who smoked 11 to 15 sessions per day (HR, 3.42; 95% CI, 2.03-5.75), started smoking at age 26 to 30 years (HR, 4.01; 95% CI, 2.63-6.11), smoked for 9 to 20 years (HR, 4.04; 95% CI, 2.16-7.56), and smoked 61 to 160 sessions annually (HR, 3.68; 95% CI, 2.38-5.71). For males, the risk of cancer death was lower for those who had quit smoking for more than 10 years, compared with those who quit smoking within 1 year (HR, 0.27; 95% CI, 0.11-0.66; P for trend < .001). Conclusion and Relevance In this cohort study in Vietnam, WTP smoking alone or in combination with cigarette smoking was associated with an increased risk of cancer death due to liver cancer, lung cancer, nasopharyngeal carcinoma, and stomach cancer. A tailored program to control WTP smoking is warranted in Vietnam and low- and middle-income countries with a high prevalence of smoking and modest resources to address smoking-related issues.
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Affiliation(s)
- Ngoan Tran Le
- Institute of Research and Development, Duy Tan University, Da Nang City, Vietnam
- Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Ha Noi City, Vietnam
- Center for Health Promotion and Research, Hanoi Prospective Cohort Study, Hanoi City, Vietnam
| | - Can Van Phan
- Center for Health Promotion and Research, Hanoi Prospective Cohort Study, Hanoi City, Vietnam
- Center for Population Health Sciences, Hanoi University of Public Health, Ha Noi City, Vietnam
| | - Yen Thi-Hai Pham
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phuoc Hong Le
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hang Viet Dao
- Department of Internal Medicine, Hanoi Medical University, Ha Noi City, Vietnam
| | - Long Cong Nguyen
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Ha Noi City, Vietnam
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hung N. Luu
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Yan YY, Ye F, Ho MH, Yeung KCY, Lee JJ. Biomarkers of Waterpipe Tobacco Smoke Exposure: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:655-662. [PMID: 38157415 DOI: 10.1093/ntr/ntad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/01/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prevalence of waterpipe tobacco smoking is increasing globally. Biomarkers of waterpipe tobacco smoke (WTS) exposure are less studied. AIMS AND METHODS To identify the types of biomarkers of WTS exposure and estimate changes in biomarker concentrations pre- to post-WTS exposure. PubMed, Embase, Web of Science, CINAHL Plus, PsycINFO, and Cochrane Library were searched for studies up to April 24, 2023. The types of biomarkers were identified. Random-effects models were used to estimate changes in biomarker concentrations pre- to post-WTS exposure. RESULTS Seventy-three studies involving 3755 participants exposed to WTS (49% male, mean age: 24.8 years) and 11 types of biomarkers of WTS exposure were identified. The biomarkers included tobacco alkaloids, expired carbon monoxide (eCO), carboxyhemoglobin (COHb), tobacco-specific nitrosamines, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), heavy metals, unmetabolized VOCs, unmetabolized PAHs, furan metabolites, and heterocyclic aromatic amines. Compared with pre-WTS exposure, eCO (breath; mean difference [MD] 27.00 ppm; 95% confidence interval [CI]: 20.91 to 33.08), COHb (blood; MD 4.30%; 95%CI: 2.57 to 6.03), COHb (breath; MD 7.14%; 95%CI: 4.96 to 9.31), nicotine (blood; MD 8.23 ng/mL; 95%CI: 6.27 to 10.19), and cotinine (urine; MD 110.40 ng/mL; 95%CI: 46.26 to 174.54) significantly increased post-WTS exposure. CONCLUSIONS Biomarkers of WTS exposure were systematically identified. The similarity between the biomarkers of WTS exposure and those of cigarette smoke and higher concentrations of some biomarkers post-WTS exposure underscore the need for further research on applying biomarkers in surveillance, interventions, and regulations to mitigate the harms of waterpipe tobacco smoking. IMPLICATIONS This study provides the first comprehensive overview of biomarkers investigated and available for assessing WTS exposure and their concentration changes in the human body. Researchers can use biomarkers such as eCO, COHb, nicotine, and cotinine to measure the health risks associated with WTS exposure and objectively evaluate the effectiveness of public health interventions aimed at reducing waterpipe tobacco smoking. Public health policymaking can also be informed through increased biomarker concentrations following WTS exposure, to implement regulations and public health education campaigns on limiting or preventing waterpipe tobacco smoking.
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Affiliation(s)
- Yong Yang Yan
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Fen Ye
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Mu-Hsing Ho
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | | | - Jung Jae Lee
- LKS Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong SAR, China
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Factors Predicting Dependence on Waterpipe Smoking Among Waterpipe Exclusive Smokers. J Addict Nurs 2023; 34:23-29. [PMID: 36857545 DOI: 10.1097/jan.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
ABSTRACT The current study targeted a sample of waterpipe (WP) exclusive smokers to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. A cross-sectional research design was employed with a community sample of 270 subjects who are currently WP exclusive smokers. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The unique significant predictors of WPS dependence were age, depression levels, age of starting WPS, duration of WPS, income, smoking WP daily, the belief of being attracted to WPS, and the desire to stop WPS. These predictors explained 35% of the variance in WPS dependence. WPS dependence was associated with increased depressive symptoms. Although few studies have been conducted, the WPS dependence prevalence appears to be alarmingly high among WP exclusive smokers. Factors associated with WPS dependence provide useful information that can be used to tailor WP prevention interventions.
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Do Not Miss Acute Diffuse Panbronchiolitis for Tree-in-Bud: Case Series of a Rare Lung Disease. Diagnostics (Basel) 2022; 12:diagnostics12071653. [PMID: 35885557 PMCID: PMC9323848 DOI: 10.3390/diagnostics12071653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Acute bronchiolitis is a common disease of infants affecting the small airways. Rarely, acute bronchiolitis may occur in adolescents and adults. Here, we present four unrelated adolescent patients with severe clinical presentation and unique CT imaging with extensive tree-in-bud pattern, representing a rare clinical phenotype of acute diffuse panbronchiolitis. This characteristic disease pattern caused by inhalation injury from waterpipes, smoked tobacco, and cannabinoids must be differentiated from e-cigarette or vaping product-use-associated lung injury (EVALI). Visual diagnosis of CT and an early diagnostic procedure for detection and differentiation of inhaled hazards, including sample storage for future identification of novel noxious agents, are warranted.
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Stroud LR, Papandonatos GD, Sharma E, Jao NC, Goldman S, Vergara-Lopez C, Scott-Sheldon LA. Flavored waterpipe tobacco preferences, perceptions, and use in pregnant women: A latent factor mapping approach. Addict Behav 2022; 126:107194. [PMID: 34864479 PMCID: PMC8926392 DOI: 10.1016/j.addbeh.2021.107194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
Waterpipe tobacco (WPT) use is increasingly common in young adults including pregnant and reproductive-age women. Sweet flavors contribute to the appeal of WPT and are a promising regulatory target. The present study utilized correspondence analysis of contingency tables, a latent factor mapping technique, to investigate preferences and perceptions of WPT flavors in a sample of racially/ethnically diverse, low-income pregnant women. One hundred pregnant women (mean age = 26 years, 65% racial/ethnic minorities) completed a detailed interview regarding their use, preferences, and perceptions of WPT flavors. Eighty-three percent of participants reported lifetime WPT use; 11% reported prenatal WPT use. Pregnant women reported greatest use of and stronger preferences for sweet (fruit, candy, alcohol) and menthol/mint flavors, and weaker preferences for tobacco flavored WPT. Latent factor mapping revealed clustering of preferred sweet (fruit, candy, alcohol) and menthol/mint flavors versus tobacco flavors, with pungent flavors (coffee, chocolate, spice) clustering between sweet and tobacco flavors. Preferences for sweet and menthol/mint flavors distinguished pregnant women who reported lifetime WPT versus no lifetime WPT use, and prenatal WPT use versus no prenatal WPT use. Harm perceptions did not vary by flavor. Regulations to restrict the availability of WPT flavors may reduce the appeal and use of WPT, especially among pregnant women.
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Affiliation(s)
- Laura R. Stroud
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
| | - George D. Papandonatos
- Department of Biostatistics, School of Public Health, Brown University, 121 South Main Street, Room 703, Providence, RI 02903, United States
| | - Eva Sharma
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA.
| | - Nancy C. Jao
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
| | - Samantha Goldman
- Department of Psychology, Adelphi University, Hy Weinberg Center, Room 308, Garden City, NY 11530, USA.
| | - Chrystal Vergara-Lopez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Lori A.J. Scott-Sheldon
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, United States
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Hajjar R, Tsolakian I, Chaaya M, Daher A, Bazi T. Overactive bladder syndrome in nulliparous female university students: prevalence and risk factors including waterpipe smoking. Int Urogynecol J 2021; 33:1207-1223. [PMID: 34825923 DOI: 10.1007/s00192-021-05004-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess the prevalence of symptoms of overactive bladder syndrome (OAB) among healthy nulliparous female university students, and to evaluate the correlation of these symptoms with a variety of factors, including waterpipe (WP) smoking. METHODS This is a cross-sectional study. A questionnaire was administered to evaluate symptoms of OAB in healthy nulliparous female university students. Variables assessed included body mass index (BMI), cigarette smoking, WP smoking, consumption of alcohol, coffee, and tea with and without artificial sweeteners, soft drinks, and energy drinks. Adjusted odds ratio were calculated to determine the correlation of these variables with OAB symptoms. RESULTS A total of 767 out of 2,900 females responded to the questionnaire. Bothersome frequency was reported in 32.3%, and nocturia in 47.5% of the women. Urgency and urgency urinary incontinence (UUI) were present in 25.5 and 24.7% of the study participants respectively. Urgency was associated with WP smoking (p value 0.048). Bothersome frequency was associated with artificial sweeteners used with coffee and tea (p value 0.013). UUI was associated with cigarette smoking (p value 0.034) and elevated BMI (p value < 0.001). OAB symptoms were not found to be significantly associated with soft drink and energy drink consumption. A lower prevalence of nocturia (p value 0.009) and urgency was associated with alcohol consumption (p value 0.017). More than two-thirds (69.2%) of WP smokers expressed readiness to decrease WP smoking if this would improve their lower urinary tract symptoms (LUTS). CONCLUSION Overactive bladder is common in healthy young nulliparous women and is associated with multiple risk factors, including WP smoking.
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Affiliation(s)
- Rima Hajjar
- Department of Obstetrics and Gynecology, American University in Beirut-Medical Center, PO Box 11-0236, Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Ibrahim Tsolakian
- Department of Obstetrics and Gynecology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - Alaa Daher
- Department of Obstetrics and Gynecology, American University in Beirut-Medical Center, PO Box 11-0236, Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Tony Bazi
- Department of Obstetrics and Gynecology, American University in Beirut-Medical Center, PO Box 11-0236, Beirut, Riad El Solh, 1107 2020, Lebanon.
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Malovichko MV, Abplanalp WT, McFall SA, Taylor BS, Wickramasinghe NS, Sithu ID, Zelko IN, Uchida S, Hill BG, Sutaria SR, Nantz MH, Bhatnagar A, Conklin DJ, O'Toole TE, Srivastava S. Subclinical markers of cardiovascular toxicity of benzene inhalation in mice. Toxicol Appl Pharmacol 2021; 431:115742. [PMID: 34624356 PMCID: PMC8647905 DOI: 10.1016/j.taap.2021.115742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022]
Abstract
Benzene is a ubiquitous environmental pollutant. Recent population-based studies suggest that benzene exposure is associated with an increased risk for cardiovascular disease. However, it is unclear whether benzene exposure by itself is sufficient to induce cardiovascular toxicity. We examined the effects of benzene inhalation (50 ppm, 6 h/day, 5 days/week, 6 weeks) or HEPA-filtered air exposure on the biomarkers of cardiovascular toxicity in male C57BL/6J mice. Benzene inhalation significantly increased the biomarkers of endothelial activation and injury including endothelial microparticles, activated endothelial microparticles, endothelial progenitor cell microparticles, lung endothelial microparticles, and activated lung and endothelial microparticles while having no effect on circulating levels of endothelial adhesion molecules, endothelial selectins, and biomarkers of angiogenesis. To understand how benzene may induce endothelial injury, we exposed human aortic endothelial cells to benzene metabolites. Of the metabolites tested, trans,trans-mucondialdehyde (10 μM, 18h) was the most toxic. It induced caspases-3, -7 and -9 (intrinsic pathway) activation and enhanced microparticle formation by 2.4-fold. Levels of platelet-leukocyte aggregates, platelet macroparticles, and a proportion of CD4+ and CD8+ T-cells were also significantly elevated in the blood of the benzene-exposed mice. We also found that benzene exposure increased the transcription of genes associated with endothelial cell and platelet activation in the liver; and induced inflammatory genes and suppressed cytochrome P450s in the lungs and the liver. Together, these data suggest that benzene exposure induces endothelial injury, enhances platelet activation and inflammatory processes; and circulatory levels of endothelial cell and platelet-derived microparticles and platelet-leukocyte aggregates are excellent biomarkers of cardiovascular toxicity of benzene.
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Affiliation(s)
- Marina V Malovichko
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Wesley T Abplanalp
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Samantha A McFall
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Breandon S Taylor
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Nalinie S Wickramasinghe
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Israel D Sithu
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Igor N Zelko
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Shizuka Uchida
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Bradford G Hill
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Saurin R Sutaria
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Department of Chemistry, University of Louisville, Louisville, KY 40202, United States of America
| | - Michael H Nantz
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; Department of Chemistry, University of Louisville, Louisville, KY 40202, United States of America
| | - Aruni Bhatnagar
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Daniel J Conklin
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Timothy E O'Toole
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America
| | - Sanjay Srivastava
- University of Louisville Superfund Research Center, University of Louisville, Louisville, KY 40202, United States of America; American Heart Association-Tobacco Center of Regulatory Science, University of Louisville, Louisville, KY 40202, United States of America; Envirome Institute, University of Louisville, Louisville, KY 40202, United States of America; Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202, United States of America.
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Zelko IN, Dassanayaka S, Malovichko MV, Howard CM, Garrett LF, Uchida S, Brittian KR, Conklin DJ, Jones SP, Srivastava S. Chronic Benzene Exposure Aggravates Pressure Overload-Induced Cardiac Dysfunction. Toxicol Sci 2021; 185:64-76. [PMID: 34718823 DOI: 10.1093/toxsci/kfab125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Benzene is a ubiquitous environmental pollutant abundant in household products, petrochemicals and cigarette smoke. Benzene is a well-known carcinogen in humans and experimental animals; however, little is known about the cardiovascular toxicity of benzene. Recent population-based studies indicate that benzene exposure is associated with an increased risk for heart failure. Nonetheless, it is unclear whether benzene exposure is sufficient to induce and/or exacerbate heart failure. We examined the effects of benzene (50 ppm, 6 h/day, 5 days/week, 6 weeks) or HEPA-filtered air exposure on transverse aortic constriction (TAC)-induced pressure overload in male C57BL/6J mice. Our data show that benzene exposure had no effect on cardiac function in the Sham group; however, it significantly compromised cardiac function as depicted by a significant decrease in fractional shortening and ejection fraction, as compared with TAC/Air-exposed mice. RNA-seq analysis of the cardiac tissue from the TAC/benzene-exposed mice showed a significant increase in several genes associated with adhesion molecules, cell-cell adhesion, inflammation, and stress response. In particular, neutrophils were implicated in our unbiased analyses. Indeed, immunofluorescence studies showed that TAC/benzene exposure promotes infiltration of CD11b+/S100A8+/myeloperoxidase+-positive neutrophils in the hearts by 3-fold. In vitro, the benzene metabolites, hydroquinone and catechol, induced the expression of P-selectin in cardiac microvascular endothelial cells by 5-fold and increased the adhesion of neutrophils to these endothelial cells by 1.5-2.0-fold. Benzene metabolite-induced adhesion of neutrophils to the endothelial cells was attenuated by anti-P-selectin antibody. Together, these data suggest that benzene exacerbates heart failure by promoting endothelial activation and neutrophil recruitment.
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Affiliation(s)
- Igor N Zelko
- University of Louisville Superfund Research Center.,Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Sujith Dassanayaka
- Diabetes and Obesity Center.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Marina V Malovichko
- University of Louisville Superfund Research Center.,Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Caitlin M Howard
- Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Lauren F Garrett
- Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Shizuka Uchida
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen SV, Denmark
| | - Kenneth R Brittian
- Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Daniel J Conklin
- University of Louisville Superfund Research Center.,Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Steven P Jones
- Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
| | - Sanjay Srivastava
- University of Louisville Superfund Research Center.,Diabetes and Obesity Center.,Envirome Institute.,Department of Medicine, Division of Environmental Medicine, University of Louisville, Louisville, KY 40202
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Tevis DS, Willmore A, Bhandari D, Bowman B, Biren C, Kenwood BM, Jacob P, Liu J, Bello K, Hecht SS, Carmella SG, Chen M, Gaudreau E, Bienvenu JF, Blount BC, De Jesús VR. Large Differences in Urinary Benzene Metabolite S-Phenylmercapturic Acid Quantitation: A Comparison of Five LC-MS-MS Methods. J Anal Toxicol 2021; 45:657-665. [PMID: 33025019 PMCID: PMC8363762 DOI: 10.1093/jat/bkaa137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/10/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Benzene is a known genotoxic carcinogen linked to many hematological abnormalities. S-phenylmercapturic acid (PHMA, N-acetyl-S-(phenyl)-L-cysteine, CAS# 4775-80-8) is a urinary metabolite of benzene and is used as a biomarker to assess benzene exposure. Pre-S-phenylmercapturic acid (pre-PHMA) is a PHMA precursor that dehydrates to PHMA at acidic pH. Published analytical methods that measure urinary PHMA adjust urine samples to a wide range of pH values using several types of acid, potentially leading to highly variable results depending on the concentration of pre-PHMA in a sample. Information is lacking on the variation in sample preparation among laboratories regularly measuring PHMA and the effect of those differences on PHMA quantitation in human urine samples. To investigate the differences in PHMA quantitation, we conducted an inter-laboratory comparison that included the analysis of 50 anonymous human urine samples (25 self-identified smokers and 25 self-identified non-smokers), quality control samples and commercially available reference samples in five laboratories using different analytical methods. Observed urinary PHMA concentrations were proportionally higher at lower pH, and results for anonymous urine samples varied widely among the methods. The method with the neutral preparation pH yielded results about 60% lower than the method using the most acidic conditions. Samples spiked with PHMA showed little variation, suggesting that the variability in results in human urine samples across methods is driven by the acid-mediated conversion of pre-PHMA to PHMA.
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Affiliation(s)
- Denise S Tevis
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Andrew Willmore
- Oak Ridge Institute for Science and Education, Knoxville, TN, 37831, USA
| | - Deepak Bhandari
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Brett Bowman
- Oak Ridge Institute for Science and Education, Knoxville, TN, 37831, USA
| | - Chloe Biren
- Oak Ridge Institute for Science and Education, Knoxville, TN, 37831, USA
| | - Brandon M Kenwood
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Peyton Jacob
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Jia Liu
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Kristina Bello
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Eric Gaudreau
- Centre de Toxicologie du Québec, Unité Laboratoire de Toxicologie, Institut National de Santé Publique du Québec, Direction de la santé environnementale et de la toxicologie, Québec, G1V 5B3, Canada
| | - Jean-François Bienvenu
- Centre de Toxicologie du Québec, Unité Laboratoire de Toxicologie, Institut National de Santé Publique du Québec, Direction de la santé environnementale et de la toxicologie, Québec, G1V 5B3, Canada
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Víctor R De Jesús
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
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10
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Hammad AM, Swiss GMS, Hall FS, Hikmat S, Sari Y, Al-Qirim TM, Amawi HA. Ceftriaxone Reduces Waterpipe Tobacco Smoke Withdrawal-induced Anxiety in rats via Modulating the Expression of TNF-α/NFĸB, Nrf2, and GLT-1. Neuroscience 2021; 463:128-142. [PMID: 33836247 DOI: 10.1016/j.neuroscience.2021.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023]
Abstract
Tobacco exposure has been linked to neuroinflammation and adaptive/maladaptive changes in neurotransmitter systems, including in glutamatergic systems. We examined the effects of waterpipe tobacco smoke (WTS) on inflammatory mediators and astroglial glutamate transporters in mesocorticolimbic brain regions including the prefrontal cortex (PFC), nucleus accumbens (NAc) and ventral tegmental area (VTA). The behavioral consequences of WTS exposure on withdrawal-induced anxiety-like behavior were assessed using elevated plus maze (EPM) and open field (OF) tests. Male Sprague-Dawley rats were randomly assigned to 3 experimental groups: a control group exposed only to standard room air, a WTS exposed group treated with saline vehicle, and a WTS exposed group treated with ceftriaxone. WTS exposure was performed for 2 h/day, 5 days/week, for 4 weeks. Behavioral tests (EPM and OF) were conducted weekly 24 h after WTS exposure, during acute withdrawal. During week 4, rats were given either saline or ceftriaxone (200 mg/kg i.p.) 30 min before WTS exposure. WTS increased withdrawal-induced anxiety, and ceftriaxone attenuated this effect. WTS exposure increased the relative mRNA levels for nuclear factor ĸB (NFĸB), tumor necrosis factor-α (TNF-α), and brain-derived neurotrophic factor (BDNF) in the PFC, NAc and VTA, and ceftriaxone treatment reversed these effects. In addition, WTS decreased the relative mRNA of nuclear factor erythroid 2 related factor 2 (Nrf2), glutamate transporter 1 (GLT-1) and cystine-glutamate transporter (xCT) in PFC, NAc and VTA, and ceftriaxone treatment normalized their expression. WTS caused neuroinflammation, alteration in relative mRNA glutamate transport expression, and increased anxiety-like behavior, and these effects were attenuated by ceftriaxone treatment.
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Affiliation(s)
- Alaa M Hammad
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan.
| | - Ghadeer M S Swiss
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - F Scott Hall
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Suhair Hikmat
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Youssef Sari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - T M Al-Qirim
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - H A Amawi
- Faculty of Pharmacy, Yarmouk University, Irbid 21110, Jordan
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11
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Liu J, Benowitz NL, Hatsukami DK, Havel CM, Lazcano-Ponce E, Strasser AA, Jacob P. 3-Ethenylpyridine Measured in Urine of Active and Passive Smokers: A Promising Biomarker and Toxicological Implications. Chem Res Toxicol 2021; 34:1630-1639. [PMID: 33998799 DOI: 10.1021/acs.chemrestox.1c00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In studies of tobacco toxicology, including comparisons of different tobacco products and exposure to secondhand or thirdhand smoke, exposure assessment using biomarkers is often useful. Some studies have indicated that most of the toxicity of tobacco smoke is due to gas-phase compounds. 3-Ethenylpyridine (3-EP) is a major nicotine pyrolysis product occurring in the gas phase of tobacco smoke. It has been used extensively as an environmental tracer for tobacco smoke. 3-EP would be expected to be a useful tobacco smoke biomarker as well, but nothing has been published about its metabolism and excretion in humans. In this Article we describe a solid-phase microextraction (SPME) GC-MS/MS method for determination of 3-EP in human urine and its application to the determination of 3-EP in the urine of smokers and people exposed to secondhand smoke. We conclude that 3-EP is a promising biomarker that could be useful in studies of tobacco smoke exposure and toxicology. We also point out the paucity of data on 3-EP toxicity and suggest that additional studies are needed.
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Affiliation(s)
- Jia Liu
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Christopher M Havel
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
| | - Eduardo Lazcano-Ponce
- School of Public Health of Mexico, National Institute of Public Health, 62100 Cuernavaca, Morelos, Mexico
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science, Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Peyton Jacob
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, United States
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12
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Tevis DS, Flores SR, Kenwood BM, Bhandari D, Jacob P, Liu J, Lorkiewicz PK, Conklin DJ, Hecht SS, Goniewicz ML, Blount BC, De Jesús VR. Harmonization of acronyms for volatile organic compound metabolites using a standardized naming system. Int J Hyg Environ Health 2021; 235:113749. [PMID: 33962120 DOI: 10.1016/j.ijheh.2021.113749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/17/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Increased interest in volatile organic compound (VOC) exposure has led to an increased need for consistent, systematic, and informative naming of VOC metabolites. As analytical methods have expanded to include many metabolites in a single assay, the number of acronyms in use for a single metabolite has expanded in an unplanned and inconsistent manner due to a lack of guidance or group consensus. Even though the measurement of VOC metabolites is a well-established means to investigate exposure to VOCs, a formal attempt to harmonize acronyms amongst investigators has not been published. The aim of this work is to establish a system of acronym naming that provides consistency in current acronym usage and a foundation for creating acronyms for future VOC metabolites.
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Affiliation(s)
- Denise S Tevis
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon R Flores
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brandon M Kenwood
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deepak Bhandari
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Peyton Jacob
- Department of Medicine, University of California San Francisco, Division of Cardiology, Clinical Pharmacology Program, San Francisco General Hospital Medical Center, University of California at San Francisco, San Francisco, CA, USA
| | - Jia Liu
- Department of Medicine, University of California San Francisco, Division of Cardiology, Clinical Pharmacology Program, San Francisco General Hospital Medical Center, University of California at San Francisco, San Francisco, CA, USA
| | - Pawel K Lorkiewicz
- American Heart Association - Tobacco Regulation and Addiction Center, Superfund Research Center, Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
| | - Daniel J Conklin
- American Heart Association - Tobacco Regulation and Addiction Center, Superfund Research Center, Diabetes and Obesity Center, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Maciej L Goniewicz
- Nicotine and Tobacco Product Assessment Resource, Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Víctor R De Jesús
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Trowsdale S, Price M, Wilkins C, Tscharke B, Mueller J, Baker T. Quantifying nicotine and alcohol consumption in New Zealand using wastewater-based epidemiology timed to coincide with census. Drug Alcohol Rev 2021; 40:1178-1185. [PMID: 33715226 DOI: 10.1111/dar.13268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/19/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Accurate and timely information about nicotine and alcohol consumption is needed to inform effective policy. Wastewater-based epidemiology provides an opportunity to quantify consumption, which can complement traditional data collection methods. METHODS Wastewater samples were collected from seven wastewater treatment plants on seven consecutive days in three regions of New Zealand during the same week as the national census (6 March 2018). Samples were analysed for nicotine and alcohol metabolites using liquid chromatography-tandem mass spectrometry. Detailed catchment maps were developed and per capita consumption calculated. RESULTS Observed nicotine consumption (mean 1528 ± 412 cigarettes/day/1000 people) was similar to national sales data. Observed alcohol consumption (mean 1155 ± 764 standard drinks/day/1000 people) was lower than estimated using alcohol availability data. Consumption of nicotine and alcohol was generally higher in the Bay of Plenty and Canterbury compared to Auckland, mirroring trends in the New Zealand Health Survey. Intra-regional differences were observed and the patterns could not be attributed to urbanisation alone. Nicotine consumption was consistent throughout the week whereas alcohol consumption often peaked at the weekend. Nicotine consumption was correlated with neighbourhood-deprivation. There was little correlation for alcohol. DISCUSSION AND CONCLUSIONS Wastewater-based epidemiology provides a quantitative dataset that complements traditional methods of investigating nicotine and alcohol consumption. Timing data collection to coincide with the census helps to account for the influence of population mobility when normalising consumption.
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Affiliation(s)
- Sam Trowsdale
- School of Environment, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Mackay Price
- School of Environment, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Chris Wilkins
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Ben Tscharke
- Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Tom Baker
- School of Environment, Faculty of Science, University of Auckland, Auckland, New Zealand
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14
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St Helen G, Benowitz NL, Ko J, Jacob P, Gregorich SE, Pérez-Stable EJ, Murphy SE, Hecht SS, Hatsukami DK, Donny EC. Differences in exposure to toxic and/or carcinogenic volatile organic compounds between Black and White cigarette smokers. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:211-223. [PMID: 31406274 PMCID: PMC7012700 DOI: 10.1038/s41370-019-0159-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE It is unclear why Black smokers in the United States have elevated risk of some tobacco-related diseases compared to White smokers. One possible causal mechanism is differential intake of tobacco toxicants, but results across studies are inconsistent. Thus, we examined racial differences in biomarkers of toxic volatile organic compounds (VOCs) present in tobacco smoke. METHOD We analyzed baseline data collected from 182 Black and 184 White adult smokers who participated in a randomized clinical trial in 2013-2014 at 10 sites across the United States. We examined differences in urinary levels of ten VOC metabolites, total nicotine equivalents (TNE), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), controlling for covariates such as cigarettes per day (CPD), as well as differences in VOCs per TNE to assess the extent to which tobacco exposure, and not metabolic factors, accounted for racial differences. RESULTS Concentration of metabolites of acrolein, acrylonitrile, ethylene oxide, and methylating agents were significantly higher in Blacks compared to Whites when controlled for covariates. Other than the metabolite of methylating agents, VOCs per TNE did not differ between Blacks and Whites. Concentrations of TNE/CPD and VOCs/CPD were significantly higher in Blacks. Menthol did not contribute to racial differences in VOC levels. CONCLUSIONS For a given level of CPD, Black smokers likely take in higher levels of acrolein, acrylonitrile, and ethylene oxide than White smokers. Our findings are consistent with Blacks taking in more nicotine and toxicants per cigarette smoked, which may explain their elevated disease risk relative to other racial groups.
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Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA.
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA.
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Jennifer Ko
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - Peyton Jacob
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute and Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Martinasek MP, Calvanese AV, Lipski BK. A Naturalistic Study of Carbon Monoxide, Heart Rate, Oxygen Saturation, and Perfusion Index in Hookah Lounge Patrons. Respir Care 2021; 66:269-274. [PMID: 32636277 PMCID: PMC9994219 DOI: 10.4187/respcare.08056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Waterpipe (also known as hookah) smokers are exposed to several toxicants, heavy metals, and carcinogens. This study assessed physiologic data from hookah bar participants in an urban area in Florida. We hypothesized that hookah lounge patrons would have a decreased [Formula: see text] and perfusion index, as well as an increased heart rate and exhaled carbon monoxide (CO) levels upon exiting the bars. METHODS Exhaled CO levels, heart rate, pulse oximetry for carboxyhemoglobin, and perfusion index were obtained immediately before entering the hookah lounges and after exiting hookah lounges on a sample size of 200 patrons attending hookah lounges. Averages were then used for Wilcoxon signed-rank tests to assess differences across means. RESULTS Combining data from both hookah smokers and concurrent smokers, the mean CO measurements went from 5.7 ppm prior to lounge entry to 66.5 ppm after the lounge visit (P < .001). Conversion to carboxyhemoglobin for all hookah smokers represents an increase from 1.5% to 10.6% (P < .001). Carboxyhemoglobin mean values as measured with pulse oximetry increased from 1.4% prior to the lounge visit to 7.2% after the lounge visit (P < .001). The mean heart rate for the subjects also increased from 90.3 beats/min to 94.2 beats/min (P < .001). [Formula: see text] levels decreased from 98.4% to 97.8% (P < .001). Similarly, the mean perfusion index decreased from 3.1% to 2.7% (P = .002). CONCLUSIONS Hookah lounge smokers in the United States are exposed to high levels of CO that have the potential for detrimental health effects, as evidenced by rapid negative changes in physiological parameters. Respiratory therapists should be aware of potential cardiovascular changes in hookah lounge patrons who enter emergency rooms and health facilities due to recent exposures.
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Affiliation(s)
- Mary P Martinasek
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida.
| | - Allison V Calvanese
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida
| | - Briana K Lipski
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, Florida
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Luo X, Carmella SG, Chen M, Jensen JA, Wilkens LR, Le Marchand L, Hatsukami DK, Murphy SE, Hecht SS. Urinary Cyanoethyl Mercapturic Acid, a Biomarker of the Smoke Toxicant Acrylonitrile, Clearly Distinguishes Smokers From Nonsmokers. Nicotine Tob Res 2021; 22:1744-1747. [PMID: 32391548 DOI: 10.1093/ntr/ntaa080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cyanoethyl mercapturic acid (CEMA) is a urinary metabolite of acrylonitrile, a toxicant found in substantial quantities in cigarette smoke, but not in non-combusted products such as e-cigarettes or smokeless tobacco and rarely in the diet or in the general human environment. Thus, we hypothesized that CEMA is an excellent biomarker of combusted tobacco product use. AIMS AND METHODS We tested this hypothesis by analyzing CEMA in the urine of 1259 cigarette smokers (urinary cotinine ≥25 ng/mL) and 1191 nonsmokers. The analyses of CEMA and cotinine were performed by validated liquid chromatography-tandem mass spectrometry methods. Logistic regression was fit for log-transformed CEMA to construct the receiver operating characteristic curve. RESULTS We found that a CEMA cutpoint of 27 pmol/mL urine differentiated cigarette smokers from nonsmokers with sensitivity and specificity greater than 99%. The use of different cotinine cutpoints to define smokers (10-30 ng/mL) had little effect on the results. CONCLUSIONS CEMA is a highly reliable urinary biomarker to identify users of combusted tobacco products such as cigarettes as opposed to users of non-combusted products, medicinal nicotine, or nonusers of tobacco products. IMPLICATIONS CEMA can be used to distinguish users of combusted tobacco products from non-combusted products such as e-cigarettes, smokeless tobacco, and medicinal nicotine. Levels of CEMA in the urine of people who use these non-combusted products are extremely low, in contrast to cotinine.
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Affiliation(s)
- Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Joni A Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | | | | | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
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17
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Chung CJ, Hsu HT, Chang CH, Li SW, Liu CS, Chung MC, Wu GW, Jung WT, Kuo YJ, Lee HL. Relationships among cigarette smoking, urinary biomarkers, and urothelial carcinoma risk: a case-control study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:43177-43185. [PMID: 32729033 DOI: 10.1007/s11356-020-10196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Cigarette smoke is a known risk factor for urothelial carcinoma (UC). However, there is limited information about the distributions and effects of volatile organic compounds (VOCs) on smoking-related UC risk. With this hospital-based case-control study, we explored the associations between urinary levels of cotinine and VOC metabolites (acrylamide, 1,3-butadiene, and benzene) and the risk of UC. Urological examinations and pathological verifications were used to confirm the diagnoses of UC. All study participants provided smoking-related information via questionnaires and face-to-face interviews; they also provided urine samples for the measurement of VOC metabolites, cotinine, and 8-hydroxydeoxyguanosine (8-OHdG), which was used as an indicator of oxidative stress. We applied multiple logistic regression analysis to estimate the risk of UC, and we found that levels of urinary cotinine and 8-OHdG were higher in the UC group than in the control group. Furthermore, urinary levels of VOC metabolites, including N-acetyl-S-(2-carbamoylethyl)-L-cysteine (AAMA), N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine, N-acetyl-S-(4-hydroxy-2-buten-1-yl)-L-cysteine-3, trans,trans-muconic acid (t,t-MA), and S-phenylmercapturic acid (SPMA), increased with increasing levels of urinary cotinine. After adjusting for potential risk factors, dose-response relationships were observed between UC risk and urinary levels of AAMA, t,t-MA, SPMA, and 8-OHdG. Participants with high urinary levels of cotinine, AAMA, t,t-MA, SPMA, and 8-OHdG had risks of UC that were 3.5- to 6-fold higher than those of participants with lower levels. Future, large-scale investigations of the risks of UC should be explored, and repeated measurement of VOC metabolites should be assessed.
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Affiliation(s)
- Chi-Jung Chung
- Department of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Hui-Tsung Hsu
- Department of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Wei Li
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Guo-Wei Wu
- Department of Public Health, China Medical University, No. 91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Wei-Ting Jung
- Department of Chemistry, Fu Jen Catholic University, 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 24205, Taiwan
| | - Yen-Jung Kuo
- Department of Chemistry, Fu Jen Catholic University, 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 24205, Taiwan
| | - Hui-Ling Lee
- Department of Chemistry, Fu Jen Catholic University, 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 24205, Taiwan.
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Habibagahi A, Alderman N, Kubwabo C. A review of the analysis of biomarkers of exposure to tobacco and vaping products. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:4276-4302. [PMID: 32853303 DOI: 10.1039/d0ay01467b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Quantification of exposure to different chemicals from both combustible cigarettes and vaping products is important in providing information on the potential health risks of these products. To assess the exposure to tobacco products, biomarkers of exposure (BOEs) are measured in a variety of biological matrices. In this review paper, current knowledge on analytical methods applied to the analysis of biomarkers of exposure to tobacco products is discussed. Numerous sample preparation techniques are available for the extraction and sample clean up for the analysis of BOEs to tobacco and nicotine delivery products. Many tobacco products-related exposure biomarkers have been analyzed using different instrumental techniques, the most common techniques being gas and liquid chromatography coupled with mass spectrometry (GC-MS, GC-MS/MS and LC-MS/MS). To assess exposure to emerging tobacco products and study exposure in dual tobacco users, the list of biomarkers analyzed in urine samples has been expanded. Therefore, the current state of the literature can be used in preparing a preferred list of biomarkers based on the aim of each study. The information summarized in this review is expected to be a handy tool for researchers involved in studying exposures to tobacco products, as well as in risk assessment of biomarkers of exposure to vaping products.
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Affiliation(s)
- Arezoo Habibagahi
- Exposure and Biomonitoring Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada.
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19
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Travers MJ, Rivard C, Sharma E, Retzky S, Yucesoy B, Goniewicz ML, Stanton CA, Chen J, Callahan-Lyon P, Kimmel HL, Xia B, Wang Y, Sosnoff CS, De Jesús VR, Blount BC, Hecht SS, Hyland A. Biomarkers of Exposure among USA Adult Hookah Users: Results from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2014). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6403. [PMID: 32887496 PMCID: PMC7504577 DOI: 10.3390/ijerph17176403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
Hookah smoking has become common in the USA, especially among young adults. This study measured biomarkers of exposure to known tobacco product toxicants in a population-based sample of exclusive, established hookah users. Urinary biomarker data from 1753 adults in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study were used to compare geometric mean concentrations of biomarkers of exposure in exclusive, established past 30-day hookah users to never users of tobacco. Geometric mean ratios were calculated comparing hookah user groups with never users adjusting for age, sex, race/ethnicity, education, past 30-day marijuana use, secondhand smoke exposure and creatinine. Past 30-day hookah users (n = 98) had 10.6 times the urinary cotinine level of never tobacco users. Compared to never tobacco users, past 30-day hookah users had 2.3 times the level of the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a metabolite of the tobacco-specific nitrosamine (TSNA) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), 1.3 times higher polycyclic aromatic hydrocarbons (PAHs) 3-hydroxyfluorene and 1-hydroxypyrene, 1.8 times higher levels of acrylonitrile, 1.3 times higher levels of acrylamide, and 1.2 times higher levels of acrolein exposure. These data indicate that hookah use is a significant source of exposure to nicotine, carcinogens, and respiratory toxicants.
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Affiliation(s)
- Mark J. Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.J.T.); (M.L.G.); (A.H.)
| | - Cheryl Rivard
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.J.T.); (M.L.G.); (A.H.)
| | - Eva Sharma
- Westat, Rockville, MD 20850, USA; (E.S.); (C.A.S.)
| | - Sandra Retzky
- Food and Drug Administration, Center for Tobacco Products, Calverton, MD 20705, USA; (S.R.); (B.Y.); (J.C.); (P.C.-L.)
| | - Berran Yucesoy
- Food and Drug Administration, Center for Tobacco Products, Calverton, MD 20705, USA; (S.R.); (B.Y.); (J.C.); (P.C.-L.)
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.J.T.); (M.L.G.); (A.H.)
| | | | - Jiping Chen
- Food and Drug Administration, Center for Tobacco Products, Calverton, MD 20705, USA; (S.R.); (B.Y.); (J.C.); (P.C.-L.)
| | - Priscilla Callahan-Lyon
- Food and Drug Administration, Center for Tobacco Products, Calverton, MD 20705, USA; (S.R.); (B.Y.); (J.C.); (P.C.-L.)
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Baoyun Xia
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (B.X.); (Y.W.); (C.S.S.); (V.R.D.J.); (B.C.B.)
| | - Yuesong Wang
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (B.X.); (Y.W.); (C.S.S.); (V.R.D.J.); (B.C.B.)
| | - Connie S. Sosnoff
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (B.X.); (Y.W.); (C.S.S.); (V.R.D.J.); (B.C.B.)
| | - Víctor R. De Jesús
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (B.X.); (Y.W.); (C.S.S.); (V.R.D.J.); (B.C.B.)
| | - Benjamin C. Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (B.X.); (Y.W.); (C.S.S.); (V.R.D.J.); (B.C.B.)
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.J.T.); (M.L.G.); (A.H.)
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Ramic-Catak A, Kurtovic A, Gavran L, Hasanica N, Mujezinovic A, Oruc M. Water Pipe as Growing Public Health Challenge Among School Children in the Federation of Bosnia and Herzegovina. Mater Sociomed 2020; 32:207-211. [PMID: 33424450 PMCID: PMC7780818 DOI: 10.5455/msm.2020.32.207-211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/30/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The water pipe is a form of tobacco smoking that recently become very popular among youth in many countries all over the globe. AIM To highlight recent data collected through Global Youth Tobacco Survey (GYTS) in the Federation of Bosnia and Herzegovina (FBiH) 2019, related to knowledge, attitudes and behavior of school children and youth to water pipe consumption. METHODS The GYTS questionnaire for the Federation of BiH 2019 contained 60 multiple-choice questions. The GYTS 2019 in the Federation of BiH was conducted in a total of 73 of the 75 sampled primary and secondary schools with a school response rate of 97.3%. From the 6,972 sampled students a total of 6,415 participated as eligible students in grades 8-9 of primary and 1st grade of secondary school, with a response rate for students of 92.0%. RESULTS Survey findings show that almost half (44.1%) of the school children confirm ever smoking the water pipe, while Current smoking of water pipe is confirmed by 16.1% school children. CONCLUSION There is a substantial need for implementing of systematic and inter sectorial tobacco control measures that involves a water pipe as new public health challenge among youth.
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Affiliation(s)
- Aida Ramic-Catak
- Institute for Public Health of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Aida Kurtovic
- Institute for Public Health of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Larisa Gavran
- Health Centre Zenica, Medical Faculty University Zenica, Zenica, Bosnia and Herzegovina
| | - Nino Hasanica
- Institute for Health and Food Safety Zenica, Zenica, Bosnia and Herzegovina
| | - Adnan Mujezinovic
- Medical Faculty University of Zenica, Zenica, Bosnia and Herzegovina
| | - Mirza Oruc
- Medical Faculty University of Zenica, Zenica, Bosnia and Herzegovina
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Dugheri S, Mucci N, Cappelli G, Bonari A, Campagna M, Arcangeli G, Bartolucci G. New fully automated gas chromatographic analysis of urinary S-phenylmercapturic acid in isotopic dilution using negative chemical ionization with isobutane as reagent gas. JOURNAL OF MASS SPECTROMETRY : JMS 2020; 55:e4481. [PMID: 31770470 DOI: 10.1002/jms.4481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
The determination of urinary S-phenylmercapturic acid (S-PMA) represents the most reliable biomarker to monitor the intake risk of airborne benzene. Recently, the European Chemical Agency deliberated new occupational exposure limits for benzene and recommended an S-PMA biological limit value of 2-μg/g creatinine. This limit is an order of magnitude lower than the previous one, and its determination constitutes a challenge in the analytical field. We developed and validated a method that allows the fully automated and sensitive determination of S-PMA by the use of gas-chromatography negative chemical ionization tandem mass spectrometry in isotopic dilution. For negative chemical ionization, we selected a mixture of 1% isobutane in argon as reactive gas, by studying its chemical ionization mechanism and optimal parameters compared with pure isobutane or pure methane. This gas mixture produces a more abundant signal of the target analyte than isobutane or methane, and it extended the operative lifetime of the ion source, enabling us to start a high-throughput approach of the S-PMA analysis. Moreover, energy-resolved mass spectrometry experiments were carried out to refine the MS/MS analysis conditions, testing nitrogen and argon as collision gases. The method optimization was pursued by a chemometric model by using the experimental design. The quantification limit for S-PMA was 0.10 μg/L. Accuracy (between 98.3% and 99.6%) and precision (ranging from 1.6% to 6.4%) were also evaluated. In conclusion, the newly developed assay represents a powerful tool for the robust, reliable, and sensitive quantification of urinary S-PMA, and because of its automation, it is well suited for application in large environmental and biological monitoring.
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Affiliation(s)
- Stefano Dugheri
- Industrial Hygiene and Toxicology Laboratory, Occupational Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Cappelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Marcello Campagna
- Department of Medical Science and Public Health, University of Cagliari, Monserrato, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Sesto Fiorentino, Italy
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Jafari AJ, Asl YA, Momeniha F. Determination of metals and BTEX in different components of waterpipe: charcoal, tobacco, smoke and water. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2020; 18:243-251. [PMID: 32399236 PMCID: PMC7203304 DOI: 10.1007/s40201-020-00459-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND The main objective of this study was to evaluate the concentrations of heavy metals and BTEX (benzene, toluene, ethylbenzene and xylene) in smoke and water bowl of 5-most commonly used tobacco brand in waterpipe in Tehran, the capital of Iran. METHODS Five types of conventional tobacco in Tehran were investigated. Heavy metals and BTEX were analyzed in waterpipe smoke, tobacco, charcoal and water bowl prior to and after smoking by using ICP-OES and GC-MS, respectively. RESULTS Our results indicated that Khansar and Al Fakher brands had the maximum and minimum concentrations of metals among tobacco consumed, respectively. The results showed that there was a significant difference between content of heavy metals in burned and unburned tobacco. The highest and lowest concentrations of metals were related to Fe and Hg, respectively. CONCLUSION Results showed that tobacco, charcoal and smoke of waterpipe contained significant contents of toxic metals and BTEX, and exposure to these components could be the main reason for the concerns about waterpipe smoking.
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Affiliation(s)
- Ahmad Jonidi Jafari
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Momeniha
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Waterpipe Tobacco Smoking and Associated Risk Factors among Bangladeshi University Students: An Exploratory Pilot Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractOver the past two decades, there has been a global rise in the prevalence of waterpipe tobacco smoking. Waterpipe tobacco smoking involves the inhalation of heated tobacco smoke after passing through water, and it has been associated with an identified dependence effect similar to that found with cigarette smoking. Despite the popularity of waterpipe tobacco among youth (and in particular, university students) in many countries, detailed data of its usage are lacking in Bangladesh. Therefore, the present study was conducted to explore waterpipe tobacco smoking behavior and normative beliefs among university students in Bangladesh and to assess the factors associated with waterpipe tobacco use. A quantitative cross-sectional survey was carried out among 340 Bangladeshi university students (64.4% male; mean age 21.6 years). Among participants, 13.5% reported they had ever smoked tobacco from a waterpipe and 9.4% had it in past 30 days. Among past 30-day users, 72% were categorized as having waterpipe smoking dependence (n = 23). No females in the sample had ever smoked using a waterpipe. Maternal occupation, monthly expenditure, and regular smoking status were major predominant factors associated with waterpipe smoking behavior of the students. The study is of existential value given that there are no prior studies ever carried out in Bangladesh previously. Recommendations are provided based on the study’s findings, particularly in relation to what action is needed from universities in Bangladesh.
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Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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25
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St Helen G, Liakoni E, Nardone N, Addo N, Jacob P, Benowitz NL. Comparison of Systemic Exposure to Toxic and/or Carcinogenic Volatile Organic Compounds (VOC) during Vaping, Smoking, and Abstention. Cancer Prev Res (Phila) 2020; 13:153-162. [PMID: 31554628 PMCID: PMC7007368 DOI: 10.1158/1940-6207.capr-19-0356] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
Comparisons of systemic exposure to toxicants during monitored cigarette smoking, electronic cigarette (e-cigarette) use, and abstention are needed to enhance our understanding of the risks of e-cigarette use (vaping). In a cross-over study, we measured 10 mercapturic acid metabolites of volatile organic compounds (VOCs) in 24-hour urine samples collected from 36 dual users (8 women) of e-cigarettes and cigarettes during 2 days of ad libitum vaping or cigarette-only use, and 2 days of enforced abstention. Concentrations of VOC metabolites were higher during smoking compared with vaping, except for the methylating agents' metabolite. The fold-difference in concentrations when smoking relative to vaping ranged from 1.31 (1.06-1.61; geometric mean, 95% confidence interval; 1,3-butadiene) to 7.09 (5.88-8.54; acrylonitrile). Metabolites of acrylamide [fold difference of 1.21 (1.03-1.43)] and benzene [1.46 (1.13-1.90)] were higher during vaping compared with abstention. The 1,3-butadiene and propylene oxide metabolites were higher in variable-power tank users compared with users of cig-a-likes. E-cigarettes expose users to lower levels of toxic VOCs compared with cigarette smoking, supporting their harm reduction potential among smokers. However, some e-cigarettes expose users to VOCs such as acrylamide, benzene, and propylene oxide, and may pose health risks to nonsmoking users. The results of our study will inform regulators in assessing e-cigarettes with respect to the balance between its potential harm reduction for adult smokers and risk to nonsmoking users.
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Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California.
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, California
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natalie Nardone
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California
| | - Newton Addo
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California
| | - Peyton Jacob
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, California
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, California
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California
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The exposure level of environmental harmful substances related to the secondhand smoke in Korean non-smoker adults: data from the second Korean National Environmental Health Survey (KoNEHS 2012-2014): a cross-sectional study. Ann Occup Environ Med 2019; 31:e30. [PMID: 31737285 PMCID: PMC6850792 DOI: 10.35371/aoem.2019.31.e30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background We aimed to find the exposure level of environmental harmful substances related to the secondhand smoke (SHS) using a nationally representative data of the general population in Korea. Methods Total 3,533 people were included in this study. We compared the proportion exceeding 95 percentile of the concentrations of harmful substances by sex according to SHS exposure. 16 kinds of substances related to tobacco smoke were analyzed including heavy metals, polycyclic aromatic hydrocarbons, volatile organic compounds, and environmental phenol. For 16 kinds of substances, the odds ratios (ORs) for exceeding 95 percentile of each harmful substance were calculated by multiple logistic regression according to SHS exposure. Age, education level, marital status, body mass index, drinking, and exercise were adjusted as covariates. Cotinine level was additionally adjusted to increase reliability of our results. Results SHS was associated with high exposure of mercury, methylhippuric acid, fluorene, and cotinine. In women, SHS was associated with mercury, methylhippuric acid, fluorene, and cotinine, while in men, it was associated with cotinine. After adjusting covariates, ORs of blood mercury, methylhippuric acid and hydroxyfluorene in the exposed gruop were greater than that in the non-exposed group. Especially in female, methylhippuric acid and hydroxyfluorene showed consistent result. Conclusions Our finding demonstrates that SHS is related to several harmful substances. Therefore, to reduce the health effects of SHS, it is necessary to educate and publicize the risk of SHS. Future studies are necessary to more accurately analyze factors such as exposure frequency, time, and pathway of SHS.
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Rezk-Hanna M, Toyama J, Ikharo E, Brecht ML, Benowitz NL. E-Hookah Versus E-Cigarettes: Findings From Wave 2 of the PATH Study (2014-2015). Am J Prev Med 2019; 57:e163-e173. [PMID: 31564602 DOI: 10.1016/j.amepre.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION ENDS are evolving quickly with increasing use in the U.S. More recently, e-hookahs have been introduced as healthier alternatives to the traditional hookah-flavored tobacco smoking. To date, virtually all studies of ENDS have focused on e-cigarettes; consequently, little is known about e-hookah use. METHODS Data were drawn from the 2014-2015 Wave 2 Population Assessment of Tobacco and Health study, a nationally representative sample of adults aged ≥18 years (n=28,362) and youth aged 12-17 years (n=12,172). Weighted analyses, conducted in 2018-2019, estimated the prevalence of e-hookah versus e-cigarette and examined comparisons among users and sociodemographics, patterns of use, and co-use of tobacco products and substances. RESULTS Overall, 4.6% of adults reported ever e-hookah use; of these, more than a quarter (26.8%) reported current use. For e-cigarettes, 22.5% reported ever use with 24.8% reporting current use. Among youth, 7.7% reported ever e-hookah use versus 14.3% for e-cigarette use. Comparing e-hookah versus e-cigarette only users, the majority were young adults aged 18-24 years versus ≥25 years (60.5% vs 17.3%, p<0.0001) with the majority being female (58.8% vs 46.0%, p<0.0001). Although alcohol and marijuana were the most common substances used among e-hookah and e-cigarette users, both adult and youth e-hookah only users had a higher prevalence of use than e-cigarette only users. CONCLUSIONS Although e-hookahs are used less commonly than e-cigarettes, e-hookah use is not rare. Compared with e-cigarette users, e-hookah users have a different profile in terms of user demographics and co-use of substances. Given the rapid uptake of ENDS by young adults, these findings suggest the need to understand e-hookah products' distinct characteristics and users' smoking patterns and behaviors to help inform tobacco regulation specific to hookah.
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Affiliation(s)
- Mary Rezk-Hanna
- School of Nursing, University of California, Los Angeles, Los Angeles, California; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Joy Toyama
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Ebahi Ikharo
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, Divsion of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, San Francisco, California
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Qasim H, Alarabi AB, Alzoubi KH, Karim ZA, Alshbool FZ, Khasawneh FT. The effects of hookah/waterpipe smoking on general health and the cardiovascular system. Environ Health Prev Med 2019; 24:58. [PMID: 31521105 PMCID: PMC6745078 DOI: 10.1186/s12199-019-0811-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. The misperception of hookah being less harmful than cigarettes and the availability of different but "appealing" flavors are considered among the main reasons for this trend. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.
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Affiliation(s)
- Hanan Qasim
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Texas at El Paso, El Paso, Texas, 79902, USA
| | - Ahmed B Alarabi
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Texas at El Paso, El Paso, Texas, 79902, USA
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Zubair A Karim
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Texas at El Paso, El Paso, Texas, 79902, USA
| | - Fatima Z Alshbool
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Texas at El Paso, El Paso, Texas, 79902, USA.
| | - Fadi T Khasawneh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Texas at El Paso, El Paso, Texas, 79902, USA.
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Naddafi K, Nabizadeh R, Rostamy R, Ebrahimi Kalan M, Hassanvand MS, Fazlzadeh M. Indoor air quality in waterpipe cafés: exposure level to particulate matter. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:26605-26616. [PMID: 31290048 DOI: 10.1007/s11356-019-05546-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 05/11/2023]
Abstract
Waterpipe is increasingly being used worldwide. Despite waterpipe cafés gaining popularity among Iranian population, there is a paucity of research measuring exposures and assessing the health effects of waterpipe smoke in these places. The objective of the current study was to investigate the exposure to PM10, PM2.5, and PM1 concentrations and risk assessment of PM2.5 exposures in different age groups in the indoor air of waterpipe cafés. The study samples were taken from indoor air of 50 waterpipe cafés in Ardabil, Iran. The PM10, PM2.5, and PM1 concentrations were assessed using a portable GRIMM dust monitors. The mean (±SD) concentrations of indoor air PM10, PM2.5, and PM1 were 765 ± 352, 624 ± 327, and 500 ± 305 μg/m3, respectively. The mean of HQ (hazard quotient) for PM2.5 in all age groups of 16 and older was > 1, which corresponds to an unacceptably high risk for human health. Also, the mean of ELCRs (excess lifetime cancer risk) for PM2.5 in different age groups exceeded the limit value by the USEPA. The results indicated that the PM concentration is significantly influenced by the number of waterpipe smokers, type of ventilation system, and kind of tobacco. Therefore, waterpipe cafés are a potential source for exposure to PM10, PM2.5, and PM1 and increase the risk of respiratory diseases and cardiovascular problems among waterpipe smokers.
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Affiliation(s)
- Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Roohollah Rostamy
- Research Center for Health Sciences and Technologies, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Fazlzadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
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Moon KA, Rule AM, Magid HS, Ferguson JM, Susan J, Sun Z, Torrey C, Abubaker S, Levshin V, Çarkoglu A, Radwan GN, El-Rabbat M, Cohen JE, Strickland P, Breysse PN, Navas-Acien A. Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo. Nicotine Tob Res 2019; 20:482-491. [PMID: 28582531 DOI: 10.1093/ntr/ntx125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/30/2017] [Indexed: 11/12/2022]
Abstract
Background Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hoda S Magid
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline M Ferguson
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jolie Susan
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Zhuolu Sun
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christine Torrey
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Salahaddin Abubaker
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Asli Çarkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | - Ghada Nasr Radwan
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha El-Rabbat
- Department of Psychology, Kadir Has University, Istanbul, Turkey
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Patrick N Breysse
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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31
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Stroud L, Werner E, Matteson K, Carey M, Helen GS, Eissenberg T, Scott-Sheldon LAJ. Waterpipe (hookah) tobacco use in pregnancy: use, preferences and perceptions of flavours. Tob Control 2019; 29:s62-s71. [PMID: 31320397 DOI: 10.1136/tobaccocontrol-2019-054984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Waterpipe tobacco (WPT; hookah) use is common in pregnant and reproductive-age women. Sweet flavours contribute to the appeal of WPT and are a potential regulatory target. This study investigated use, preferences and perceptions of WPT flavours in pregnant WPT users, and the impact of flavour preferences on preconception/prenatal WPT use and exposure biomarkers. METHODS 58 pregnant WPT users (mean age=27 years) completed a detailed interview regarding their WPT flavours use, preferences and perceptions. Biomarkers of nicotine and carcinogen exposure (eg, cotinine, benzene, butadiene) were also collected. RESULTS 55% of participants were dual/poly WPT users (ie, reported use of one or more other tobacco products in addition to WPT). Pregnant WPT users reported nearly exclusive use of flavoured WPT, with greater use of menthol/mint (68%) followed by fruit flavours (48%) (p<0.001), and greater preferences for fruit followed by menthol/mint flavours (ps<0.05). Harm perceptions did not differ among flavours. Compared with dual/poly WPT users, WPT-only users reported more total WPT use events, greater use of and preference for menthol/mint flavoured WPT (ps<0.001), and decreased exposure biomarkers (ps≤0.040). Preference for menthol/mint and fruit flavours predicted more flavoured WPT use events during preconception and pregnancy; preference for menthol/mint predicted detectable cotinine and benzene levels but not butadiene. CONCLUSIONS This is the first study of WPT flavour use, preferences and perceptions in pregnant women. Use of and preference for menthol/mint and fruit WPT flavours in this vulnerable population could be considered in regulating WPT flavours to protect the health of women and children.
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Affiliation(s)
- Laura Stroud
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA .,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Erika Werner
- Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Kristen Matteson
- Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Michael Carey
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Gideon St Helen
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lori A J Scott-Sheldon
- Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA .,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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32
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Kaplan B, Sussan T, Rule A, Moon K, Grau-Perez M, Olmedo P, Chen R, Carkoglu A, Levshin V, Wang L, Watson C, Blount B, Calafat AM, Jarrett J, Caldwell K, Wang Y, Breysse P, Strickland P, Cohen J, Biswal S, Navas-Acien A. Waterpipe tobacco smoke: Characterization of toxicants and exposure biomarkers in a cross-sectional study of waterpipe employees. ENVIRONMENT INTERNATIONAL 2019; 127:495-502. [PMID: 30981020 PMCID: PMC6513716 DOI: 10.1016/j.envint.2019.03.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Few studies have comprehensively characterized toxic chemicals related to waterpipe use and secondhand waterpipe exposure. This cross-sectional study investigated biomarkers of toxicants associated with waterpipe use and passive waterpipe exposure among employees at waterpipe venues. METHOD We collected urine specimens from employees in waterpipe venues from Istanbul, Turkey and Moscow, Russia, and identified waterpipe and cigarette smoking status based on self-report. The final sample included 110 employees. Biomarkers of exposure to sixty chemicals (metals, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), nicotine, and heterocyclic aromatic amines (HCAAs)) were quantified in the participants' urine. RESULTS Participants who reported using waterpipe had higher urinary manganese (geometric mean ratio (GMR): 2.42, 95% confidence interval (CI): 1.16, 5.07) than never/former waterpipe or cigarette smokers. Being exposed to more hours of secondhand smoke from waterpipes was associated with higher concentrations of cobalt (GMR: 1.38, 95% CI: 1.10, 1.75). Participants involved in lighting waterpipes had higher urinary cobalt (GMR: 1.43, 95% CI: 1.10, 1.86), cesium (GMR: 1.21, 95% CI: 1.00, 1.48), molybdenum (GMR: 1.45, 95% CI: 1.08, 1.93), 1-hydroxypyrene (GMR: 1.36, 95% CI: 1.03, 1.80), and several VOC metabolites. CONCLUSION Waterpipe tobacco users and nonsmoking employees of waterpipe venues had higher urinary concentrations of several toxic metals including manganese and cobalt as well as of VOCs, in a distinct signature compared to cigarette smoke. Employees involved in lighting waterpipes may have higher exposure to multiple toxic chemicals compared to other employees.
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Affiliation(s)
- Bekir Kaplan
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America.
| | - Thomas Sussan
- U.S. Army Public Health Center, Toxicology Directorate, United States of America
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Katherine Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Maria Grau-Perez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
| | - Pablo Olmedo
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America; Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Granada, Spain
| | - Rui Chen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Asli Carkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | | | - Lanqing Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Clifford Watson
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Benjamin Blount
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Jeffery Jarrett
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Kathleen Caldwell
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Yuesong Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Pattrick Breysse
- National Center for Environmental Health, Centers for Disease Control and Prevention, United States of America
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Joanna Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Shyam Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, United States of America
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Now is the Time for Effective Regulation Regarding Tobacco Smoking Using a Waterpipe (Hookah). J Adolesc Health 2019; 64:685-686. [PMID: 31122500 DOI: 10.1016/j.jadohealth.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 12/15/2022]
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Rababa’h AM, Bsoul RW, Alkhatatbeh MJ, Alzoubi KH, Khabour OF. Waterpipe tobacco smoke distresses cardiovascular biomarkers in mice: alterations in protein expression of metalloproteinases, endothelin and myeloperoxidase. Inhal Toxicol 2019; 31:99-106. [DOI: 10.1080/08958378.2019.1606366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Abeer M. Rababa’h
- Department of Clinical Pharmacy Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Raghad W. Bsoul
- Department of Clinical Pharmacy Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad J. Alkhatatbeh
- Department of Clinical Pharmacy Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Department of Clinical Pharmacy Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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El Hourani M, Talih S, Salman R, Karaoghlanian N, Karam E, El Hage R, Saliba NA, Shihadeh A. Comparison of CO, PAH, Nicotine, and Aldehyde Emissions in Waterpipe Tobacco Smoke Generated Using Electrical and Charcoal Heating Methods. Chem Res Toxicol 2019; 32:1235-1240. [DOI: 10.1021/acs.chemrestox.9b00045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mario El Hourani
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Soha Talih
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Rola Salman
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nareg Karaoghlanian
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Ebrahim Karam
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Rachel El Hage
- Chemistry Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Najat Aoun Saliba
- Chemistry Department, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut 1107 2020, Lebanon
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Heydari G, Taghizdeh F, Fazlzadeh M, Jafari AJ, Asadgol Z, Mehrizi EA, Moradi M, Arfaeinia H. Levels and health risk assessments of particulate matters (PM 2.5 and PM 10) in indoor/outdoor air of waterpipe cafés in Tehran, Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:7205-7215. [PMID: 30656582 DOI: 10.1007/s11356-019-04202-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/08/2019] [Indexed: 05/21/2023]
Abstract
To determine the concentration of particulate matters (PM2.5 and PM10), 36 samples were collected from indoor/outdoor air of hookah cafés (HS), cigarette cafés (CS), both hookah and cigarette (HCS), and no-smoking building (NS) in Tehran City from December 2017 to March 2018. The mean ± SD of PM10 concentration in the indoor air of the cafés in terms of HS, CS, HCS, and NS sites has been 702.35, 220.20, 1156.60, and 60.12 μg/m3, while for PM2.5, the values have been 271.92, 111.80, 619.10, and 22.25 μg/m3, respectively. It was also found that the PM concentration inside the cafés was higher during weekend session (with a higher number of active smokers), than during the weekday sessions. Moreover, the PM levels in the indoor air of the cafés were considerably higher than those of the outdoors (p < 0.05). Based on path analysis, the number of "active smokers" had the highest influence on production of PM inside the cafés, followed by the tobacco type. Finally, the mean excess lifetime cancer risk (ELCR) for PM2.5 in the indoor air of cafés was observed in the range of 0.64 × 10-5-14.98 × 10-5. Also, the mean of hazard quotient (HQ) for PM2.5 and PM10 was calculated in range of 0.82-18.4 and 0.16-3.28, respectively, which corresponds to an unacceptably high risk for human health. The PM levels in the indoor air of smoking cafés in Tehran are significantly high, such that it can cause serious risks for the health of both the customers and personnel. Thus, it is necessary that suitable controlling strategies be adopted for this public health threat.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Taghizdeh
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Fazlzadeh
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Asadgol
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Abouee Mehrizi
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Arfaeinia
- Department of Environmental Health Engineering, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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Hallit S, Hallit R, Haddad C, Youssef L, Zoghbi M, Costantine R, Kheir N, Salameh P. Previous, current, and cumulative dose effect of waterpipe smoking on LDL and total cholesterol. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:8194-8201. [PMID: 30694434 DOI: 10.1007/s11356-019-04311-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region. To the best of our knowledge, no studies have assessed the impact of waterpipe smoking on lipid levels in the Lebanese population. Therefore, the objective of the study was to evaluate the correlation between waterpipe smoking and LDL-C and total cholesterol levels in exclusive Lebanese waterpipe smokers compared to non-smokers. This cross-sectional study was conducted between October 2016 and February 2017, enrolling 308 patients (156 non-smokers and 147 waterpipe smokers) from four laboratories. Current and previous WS (beta = 66.64 and beta = 71.49) were significantly associated with higher LDL scores. Current WS was significantly associated with and total cholesterol levels (beta = 34.12). Cumulative WS (number of waterpipes per week × duration in years) was significantly associated with higher LDL-C and total cholesterol levels respectively (p < 0.001 for all 3 variables). The university level of education (beta = 8.89) and current alcohol drinking (beta = 8.81) were significantly associated with higher LDL scores. Our study demonstrated an association between previous or current waterpipe smoking and lipid level. Future research are needed to detect the direct cause of the relation between waterpipe smoking and CVD. Concerned authorities should set up awareness campaigns to increase alertness on dangers of WS and dependence, and encourage these young adults to embrace health-promoting behaviors.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon.
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
| | - Lara Youssef
- Department of Nursing and Health Sciences, Notre-Dame University, Shouf, Lebanon
| | - Marouan Zoghbi
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | - Nelly Kheir
- Faculty of Pedagogy, Université de la Sainte Famille, Batroun, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
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38
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Masjedi MR, Taghizadeh F, Hamzehali S, Ghaffari S, Fazlzadeh M, Jafari AJ, Niazi S, Mehrizi EA, Moradi M, Pasalari H, Arfaeinia H. Air pollutants associated with smoking in indoor/outdoor of waterpipe cafés in Tehran, Iran: Concentrations, affecting factors and health risk assessment. Sci Rep 2019; 9:3110. [PMID: 30816239 PMCID: PMC6395650 DOI: 10.1038/s41598-019-39684-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/29/2019] [Indexed: 11/08/2022] Open
Abstract
Despite increasingly growth in waterpipe smoking in Tehran, so far no study has been conducted on the air quality of the waterpipe and cigarette cafés. Thirty-six cafés were selected and the concentration of three pollutants including formaldehyde, carbon monoxide and nicotine were measured in both indoor and outdoor air of cafés two times (week-day and weekend's session). Air sampling was performed for 180 min for each pollutant. It was observed that the concentration of pollutants inside the cafés was higher during weekend session (with a higher number of "active waterpipe heads") compared with findings during the week-day sessions. Furthermore, the concentration of pollutants in the indoor air of the cafés was significantly higher than that of the outdoors (p < 0.05). According to path analysis, the number of "active waterpipe heads" had the maximum impact on generation of pollutants inside the cafés, followed by the type of tobacco as the second influential factor. The average of lifetime cancer risk (LTCR) resulted by formaldehyde exposure through inhalation in waterpipe (WS), cigarette (CS), waterpipe and cigarette (WCS) and none-smoking (NS) cafés in week-day and weekend sessions were estimated to be 111 × 10-5 and 61.2 × 10-5, 33.7 × 10-5 and 39.4 × 10-5, 271 × 10-5 and 322 × 10-5, and 4.80 × 10-5 and 5.90 × 10-5, respectively, which exceed the limit value by the U.S.EPA and WHO. The concentration of pollutants in the indoor air of smoking cafés in Tehran is significantly high, such that it can pose serious risks for the health of both personnel and customers. Therefore, decision makers are expected to enact applicable and strict policies so as to abate this public health risk.
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Affiliation(s)
- Mohammad Reza Masjedi
- Professor of pulmonary medicine, Tobacco Control Research Center (TCRC), Iranian Anti-tobacco Association, Tehran, Iran
| | - Farhad Taghizadeh
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Hamzehali
- Researcher, Tobacco Control Research Center (TCRC), Iranian Anti-tobacco Association, Tehran, Iran
| | - Sonia Ghaffari
- Researcher, Tobacco Control Research Center (TCRC), Iranian Anti-tobacco Association, Tehran, Iran
| | - Mehdi Fazlzadeh
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Sadegh Niazi
- International laboratory for air quality and health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Ehsan Abouee Mehrizi
- Department of Environmental Health Engineering, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hasan Pasalari
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Arfaeinia
- Department of Environmental Health Engineering, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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Etemadi A, Poustchi H, Chang CM, Blount BC, Calafat AM, Wang L, De Jesus VR, Pourshams A, Shakeri R, Shiels MS, Inoue-Choi M, Ambrose BK, Christensen CH, Wang B, Murphy G, Ye X, Bhandari D, Feng J, Xia B, Sosnoff CS, Kamangar F, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Freedman ND. Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 28:337-347. [PMID: 30622099 PMCID: PMC6935158 DOI: 10.1158/1055-9965.epi-18-0743] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND How carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood. METHODS We randomly selected 165 participants of the Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC). We also quantified the same biomarkers in a second urine sample, obtained 5 years later, among continuing cigarette smokers and never tobacco users. RESULTS Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations, which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than in all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over 5 years, particularly in continuing cigarette smokers. CONCLUSIONS We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from nontobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort. IMPACT Most of these biomarkers would be useful for exposure assessment in a longitudinal study.
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Affiliation(s)
- Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland.
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Cindy M Chang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Benjamin C Blount
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lanqing Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victor R De Jesus
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shakeri
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Bridget K Ambrose
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Carol H Christensen
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Baoguang Wang
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland
| | - Gwen Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Xiaoyun Ye
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deepak Bhandari
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Feng
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Baoyun Xia
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Connie S Sosnoff
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- The Tisch Cancer Institute, Mount Sinai School of Medicine and Institute for Translational Epidemiology, New York, New York
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
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Chen M, Carmella SG, Sipe C, Jensen J, Luo X, Le CT, Murphy SE, Benowitz NL, McClernon FJ, Vandrey R, Allen SS, Denlinger-Apte R, Cinciripini PM, Strasser AA, al’Absi M, Robinson JD, Donny EC, Hatsukami D, Hecht SS. Longitudinal stability in cigarette smokers of urinary biomarkers of exposure to the toxicants acrylonitrile and acrolein. PLoS One 2019; 14:e0210104. [PMID: 30608961 PMCID: PMC6319718 DOI: 10.1371/journal.pone.0210104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/17/2018] [Indexed: 01/07/2023] Open
Abstract
The urinary metabolites cyanoethyl mercapturic acid (CEMA) and 3-hydroxypropyl mercapturic acid (3-HPMA) have been widely used as biomarkers of exposure to acrylonitrile and acrolein, respectively, but there are no published data on their consistency over time in the urine of cigarette smokers. We provided, free of charge over a 20 week period, Spectrum NRC600/601 research cigarettes to cigarette smokers in the control arm of a randomized clinical trial of the reduced nicotine cigarette. Urine samples were collected at weeks 4, 8, 12, 16, and 20 and analyzed for CEMA and 3-HPMA, and total nicotine equivalents (TNE) using validated methods. Creatinine-corrected intra-class correlation coefficients for CEMA, 3-HPMA, and TNE were 0.67, 0.46, and 0.68, respectively, indicating good longitudinal consistency for CEMA, while that of 3-HPMA was fair. A strong correlation between CEMA and TNE values was observed. These data support the use of CEMA as a reliable biomarker of tobacco smoke exposure. This is the first report of the longitudinal stability of the biomarkers of acrylonitrile and acrolein exposure in smokers. The data indicate that CEMA, the biomarker of acrylonitrile exposure, is consistent over time in cigarette smokers, supporting its use. While 3-HPMA levels were less stable over time, this biomarker is nevertheless a useful monitor of human acrolein exposure because of its specificity to this toxicant.
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Affiliation(s)
- Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Steven G. Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chistopher Sipe
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chap T. Le
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon E. Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Neal L. Benowitz
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - F. Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharon S. Allen
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Rachel Denlinger-Apte
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, United States of America
| | - Paul M. Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Andrew A. Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mustafa al’Absi
- Behavioral Medicine Laboratories, University of Minnesota Medical School, Duluth, Minnesota, United States of America
| | - Jason D. Robinson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Eric C. Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Dorothy Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
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41
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Pratiti R, Mukherjee D. Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review. Cardiovasc Hematol Agents Med Chem 2019; 17:82-93. [PMID: 31483237 DOI: 10.2174/1871525717666190904151856] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.
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Affiliation(s)
- Rebecca Pratiti
- McLaren HealthCare, G-3245 Beecher Rd, Flint, MA 48532, United States
| | - Debabrata Mukherjee
- Texas Tech University Health Science Center, Department of Internal Medicine, El Paso, TX 79905, United States
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42
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Sadek KW, Haik MY, Ashour AA, Baloch T, Aboulkassim T, Yasmeen A, Vranic S, Zeidan A, Al Moustafa AE. Water-pipe smoking promotes epithelial-mesenchymal transition and invasion of human breast cancer cells via ERK1/ERK2 pathways. Cancer Cell Int 2018; 18:180. [PMID: 30473629 PMCID: PMC6234648 DOI: 10.1186/s12935-018-0678-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background With the increasing popularity of water-pipe smoking (WPS), it is critical to comprehend how WPS may affect women's health. The main goal of this study is to identify the potential outcome of WPS on human breast cancer progression. Methods Two breast cancer cell lines, MCF7 and BT20, were used in this investigation. We explored the outcome of WPS on cell morphology and cell invasion using inverted microscope and Biocoat Matrigel invasion chambers. On the other hand, Western blot was employed to study the expression patterns of key control genes of cell adhesion and invasion. Results Our data reveal that WPS induces epithelial-mesenchymal transition (EMT) of MCF7 and BT20 breast cancer cell lines; thus, WPS enhances cell invasion ability of both cell lines in comparison with their matched controls. More significantly, WPS provokes a down- and up-regulation of E-cadherin and focal adhesion kinase (FAK), respectively, which are important key regulators of cancer progression genes. Finally, our data point out that WPS incites the activation of Erk1/Erk2, which could be behind the stimulation of EMT and invasion as well as the deregulation of E-cadherin and FAK expression. Conclusion Our data show, for the first time, that WPS initiates EMT and stimulates cell invasion of breast cancer cells, which could incite metastatic development in breast cancer patients. Thus, we believe that further studies, both in vitro and in vivo, are required to elucidate the pathogenic outcome of WPS on cancer progression of several human carcinomas including breast.
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Affiliation(s)
- Khaled W Sadek
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Mahmoud Y Haik
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Anas A Ashour
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Tahira Baloch
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Tahar Aboulkassim
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Amber Yasmeen
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Semir Vranic
- 1College of Medicine, Qatar University, Doha, Qatar
| | - Asad Zeidan
- 1College of Medicine, Qatar University, Doha, Qatar
| | - Ala-Eddin Al Moustafa
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar.,4Oncology Department, McGill University, Montreal, QC Canada.,Syrian Research Cancer Centre of the Syrian Society against Cancer, Aleppo, Syria
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43
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Akram Z, Al-Kheraif AA, Kellesarian SV, Vohra F, Javed F. Comparison of oral Candida carriage in waterpipe smokers, cigarette smokers, and non-smokers. J Oral Sci 2018; 60:115-120. [PMID: 29576571 DOI: 10.2334/josnusd.17-0090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The aim of the present cohort study was to compare oral carriage of Candida in waterpipe smokers (WS), cigarette smokers (CS), and non-smokers (NS). A total of 141 individuals (46 WS, 45 CS, and 50 NS) were included. A questionnaire was used to gather demographic information and data on the daily frequency and duration of smoking habits, the reasons for smoking, and daily oral hygiene maintenance habits. Oral Candida (C.) samples were cultured and yeast species were identified using polymerase chain reaction. Unstimulated whole salivary flow rate (UWSFR) was also recorded. The numbers of missing teeth (MT) were counted and tongue lesions were clinically identified. C. albicans was the most prevalent yeast species isolated from all groups. Oral C. albicans carriage was higher among WS (P < 0.05) and CS (P < 0.05) than among NS. Oral C. tropicalis carriage, age, UWSFR and the number of MT were comparable among the groups. Oral Candida carriage was significantly higher among WS and CS than among NS. Therefore it appears that WS and CS are at an increased risk of developing oral candida infections.
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Affiliation(s)
- Zohaib Akram
- Department of Periodontology, Faculty of Dentistry, Ziauddin University
| | | | - Sergio V Kellesarian
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester
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44
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Primack BA, Shensa A, Sidani JE, Tulikangas MC, Roberts MS, Colditz JB, Mor MK, James AE, Fine M. Comparison of toxicant load from waterpipe and cigarette tobacco smoking among young adults in the USA. Tob Control 2018:tobaccocontrol-2017-054226. [PMID: 29773707 PMCID: PMC9299954 DOI: 10.1136/tobaccocontrol-2017-054226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To form population-level comparisons of total smoke volume, tar, carbon monoxide and nicotine consumed from waterpipe tobacco smoking (WTS) and cigarette smoking using data from a nationally representative sample of smokers and non-smokers aged 18-30 years. METHODS In March and April 2013, we surveyed a nationally representative sample of 3254 US young adults to assess the frequency and volume of WTS and cigarette smoking. We used Monte Carlo analyses with 5000 repetitions to estimate the proportions of toxicants originating from WTS and cigarette smoking. Analyses incorporated survey weights and used recent meta-analytic data to estimate toxicant exposures associated with WTS and cigarette smoking. RESULTS Compared with the additive estimates of WTS and cigarette smoking combined, 54.9% (95% CI 37.5% to 72.2%) of smoke volume was attributed to WTS. The proportions of tar attributable to WTS was 20.8% (95% CI 6.5% to 35.2%), carbon monoxide 10.3% (95% CI 3.3% to 17.3%) and nicotine 2.4% (95% CI 0.9% to 3.8%). CONCLUSIONS WTS accounted for over half of the tobacco smoke volume consumed among young US adult waterpipe and cigarette smokers. Toxicant exposures to tar, carbon monoxide and nicotine were lower, but still substantial, for WTS alone compared with WTS and cigarette smoking. Public health and policy interventions to reduce harm from tobacco smoking in young US adults should explicitly address WTS toxicant exposures.
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Affiliation(s)
- Brian A. Primack
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ariel Shensa
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jaime E. Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan C. Tulikangas
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
| | - Mark S. Roberts
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jason B. Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maria K. Mor
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - A. Everette James
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael Fine
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Sutfin EL, Soule EK, McKelvey K, Jenson D. Implications and challenges for implementation of the FDA's final deeming rule for waterpipe tobacco. Tob Control 2018; 27:347-351. [PMID: 28667092 PMCID: PMC5748017 DOI: 10.1136/tobaccocontrol-2017-053634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/28/2017] [Accepted: 05/09/2017] [Indexed: 11/04/2022]
Abstract
For the first time, the Food and Drug Administration's (FDAs) Center for Tobacco Products now has regulatory authority over all tobacco products, including waterpipe tobacco. In the rule expanding its authority to cover all tobacco products, the FDA uses largely a one-size-fits-all approach. However, several aspects of waterpipe tobacco smoking make it unique from other tobacco products, which may require more specific, tailored rules. This paper describes the distinct features of waterpipe tobacco products and accessories, and identifies unique challenges to the current regulation posed by this form of tobacco use. Additionally, we highlight the need for further research-generated evidence to support additional rulemaking.
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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
| | - Eric K Soule
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Karma McKelvey
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Desmond Jenson
- Tobacco Control Legal Consortium, a program of the Public Health Law Center, Mitchell Hamline School of Law, St Paul, MN, USA
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46
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Rezk-Hanna M, Benowitz NL. Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk. Nicotine Tob Res 2018; 21:1151-1161. [DOI: 10.1093/ntr/nty065] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
Abstract
Introduction
Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Hookah (ie, waterpipe) smoking is a centuries-old revived yet understudied global epidemic of tobacco use. Because of the traditional set-up of a hookah-pipe, in addition to inhaling tobacco-combustion products, smokers are also exposed to large amounts of charcoal combustion products from the burning charcoal briquettes used to heat the hookah flavored tobacco. Despite being heavily advertised and actively glamorized in the mass media as a healthier tobacco alternative, the toxicological constituents of hookah smoke—including nicotine, carbon monoxide, particulates, oxidants, heavy metals, phenols and flavorants—indicate the potential to cause adverse cardiovascular events.
Methods
Herein, we review evidence on hookah smoke toxicological constituents, cardiovascular effects and potential mechanisms by which hookah smoke aerosol could cause cardiovascular disease.
Results
The evidence reviewed here indicates that contrary to the widespread popular belief that hookah is a healthier tobacco alternative, the constituents of hookah smoke aerosol contains similar chemicals compared to cigarette smoke, many of which are known to be harmful to cardiovascular health and mediated by similar pathophysiologic processes. Because the burning charcoal briquettes are a unique source of toxicant emissions specific to hookah smoking, some constituents differ in their quantities from cigarettes with some of their cardiovascular effects unknown.
Conclusions
To date, much more is known about the constituents and their toxicology than about the effects of hookah smoking on human cardiovascular health. Further research on long-term consequences of hookah use is needed.
Implications
This review provides an overview on the potential impact of hookah smoking on cardiovascular health. Readers will gain an insight into evidence on its toxicological constituents, human health effects, and pathophysiological mechanisms by which hookah smoking might cause cardiovascular disease. The review also highlights current research gaps regarding the cardiovascular consequences of hookah smoking, specifically the long-term consequences in the United States and Europe among flavored-hookah tobacco users.
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Affiliation(s)
- Mary Rezk-Hanna
- School of Nursing, University of California, Los Angeles, CA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Neal L Benowitz
- Divsion of Clinical Pharmacology and Experimental Therapeutics, Departments of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
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47
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Azab MA, Khabour OF, Alzoubi KH, Alzubi MA, Masadeh MM, Shakhatreh MAK. Chromosomal damage at bone-marrow cells is induced by exposure of rats to waterpipe water filtrate. Drug Chem Toxicol 2018; 41:394-398. [DOI: 10.1080/01480545.2018.1452933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mohammad A. Azab
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H. Alzoubi
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A. Alzubi
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
- Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, Richmond, VA, USA
| | - Majed M. Masadeh
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Muhamad Ali K. Shakhatreh
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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48
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Khabour OF, Alzoubi KH, Al-Sawalha N, Ahmad MB, Shihadeh A, Eissenberg T. The effect of chronic exposure to waterpipe tobacco smoke on airway inflammation in mice. Life Sci 2018; 200:110-114. [PMID: 29555589 DOI: 10.1016/j.lfs.2018.03.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Acute exposure of experimental animals to waterpipe tobacco smoke has been shown to induce lung inflammation and injury. The aim of this study was to investigate the effect of chronic exposure to waterpipe smoke on inflammatory markers and oxidative stress in the mouse lung. METHOD Using a whole-body exposure system, animals were exposed to waterpipe smoke for 6 weeks with a one-hour daily exposure for 5 days a week. RESULTS Exposure to waterpipe tobacco smoke induced the recruitment of inflammatory cells to the airway. Significant elevation in macrophages, lymphocytes and neutrophils was detected in the bronchoalveolar lavage fluid of exposed animals (P < 0.01). Furthermore, levels of catalase, glutathione peroxidase (GPx) and superoxide dismutase (SOD) in the lung homogenates were elevated (P < 0.05). Finally, waterpipe smoking altered the levels of a panel of inflammatory cytokines including TNFα, IL-1 β, IL-6, IL-10 and IL-12 biomarkers in the lung of exposed animals (P < 0.05). CONCLUSION These results support the notion that waterpipe tobacco smoking exerts harmful respiratory health effects.
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Affiliation(s)
- Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nour Al-Sawalha
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad Bani Ahmad
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Alan Shihadeh
- Mechanical Engineering Department, American University of Beirut, Beirut, Lebanon; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States; Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, United States
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Kassem NOF, Kassem NO, Liles S, Zarth AT, Jackson SR, Daffa RM, Chatfield DA, Carmella SG, Hecht SS, Hovell MF. Acrolein Exposure in Hookah Smokers and Non-Smokers Exposed to Hookah Tobacco Secondhand Smoke: Implications for Regulating Hookah Tobacco Products. Nicotine Tob Res 2018; 20:492-501. [PMID: 28591850 PMCID: PMC5896480 DOI: 10.1093/ntr/ntx133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/05/2017] [Indexed: 12/31/2022]
Abstract
Introduction Acrolein is a highly ciliatoxic agent, a toxic respiratory irritant, a cardiotoxicant, and a possible carcinogen present in tobacco smoke including hookah tobacco. Methods 105 hookah smokers and 103 non-smokers attended exclusively hookah smoking social events at either a hookah lounge or private home, and provided urine samples the morning of and the morning after the event. Samples were analyzed for 3-hydroxypropylmercapturic acid (3-HPMA), a metabolite of acrolein. Results Geometric mean (GM) urinary 3-HPMA levels in hookah smokers and non-smokers exposed to secondhand smoke (SHS) increased significantly, 1.41 times, 95% CI = 1.15 to 1.74 and 1.39 times, 95% CI = 1.16 to 1.67, respectively, following a hookah social event. The highest increase (1.68 times, 95% CI = 1.15 to 2.45; p = 0.007) in 3-HPMA post a hookah social event was among daily hookah smokers (GM, from 1991 pmol/mg to 3348 pmol/mg). Pre-to-post event change in urinary 3-HPMA was significantly positively correlated with pre-to-post event change in urinary cotinine among hookah smokers at either location of hookah event, (ρ = 0.359, p = 0.001), and among non-smokers in hookah lounges (ρ = 0.369, p = 0.012). Conclusions Hookah tobacco smoke is a source of acrolein exposure. Findings support regulating hookah tobacco products including reducing humectants and sugar additives, which are precursors of acrolein under certain pyrolysis conditions. We suggest posting health warning signs for indoor smoking in hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes. Implications Our study is the first to quantify the increase in acrolein exposure in hookah smokers and non-smokers exposed to exclusively hookah tobacco SHS at hookah social events in homes or hookah lounges. Our findings provide additional support for regulating hookah tobacco product content, protecting non-smokers' health by posting health warning signs for indoor smoking in hookah lounges, and encouraging home bans on hookah tobacco smoking to safeguard vulnerable residents.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Adam T Zarth
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Reem M Daffa
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Dale A Chatfield
- San Diego State University Department of Chemistry, San Diego, CA, USA
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
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Kassem NOF, Kassem NO, Liles S, Jackson SR, Posis AIB, Chatfield DA, Hovell MF. Levels of Urine Cotinine from Hookah Smoking and Exposure to Hookah Tobacco Secondhand Smoke in Hookah Lounges and Homes. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2018; 7. [PMID: 29805963 PMCID: PMC5967845 DOI: 10.5812/ijhrba.67601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Nicotine, an addictive drug, is present in all forms of tobacco products, including hookah tobacco, which is not yet regulated in the United States. Objectives This study aimed to investigate the uptake of nicotine in hookah smokers and non-smokers exposed to secondhand smoke (SHS) at indoor hookah social events in natural settings where hookah tobacco was smoked exclusively. Patients and Methods We quantified cotinine, a metabolite of nicotine, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home. Results Following a social event where exclusively hookah tobacco was smoked, urinary cotinine levels increased significantly 8.5 times (geometric mean (GM): 16.0 ng/mg to 136.1 ng/mg) among hookah smokers, and 2.5 times (GM: 0.4 ng/mg to 1.0 ng/mg) among non-smokers exposed exclusively to hookah tobacco SHS. Among hookah smokers, the highest increase in urinary cotinine levels post a hookah event was found in occasional hookah smokers in which GM levels increased significantly 31.2 times post smoking (from 2.0 ng/mg to 62.3 ng/mg). Reported reasons for preference to smoke hookah at home by hookah smokers who attended a hookah social event in a private home included recreational purposes, socializing with friends and family, ‘Me’ time and relaxing at home, more comfortable to smoke hookah at home, owning a hookah and hookah tobacco, eating and drinking while smoking hookah, and saving money by smoking at home and not going to hookah lounges. Conclusions Hookah tobacco smoke is a source of substantial nicotine exposure. Our results call for protecting hookah smokers’ and non-smokers’ health by requiring accurate hookah tobacco labels, raising taxes on hookah tobacco, reducing the spread of hookah lounges, and encouraging voluntary bans on smoking hookah tobacco in private homes.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
- Corresponding author: Nada O F Kassem, Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, United States. Tel: +1-6193707488,
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Alexander Ivan B Posis
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
| | - Dale A Chatfield
- Department of Chemistry, San Diego State University, San Diego, California, U.S.A
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, California, U.S.A
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