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Grant Details

Grant Number: 5R01CA120142-05 Interpret this number
Primary Investigator: Eissenberg, Thomas
Organization: Virginia Commonwealth University
Project Title: Waterpipe Tobacco Smoke: Toxicant Exposure and Effects
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Globally, tobacco use accounts for 4.9 million deaths each year, including 400,000 in the U.S. These deaths are caused by inhaled smoke toxicants like carcinogens, carbon monoxide (CO), and nitric oxide (NO). Another smoke toxicant, nicotine, produces dependence with prolonged use. Cigarette smoke toxicant content and smoker toxicant exposure has been well characterized, as have the subjective and cardiovascular effects of cigarette smoking. However, in the U.S. and globally, millions of people use waterpipes (hookah or shisha) to smoke tobacco: the smoker fills the "head" with sweetened and flavored tobacco, covers it with perforated aluminum foil, and tops the foil with lit charcoal. Charcoal and tobacco smoke pass to the user via a half-filled water bowl, hose, and mouthpiece. Waterpipe tobacco smoking is increasing in the U.S., especially among college students for whom prevalence rates may be 15-20%. Relative to one cigarette, one waterpipe use episode can generate 100 times the smoke, with user toxicant exposure, effects, and smoke toxicant content that are largely unknown. These outcomes may depend upon an individual's use frequency and whether the individual uses the waterpipe alone or with a group. This project combines clinical laboratory methods, analytical chemistry, and cellular biology to achieve three specific aims. 1) Learn about individual waterpipe user toxicant exposure, effects, and smoke toxicant content. In two separate sessions, 130 waterpipe users (65 reporting 2-5 uses/month and 65 reporting > 21 uses/month) will use a waterpipe loaded with preferred brand/flavor of waterpipe tobacco or placebo. Outcome measures include CO and NO, plasma nicotine, subjective, cardiovascular, and pulmonary response, and puff topography (puff number, volume, duration, and interpuff interval). Topography records will be replayed in an analytical laboratory to study smoke toxicant content and cytotoxicity/mutagenicity. 2) Learn how group use influences waterpipe toxicant exposure, effect, and smoke toxicant content. In an observational study, trained staff will use rigorous sampling and data collection procedures to study group waterpipe tobacco smoking in local cafs. In a laboratory study informed by observational study results, 65 waterpipe- sharing groups will use a waterpipe in the laboratory as a group in one session, and as individuals in another session, and user toxicant exposure and effects, and smoke toxicant content will be assessed as in Study 1. 3) Compare the toxicant exposure and effects of waterpipe tobacco smoking and cigarette smoking. In two sessions, 100 waterpipe users who also smoke cigarettes will either use a waterpipe or smoke a cigarette; outcome measures include exposure to CO, NO, and nicotine, as well as cardiovascular, respiratory, and subjective effects. Waterpipe use is disturbingly common among U.S. young adults. More information is needed about waterpipe effects, and it can be obtained from clinical laboratory studies and smoke toxicant analysis. This information is necessary to understand this potentially dangerous behavior, while shaping knowledge, opinions, and attitudes in a way that enhances public health. This project is relevant to public health because waterpipe tobacco smoking is a little-understood but rapidly emerging strain in the nation's tobacco use epidemic. The project will inform nascent efforts to prevent waterpipe tobacco smoking from contributing substantially to tobacco's morbidity and mortality by revealing the user toxicant exposure, subjective, cardiovascular, and pulmonary effects, and cytogenicity and mutagenicity of waterpipe tobacco smoke produced by individuals and groups; it will also address frequent but probably erroneous statements regarding waterpipe filtering and lower toxicant levels relative to cigarette smoke. The positive health impact of this type of research on tobacco cigarette smoking is well-documented; this project seeks similar positive outcomes on another potentially lethal form of tobacco use. This project is relevant to public health because waterpipe tobacco smoking is a little-understood but rapidly emerging strain in the nation's tobacco use epidemic. The project will inform nascent efforts to prevent waterpipe tobacco smoking from contributing substantially to tobacco's morbidity and mortality by revealing the user toxicant exposure, subjective, cardiovascular, and pulmonary effects, and cytogenicity and mutagenicity of waterpipe tobacco smoke produced by individuals and groups; it will also address frequent but probably erroneous statements regarding waterpipe ¿filtering¿ and lower toxicant levels relative to cigarette smoke. The positive health impact of this type of research on tobacco cigarette smoking is well-documented; this project seeks similar positive outcomes on another potentially lethal form of tobacco use.

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Publications

Comparison of tobacco-containing and tobacco-free waterpipe products: effects on human alveolar cells.
Authors: Shihadeh A, Eissenberg T, Rammah M, Salman R, Jaroudi E, El-Sabban M
Source: Nicotine Tob Res, 2014 Apr;16(4), p. 496-9.
EPub date: 2013 Dec 3.
PMID: 24302635
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AANA journal course: update for nurse anesthetists--Part3--Tobacco smoking using a waterpipe (hookah): what you need to know.
Authors: Eissenberg T
Source: AANA J, 2013 Aug;81(4), p. 308-13.
PMID: 24133855
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An observational study of group waterpipe use in a natural environment.
Authors: Blank MD, Brown KW, Goodman RJ, Eissenberg T
Source: Nicotine Tob Res, 2014 Jan;16(1), p. 93-9.
EPub date: 2013 Aug 13.
PMID: 23943842
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CO exposure and puff topography are associated with Lebanese waterpipe dependence scale score.
Authors: Alzoubi KH, Khabour OF, Azab M, Shqair DM, Shihadeh A, Primack B, Eissenberg T
Source: Nicotine Tob Res, 2013 Oct;15(10), p. 1782-6.
EPub date: 2013 Apr 24.
PMID: 23616231
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In vitro effects of waterpipe smoke condensate on endothelial cell function: a potential risk factor for vascular disease.
Authors: Rammah M, Dandachi F, Salman R, Shihadeh A, El-Sabban M
Source: Toxicol Lett, 2013 May 23;219(2), p. 133-42.
EPub date: 2013 Feb 28.
PMID: 23454654
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Phenolic compounds in particles of mainstream waterpipe smoke.
Authors: Sepetdjian E, Abdul Halim R, Salman R, Jaroudi E, Shihadeh A, Saliba NA
Source: Nicotine Tob Res, 2013 Jun;15(6), p. 1107-12.
EPub date: 2012 Nov 22.
PMID: 23178319
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Acute toxicant exposure and cardiac autonomic dysfunction from smoking a single narghile waterpipe with tobacco and with a "healthy" tobacco-free alternative.
Authors: Cobb CO, Sahmarani K, Eissenberg T, Shihadeh A
Source: Toxicol Lett, 2012 Nov 23;215(1), p. 70-5.
EPub date: 2012 Oct 8.
PMID: 23059956
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A multiyear survey of waterpipe and cigarette smoking on a US university campus.
Authors: Cobb CO, Khader Y, Nasim A, Eissenberg T
Source: J Am Coll Health, 2012;60(7), p. 521-7.
PMID: 23002800
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A multiple indicators and multiple causes model of alternative tobacco use.
Authors: Nasim A, Blank MD, Cobb CO, Eissenberg T
Source: Am J Health Behav, 2013 Jan;37(1), p. 25-31.
PMID: 22943098
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Acute exposure to waterpipe tobacco smoke induces changes in the oxidative and inflammatory markers in mouse lung.
Authors: Khabour OF, Alzoubi KH, Bani-Ahmad M, Dodin A, Eissenberg T, Shihadeh A
Source: Inhal Toxicol, 2012 Aug;24(10), p. 667-75.
PMID: 22906173
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Waterpipe smoking among U.S. university students.
Authors: Primack BA, Shensa A, Kim KH, Carroll MV, Hoban MT, Leino EV, Eissenberg T, Dachille KH, Fine MJ
Source: Nicotine Tob Res, 2013 Jan;15(1), p. 29-35.
EPub date: 2012 May 28.
PMID: 22641433
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Exposure of pregnant women to waterpipe and cigarette smoke.
Authors: Azab M, Khabour OF, Alzoubi KH, Anabtawi MM, Quttina M, Khader Y, Eissenberg T
Source: Nicotine Tob Res, 2013 Jan;15(1), p. 231-7.
EPub date: 2012 May 9.
PMID: 22573726
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Waterpipe tobacco and cigarette smoking among university students in Jordan.
Authors: Khabour OF, Alzoubi KH, Eissenberg T, Mehrotra P, Azab M, Carroll MV, Afifi RA, Primack BA
Source: Int J Tuberc Lung Dis, 2012 Jul;16(7), p. 986-92.
EPub date: 2012 Apr 16.
PMID: 22525279
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In vitro cytotoxicity and mutagenicity of mainstream waterpipe smoke and its functional consequences on alveolar type II derived cells.
Authors: Rammah M, Dandachi F, Salman R, Shihadeh A, El-Sabban M
Source: Toxicol Lett, 2012 Jun 20;211(3), p. 220-31.
EPub date: 2012 Apr 10.
PMID: 22516759
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Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009.
Authors: Nasim A, Khader Y, Blank MD, Cobb CO, Eissenberg T
Source: Addict Behav, 2012 Jul;37(7), p. 866-70.
EPub date: 2012 Mar 9.
PMID: 22464872
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Dependence on tobacco and nicotine products: a case for product-specific assessment.
Authors: Fagerström K, Eissenberg T
Source: Nicotine Tob Res, 2012 Nov;14(11), p. 1382-90.
EPub date: 2012 Mar 29.
PMID: 22459798
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Indoor air quality in Virginia waterpipe cafes.
Authors: Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T
Source: Tob Control, 2013 Sep;22(5), p. 338-43.
EPub date: 2012 Mar 24.
PMID: 22447194
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Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, "tar" and nicotine yields.
Authors: Shihadeh A, Salman R, Jaroudi E, Saliba N, Sepetdjian E, Blank MD, Cobb CO, Eissenberg T
Source: Food Chem Toxicol, 2012 May;50(5), p. 1494-8.
EPub date: 2012 Mar 1.
PMID: 22406330
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Electronic cigarettes: effective nicotine delivery after acute administration.
Authors: Vansickel AR, Eissenberg T
Source: Nicotine Tob Res, 2013 Jan;15(1), p. 267-70.
EPub date: 2012 Feb 6.
PMID: 22311962
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Clinical laboratory assessment of the abuse liability of an electronic cigarette.
Authors: Vansickel AR, Weaver MF, Eissenberg T
Source: Addiction, 2012 Aug;107(8), p. 1493-500.
EPub date: 2012 May 8.
PMID: 22229871
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Patterns of alternative tobacco use among adolescent cigarette smokers.
Authors: Nasim A, Blank MD, Cobb CO, Eissenberg T
Source: Drug Alcohol Depend, 2012 Jul 1;124(1-2), p. 26-33.
EPub date: 2011 Dec 29.
PMID: 22209307
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Significance of smoking machine toxicant yields to blood-level exposure in water pipe tobacco smokers.
Authors: Shihadeh AL, Eissenberg TE
Source: Cancer Epidemiol Biomarkers Prev, 2011 Nov;20(11), p. 2457-60.
EPub date: 2011 Sep 13.
PMID: 21914836
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Waterpipe tobacco products: nicotine labelling versus nicotine delivery.
Authors: Vansickel AR, Shihadeh A, Eissenberg T
Source: Tob Control, 2012 May;21(3), p. 377-9.
EPub date: 2011 Jun 2.
PMID: 21636612
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Comparative analysis of waterpipe and cigarette suppression of abstinence and craving symptoms.
Authors: Rastam S, Eissenberg T, Ibrahim I, Ward KD, Khalil R, Maziak W
Source: Addict Behav, 2011 May;36(5), p. 555-9.
EPub date: 2011 Jan 20.
PMID: 21316156
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Acute effects of waterpipe tobacco smoking: a double-blind, placebo-control study.
Authors: Blank MD, Cobb CO, Kilgalen B, Austin J, Weaver MF, Shihadeh A, Eissenberg T
Source: Drug Alcohol Depend, 2011 Jul 1;116(1-3), p. 102-9.
EPub date: 2011 Feb 1.
PMID: 21277706
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Nicotine exposure in daily waterpipe smokers and its relation to puff topography.
Authors: Maziak W, Rastam S, Shihadeh AL, Bazzi A, Ibrahim I, Zaatari GS, Ward KD, Eissenberg T
Source: Addict Behav, 2011 Apr;36(4), p. 397-9.
EPub date: 2010 Dec 2.
PMID: 21185126
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Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects.
Authors: Cobb CO, Shihadeh A, Weaver MF, Eissenberg T
Source: Nicotine Tob Res, 2011 Feb;13(2), p. 78-87.
EPub date: 2010 Dec 2.
PMID: 21127030
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Carcinogenic PAH in waterpipe charcoal products.
Authors: Sepetdjian E, Saliba N, Shihadeh A
Source: Food Chem Toxicol, 2010 Nov;48(11), p. 3242-5.
EPub date: 2010 Aug 31.
PMID: 20807559
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A clinical laboratory model for evaluating the acute effects of electronic "cigarettes": nicotine delivery profile and cardiovascular and subjective effects.
Authors: Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE
Source: Cancer Epidemiol Biomarkers Prev, 2010 Aug;19(8), p. 1945-53.
EPub date: 2010 Jul 20.
PMID: 20647410
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Water pipe tobacco smoking among university students in Jordan.
Authors: Azab M, Khabour OF, Alkaraki AK, Eissenberg T, Alzoubi KH, Primack BA
Source: Nicotine Tob Res, 2010 Jun;12(6), p. 606-12.
EPub date: 2010 Apr 23.
PMID: 20418383
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Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors.
Authors: Daher N, Saleh R, Jaroudi E, Sheheitli H, Badr T, Sepetdjian E, Al Rashidi M, Saliba N, Shihadeh A
Source: Atmos Environ (1994), 2010 Jan 1;44(1), p. 8-14.
PMID: 20161525
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Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration.
Authors: Eissenberg T
Source: Tob Control, 2010 Feb;19(1), p. 87-8.
PMID: 20154061
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Waterpipe tobacco smoking: an emerging health crisis in the United States.
Authors: Cobb C, Ward KD, Maziak W, Shihadeh AL, Eissenberg T
Source: Am J Health Behav, 2010 May-Jun;34(3), p. 275-85.
PMID: 20001185
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Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure.
Authors: Eissenberg T, Shihadeh A
Source: Am J Prev Med, 2009 Dec;37(6), p. 518-23.
PMID: 19944918
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CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers.
Authors: Maziak W, Rastam S, Ibrahim I, Ward KD, Shihadeh A, Eissenberg T
Source: Nicotine Tob Res, 2009 Jul;11(7), p. 806-11.
EPub date: 2009 May 6.
PMID: 19420278
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Evaluating the acute effects of oral, non-combustible potential reduced exposure products marketed to smokers.
Authors: Cobb CO, Weaver MF, Eissenberg T
Source: Tob Control, 2010 Oct;19(5), p. 367-73.
EPub date: 2009 Apr 2.
PMID: 19346218
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Water-pipe tobacco smoking among middle and high school students in Arizona.
Authors: Primack BA, Walsh M, Bryce C, Eissenberg T
Source: Pediatrics, 2009 Feb;123(2), p. e282-8.
PMID: 19171581
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Volatile aldehydes in the mainstream smoke of the narghile waterpipe.
Authors: Al Rashidi M, Shihadeh A, Saliba NA
Source: Food Chem Toxicol, 2008 Nov;46(11), p. 3546-9.
EPub date: 2008 Sep 11.
PMID: 18834915
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