||5R01CA255563-03 Interpret this number
||Ohio State University
||Waterpipe Tobacco Additives and Their Effect on Human Puffing Behavior, Toxicant Exposures, Pulmonary Function, and Appeal
In the 30 years since its introduction, sweetened waterpipe (WP) tobacco, or “ma’assel”, is now smoked by
over half a million middle and high school children and 1.2M young adults in the U.S. This may be due to the
sweet additives that comprise up to 70% of the weight of the tobacco and make inhaling WP tobacco smoke
more appealing and easier for first-time users. WP tobacco is unique in that the ratio of sweet additives to
nicotine is significantly higher than for any other tobacco product, making WP the perfect “starter product” for
nicotine initiation. It is largely misperceived that smoking tobacco with a WP or hookah is a less harmful form of
tobacco use. In fact, the high levels of sweet additives transfer nicotine efficiently and produce harmful and
potentially harmful constituents in the smoke, contributing to the direct and indirect harm experienced by users.
To define the effects of WP tobacco’s primary chemical additives with respect to sweet perception, appeal,
toxicant exposure, addictiveness, harm and health risk perceptions, and lung function among WP users, WP
tobacco that differs only in the additives of interest must be used. There is no set of commercially available
tobacco brands for which this is true, and thus our study will manipulate commercial products to properly
isolate the important variables. There is an existing data gap surrounding the influence of WP tobacco’s
primary additives, all of which are sweet tasting compounds, on the addictiveness, toxicity, flavor perceptions,
appeal and perceived harm of WP smoking. The proposed study uses a crossover single-blind human trial of
dyads, a manipulated WP tobacco product, a validated dual-hose research-grade WP, cutting edge
psychosocial instruments and analytical chemistry techniques to assess human exposure to systematically
investigate the effects of sweet additives on the appeal, puffing behavior, and toxicity of WP tobacco smoking.
Currently there are no regulations governing WP additives. The purpose of the proposed study is to acquire
sound scientific data to inform the development of evidenced-based product standards, or limits to additives in
WP tobacco that must not be exceeded in order for the product to be sold and distributed in the U.S. The
proposed study will address RFA-OD-19-028’s Scientific Interest Areas of: Chemistry and Engineering,
Toxicity, and Behavior and Addiction, in that it will determine how specific WP tobacco additives affect users
puffing behavior, liking, harm perceptions, the quantities of toxicants they inhale and take up in the body, and
acute pulmonary affects from WP tobacco smoking.
Effects of flavourants and humectants on waterpipe tobacco puffing behaviour, biomarkers of exposure and subjective effects among adults with high versus low nicotine dependence.
, Mehta T.
, Hale J.J.
, Leavens E.L.S.
, Shihadeh A.
, Eissenberg T.
, Brinkman M.C.
, Wagener T.L.
Tobacco control, 2022 Jul; 31(4), p. 527-533.