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

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.




Differences in puff topography, toxicant exposure, and subjective response between waterpipe tobacco smoking men and women.
Authors: Soule E.K. , Ramôa C. , Eissenberg T. , Cobb C.O. .
Source: Experimental And Clinical Psychopharmacology, 2018-08-13 00:00:00.0; , .
EPub date: 2018-08-13 00:00:00.0.
PMID: 30102062
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Group Waterpipe Tobacco Smoking Increases Smoke Toxicant Concentration
Authors: Ramôa C.P. , Shihadeh A. , Salman R. , Eissenberg T. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2016 May; 18(5), p. 770-6.
PMID: 26659913
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Comparison Of Puff Topography, Toxicant Exposure, And Subjective Effects In Low- And High-frequency Waterpipe Users: A Double-blind, Placebo-control Study
Authors: Cobb C.O. , Blank M.D. , Morlett A. , Shihadeh A. , Jaroudi E. , Karaoghlanian N. , Kilgalen B. , Austin J. , Weaver M.F. , Eissenberg T. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2015 Jun; 17(6), p. 667-74.
PMID: 25257982
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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 & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2014 Apr; 16(4), p. 496-9.
PMID: 24302635
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An Observational Study Of Group Waterpipe Use In A Natural Environment
Authors: Blank M.D. , Brown K.W. , Goodman R.J. , Eissenberg T. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2014 Jan; 16(1), p. 93-9.
PMID: 23943842
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CO exposure and puff topography are associated with Lebanese waterpipe dependence scale score.
Authors: Alzoubi K.H. , Khabour O.F. , Azab M. , Shqair D.M. , Shihadeh A. , Primack B. , Eissenberg T. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2013 Oct; 15(10), p. 1782-6.
PMID: 23616231
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Indoor air quality in Virginia waterpipe cafes.
Authors: Cobb C.O. , Vansickel A.R. , Blank M.D. , Jentink K. , Travers M.J. , Eissenberg T. .
Source: Tobacco Control, 2013 Sep; 22(5), p. 338-43.
PMID: 22447194
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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 Journal, 2013 Aug; 81(4), p. 308-13.
PMID: 24133855
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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 N.A. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2013 Jun; 15(6), p. 1107-12.
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In Vitro Effects Of Waterpipe Smoke Condensate On Endothelial Cell Function: A Potential Risk Factor For Vascular Disease
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Source: Toxicology Letters, 2013-05-23 00:00:00.0; 219(2), p. 133-42.
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Electronic Cigarettes: Effective Nicotine Delivery After Acute Administration
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Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2013 Jan; 15(1), p. 267-70.
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Exposure of pregnant women to waterpipe and cigarette smoke.
Authors: Azab M. , Khabour O.F. , Alzoubi K.H. , Anabtawi M.M. , Quttina M. , Khader Y. , Eissenberg T. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2013 Jan; 15(1), p. 231-7.
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Waterpipe smoking among U.S. university students.
Authors: Primack B.A. , Shensa A. , Kim K.H. , Carroll M.V. , Hoban M.T. , Leino E.V. , Eissenberg T. , Dachille K.H. , Fine M.J. .
Source: Nicotine & Tobacco Research : Official Journal Of The Society For Research On Nicotine And Tobacco, 2013 Jan; 15(1), p. 29-35.
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A Multiple Indicators And Multiple Causes Model Of Alternative Tobacco Use
Authors: Nasim A. , Blank M.D. , Cobb C.O. , Eissenberg T. .
Source: American Journal Of Health Behavior, 2013 Jan; 37(1), p. 25-31.
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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 C.O. , Sahmarani K. , Eissenberg T. , Shihadeh A. .
Source: Toxicology Letters, 2012-11-23 00:00:00.0; 215(1), p. 70-5.
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Dependence On Tobacco And Nicotine Products: A Case For Product-specific Assessment
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Clinical Laboratory Assessment Of The Abuse Liability Of An Electronic Cigarette
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Source: Addiction (abingdon, England), 2012 Aug; 107(8), p. 1493-500.
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Acute exposure to waterpipe tobacco smoke induces changes in the oxidative and inflammatory markers in mouse lung.
Authors: Khabour O.F. , Alzoubi K.H. , Bani-Ahmad M. , Dodin A. , Eissenberg T. , Shihadeh A. .
Source: Inhalation Toxicology, 2012 Aug; 24(10), p. 667-75.
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Patterns Of Alternative Tobacco Use Among Adolescent Cigarette Smokers
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Trends In Alternative Tobacco Use Among Light, Moderate, And Heavy Smokers In Adolescence, 1999-2009
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In Vitro Cytotoxicity And Mutagenicity Of Mainstream Waterpipe Smoke And Its Functional Consequences On Alveolar Type Ii Derived Cells
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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.
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