Waterpipe (WP) tobacco smoking is well-established in may parts of the world and is rapidly gaining in
popularity in the United States, especially among college students. It is estimated that more than 100 million
smokers smoke WP daily around the world. Both ancient lore and popular belief posit that WP smoking is less
hazardous than smoking cigarettes, with the water purported to filter nicotine and toxicants. In addition, there
are accessories that are being marketed with claims of reduced harm. WP is overtly advertised as a potentially
reduced exposure product (PREP). Yet research addressing WP smoking and exposure to smoke emissions is
scant, there are no acknowledged standards for testing WP smoking behavior or smoke emissions, there is no
standard WP configuration to use for such testing, and there have been few quantitative assessments of
human exposure to WP smoke.
The specific aims of this research are to determine the variability in human WP smoking topography,
how WP operating parameters impact the chemical and physical properties of WP smoke, how variation in WP
operating parameters affect human smoking topography, and if WP accessories advertised to reduce harm
result in lower levels of biomarkers of acute exposure. These aims will be accomplished by a series of
experiments in which operating components of WP are systematically changed and smoking topography and
select (carcinogenic) particle-bound semi-volatile organic and vapor phase organic constituents (SVOCs and
VOCs) of smoke emissions are measured. Variation in particle size distribution with changes in WP
configuration will also be assessed. These steps will result in establishing a "standard" WP configuration for
subsequent testing. Finally, another sample of experienced WP smokers will smoke the standardized WP
configuration, the standardized configuration with a charcoal filter, and the standardized configuration plus a
bubble diffuser in random order. Biomarkers of acute exposure will be measured, including plasma nicotine
and expired air CO boost, real time analysis of VOCs while smoking, and particle size distribution, and
compared across the three WP configurations.
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