Waterpipe (hookah, shisha) tobacco smoking has spread worldwide. Many waterpipe smokers believe that, relative to cigarettes, waterpipes are associated with lower smoke toxicant levels and fewer health risks. For physicians to address these beliefs credibly, waterpipe use and cigarette smoking must be compared directly.
The purpose of this study is to provide the first controlled, direct laboratory comparison of the toxicant exposure associated with waterpipe tobacco and cigarette smoking.
Participants (N=31; M=21.4 years, SD=2.3) reporting monthly waterpipe use (M=5.2 uses/month, SD=4.0) and weekly cigarette smoking (M=9.9 cigarettes/day, SD=6.4) completed a crossover study in which they each smoked a waterpipe for a maximum of 45 minutes, or a single cigarette. Outcome measures included expired-air carbon monoxide (CO) 5 minutes after session's end, and blood carboxyhemoglobin (COHb), plasma nicotine, heart rate, and puff topography. Data were collected in 2008–2009 and analyzed in 2009.
On average, CO increased by 23.9 ppm for waterpipe use (SD=19.8) and 2.7 ppm for cigarette smoking (SD=1.8), while peak waterpipe COHb levels (M=3.9%, SD=2.5) were three times those observed for cigarette smoking (M=1.3%, SD=0.5; p's<0.001). Peak nicotine levels did not differ (waterpipe M=10.2 ng/mL, SD=7.0; cigarette M=10.6 ng/mL, SD=7.7). Significant heart rate increases relative to pre-smoking were observed at 5, 10, 15, 20, 25, and 35 minutes during the cigarette session and at 5-minute intervals during the waterpipe session (p's<0.001). Mean total puff volume was 48.6 L for waterpipe use as compared to 1.0 L for cigarette smoking (p<0.001).
Relative to cigarette smoking, waterpipe use is associated with greater CO, similar nicotine, and dramatically more smoke exposure. Physicians should consider advising their patients that waterpipe tobacco smoking exposes them to some of the same toxicants as cigarette smoking and therefore the two tobacco-smoking methods likely share some of the same health risks.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to American Journal of Preventive Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- TobReg advisory note.WHO, Geneva2005
- Cigarette and waterpipe smoking among adolescents in Estonia: HBSC survey results, 1994–2006.BMC Public Health. 2008; 8: 392
- Smoking tobacco in waterpipes among adolescents in Europe: the case of Latvia and Slovakia.Tob Control. 2008; 17: 432
- Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003–2004.Nicotine Tob Res. 2008; 10: 309-314
- Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth.Am J Prev Med. 2008; 35: 334-339
- Water-pipe tobacco smoking among middle and high school students in Arizona.Pediatrics. 2009; 123: e282-e288
- Knowledge, attitudes and practice of university students regarding waterpipe smoking in Pakistan.Int J Tuberc Lung Dis. 2008; 12: 1077-1084
- Waterpipe tobacco smoking on a U.S. college campus: prevalence and predictors.J Adolesc Health. 2008; 42: 526-529
- Prevalence of and associations with waterpipe tobacco smoking among college students.Ann Behav Med. 2008; 36: 81-86
- Investigation of mainstream smoke aerosol of the argileh water pipe.Food Chem Toxicol. 2003; 41: 143-152
- Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe.Food Chem Toxicol. 2005; 43: 655-661
- Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke.Food Chem Toxicol. 2008; 46: 1582-1590
- Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behaviors in two U.S. samples.Nicotine Tob Res. 2008; 10: 393-398
- Canadian and English students' beliefs about waterpipe smoking: a qualitative study.BMC Public Health. 2009; 9: 10
- Tobacco use and cessation among Somalis in Minnesota.Am J Prev Med. 2008; 35: S457-S462
- Comparative analysis of the effects of hubble-bubble (Sheesha) and cigarette smoking on respiratory and metabolic parameters in hubble-bubble and cigarette smokers.Respirology. 2006; 11: 449-455
- Saliva cotinine and exhaled carbon monoxide levels in natural environment waterpipe smokers.Inhal Toxicol. 2007; 19: 771-777
- Exhaled carbon monoxide with waterpipe use in U.S. students.JAMA. 2008; 299: 36-38
- Hubble-bubble (water pipe) smoking: levels of nicotine and cotinine in plasma, saliva and urine.Int J Clin Pharmacol Ther. 2002; 40: 249-255
- Levels of maximum end-expiratory carbon monoxide and certain cardiovascular parameters following hubble-bubble smoking.Saudi Med J. 2002; 23: 953-958
- Nicotine absorption and cardiovascular effects with smokeless tobacco use: comparison with cigarettes and nicotine gum.Clin Pharmacol Ther. 1988; 44: 23-28
- Smokeless tobacco abstinence effects and nicotine gum dose.Psychopharmacology (Berl). 1992; 106: 60-66
- Waterpipe tobacco smoking: an emerging health crisis in the United States.Am J Health Beha. 2010; 34: 275-285
- A portable, low-resistance puff topography instrument for pulsating, high-flow smoking devices.Behav Res Methods. 2005; 37: 186-191
- Towards a topographical model of narghile water-pipe cafe smoking: a pilot study in a high socioeconomic status neighborhood of Beirut, Lebanon.Pharmacol Biochem Behav. 2004; 79: 75-82
- “Tar,” nicotine, and carbon monoxide of the smoke of 1294 varieties of domestic cigarettes for the year 1998.Author, Washington DC2000
- Clinical laboratory evaluation of potential reduced exposure products for smokers.Nicotine Tob Res. 2006; 8: 727-738
- Design and analysis: a researcher's handbook.Prentice Hall, Englewood Cliffs NJ1991
- Volatile aldehydes in the mainstream smoke of the narghile waterpipe.Food Chem Toxicol. 2008; 46: 3546-3549
- Indoor air contamination during a waterpipe (narghile) smoking session.Food Chem Toxicol. 2009; 47: 1636-1641
- CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers.Nicotine Tob Res. 2009; 11: 806-811
- Greim H. Snyder R. Toxicology and risk assessment. Wiley, New Jersey2008
- Comparison of methods for measurement of smoking behavior: mouthpiece-based computerized devices versus direct observation.Nicotine Tob Res. 2009; 11: 896-903
- Cigarette tar yields in relation to mortality from lung cancer in the cancer prevention study II prospective cohort, 1982–8.BMJ. 2004; 328: 72
© 2009 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.