Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p < 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.

Background Electronic hookah (e‐hookah) vaping has increased in popularity among youth, who endorse unsubstantiated claims that flavored aerosol is detoxified as it passes through water. However, e‐hookahs deliver nicotine by creating an aerosol of fine and ultrafine particles and other oxidants that may reduce the bioavailability of nitric oxide and impair endothelial function secondary to formation of oxygen‐derived free radicals. Methods and Results We examined the acute effects of e‐hookah vaping on endothelial function, and the extent to which increased oxidative stress contributes to the vaping‐induced vascular impairment. Twenty‐six healthy young adult habitual hookah smokers were invited to vape a 30‐minute e‐hookah session to evaluate the impact on endothelial function measured by brachial artery flow‐mediated dilation (FMD). To test for oxidative stress mediation, plasma total antioxidant capacity levels were measured and the effect of e‐hookah vaping on FMD was examined before and after intravenous infusion of the antioxidant ascorbic acid (n=11). Plasma nicotine and exhaled carbon monoxide levels were measured before and after the vaping session. Measurements were performed before and after sham‐vaping control experiments (n=10). E‐hookah vaping, which increased plasma nicotine (+4.93±0.92 ng/mL, P <0.001; mean±SE) with no changes in exhaled carbon monoxide (−0.15±0.17 ppm; P =0.479), increased mean arterial pressure (11±1 mm Hg, P <0.001) and acutely decreased FMD from 5.79±0.58% to 4.39±0.46% ( P <0.001). Ascorbic acid infusion, which increased plasma total antioxidant capacity 5‐fold, increased FMD at baseline (5.98±0.66% versus 9.46±0.87%, P <0.001), and prevented the acute FMD impairment by e‐hookah vaping (9.46±0.87% versus 8.74±0.84%, P =0.002). All parameters were unchanged during sham studies. Conclusions E‐hookah vaping has adverse effects on vascular function, likely mediated by oxidative stress, which overtime could accelerate development and progression of cardiovascular disease. Registration URL: https://ClinicalTrials.gov . Unique identifier: NCT03690427.

Background Traditional hookah smoking has grown quickly to become a global tobacco epidemic. More recently, electronic hookahs (e-hookahs)—vaped through traditional water pipes—were introduced as healthier alternatives to combustible hookah. With combustible tobacco smoking, oxidative stress, inflammation, and vascular stiffness are key components in the development and progression of atherosclerosis. The comparable effects of hookah are unknown. Research Question What is the differential acute effect of e-hookah vaping vs combustible hookah smoking on oxidation, inflammation, and arterial stiffness? Study Design and Methods In a randomized crossover design study, among a cohort of 17 healthy young adult chronic hookah smokers, we investigated the effect of e-hookah vaping and hookah smoking on measures of conduit arterial stiffness, including carotid-femoral pulse wave velocity (PWV), augmentation index-corrected for heart rate before and after a 30-min exposure session. We assessed a panel of circulating biomarkers indicative of inflammation and oxidants and measured plasma nicotine and exhaled carbon monoxide (CO) levels before and after the sessions. Results e-Hookah vaping tended to lead to a larger acute increase in PWV than hookah smoking (mean ± SE: e-hookah, +0.74 ± 0.12 m/s; combustible hookah, +0.57 ± 0.14 m/s [ P < .05 for both]), indicative of large artery stiffening. Compared with baseline, only e-hookah vaping induced an acute increase in augmentation index (e-hookah, +5.58 ± 1.54% [ P = .004]; combustible hookah, +2.87 ± 2.12% [ P = not significant]). These vascular changes were accompanied by elevation of the proinflammatory biomarkers high-sensitivity C-reactive protein, fibrinogen, and tumor necrosis factor α after vaping (all P < .05). No changes in biomarkers of inflammation and oxidants were observed after smoking. Compared with baseline, exhaled CO levels were higher after smoking than after vaping (+36.81 ± 6.70 parts per million vs –0.38 ± 0.22 parts per million; P < .001), whereas plasma nicotine concentrations were comparable (+6.14 ± 1.03 ng/mL vs +5.24 ± 0.96 ng/mL; P = .478). Interpretation Although advertised to be “safe,” flavored e-hookah vaping exerts injurious effects on the vasculature that are, at least in part, mediated by inflammation. Trial Registry ClinicalTrials.gov ; No.: NCT03690427; URL: www.clinicaltrials.gov

Electronic (e‐) hookah vaping has increased in popularity, especially among youth and young adults. Contributing to e‐hookah’s popularity is the unsubstantiated belief that smoke is detoxified as it passes through the water‐filled basin, rendering e‐hookah as a safer alternative to combustible tobacco smoking. With combustible tobacco smoking, vascular inflammation is a key component in the development and progression of atherosclerosis. However, the comparable effects of e‐hookah vaping have not been examined to date. In light of recent outbreaks of vaping‐associated deaths and related‐injuries, it is critical that the use of vaping devices is subjected to scientific scrutiny. Accordingly, the purpose of this work was to elucidate acute effects of e‐hookah vaping on a comprehensive set of systemic vascular inflammatory biomarkers and biomarkers exposure. In 23 young healthy subjects (age 26±1 years, BMI 24.1±0.6 kg·m2, mean±SE) who regularly smoke hookah but do not smoke cigarettes, we measured heart rate, blood pressure, systemic vascular inflammatory biomarkers, including, C□ reactive protein (hsCRP), interleukin‐6 (IL‐6), fibrinogen, and tumor necrosis factor alpha (TNFα), and biomarkers of exposure, including plasma nicotine and exhaled carbon monoxide (CO) before and after a typical 30‐minute session of e‐hookah bowl vaping and, for control comparison, before and after sham smoking (n=8). All biomarkers were measured before and ≤10 minutes after the vaping session. Our results show that after e‐hookah vaping, heart rate and blood pressure increased significantly (Δ heart rate: +9±2 beats.min−1; Δ systolic blood pressure: +16±1 mm Hg, Δ diastolic blood pressure: +10±1 mmHg, p<0.001 as compared with baseline). While nicotine levels increased after vaping (+5.34±1.24 ng/ml, p=0.002), exhaled carbon monoxide levels did not change (p=ns). Notably, plasma indices of systemic vascular inflammation increased significantly (all p<0.05, except for IL‐6: p=ns). All indices were unchanged after sham smoking. Though e‐hookah users endorse marketing claims that these products are safer alternatives to combustible tobacco smoking, our data herein show that despite the absence of combustion, acute exposure to e‐hookah among young healthy adults does not elude adverse cardiovascular effects and, in fact, leads to a transient increase in vascular systemic inflammation. Our data help inform the public about potential cardiovascular disease risk of vaping and guide further studies to examine the chronic long‐term vascular effects of exposure to e‐hookah vaping. Support or Funding Information This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute 1R21HL145002‐01 and the University of California, Los Angeles Clinical and Translational Science Institute grant UL1TR000124.