A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

Abstract

Background In the past decade, waterpipe smoking—also known as hookah, shisha, narghileh—has increased among youth. The scarcity of rigorous studies linking waterpipe smoking to smoking-related diseases has hindered policy and regulatory efforts to confront the waterpipe epidemic. This study compares systemic carcinogen exposure between independent groups of exclusive waterpipe smokers, cigarette smokers and nonsmokers. Methods This study was conducted at the Syrian Center for Tobacco Studies (SCTS) in Aleppo, Syria, between 2010 and 2011. First morning urinary samples were collected from three groups of subjects; exclusive daily waterpipe smokers (n=24), exclusive daily cigarette smokers (n=23), and non-smokers (n=28). These samples were analysed for carcinogenic tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) using liquid chromatography—tandem mass spectrometry (LC-MS/MS). Results Our results show that waterpipe smokers are exposed to about 5–10 times greater NNAL than nonsmokers. Mean (95% CI) free and total NNAL was 0.7 (0.3 to 1. 4) and 3.9 (1.6 to 9.5) pg/mL urine for nonsmokers, 8.4 (4.8 to 14.8) and 33.0 (21.6 to 50.6) pg/mL urine for waterpipe smokers, and 10.7 (5.0 to 22.6) and 46.8 (27.6 to 79.3) pg/mL urine for cigarette smokers (p<0.001 for all comparisons). Daily waterpipe smokers were less exposed to NNAL than daily cigarette smokers, although the difference did not reach statistical significance for all measurements. Conclusions These results provide the clearest indication to date about systemic exposure to harmful carcinogens associated with long-term waterpipe smoking. Such evidence can support policy and regulatory efforts designed to confront the emerging global waterpipe epidemic, as well as drive interventions aimed at increasing the public awareness about the cancer risk associated with waterpipe smoking.

It Is Time to Regulate Carcinogenic Tobacco-Specific Nitrosamines in Cigarette Tobacco

“…Considerable levels of NNK and NNN have been detected in pipe tobacco and cigar tobacco as well as cigar smoke (14,34). NNAL has been detected in the urine of waterpipe smokers and children exposed to secondhand smoke from waterpipes (40-42). Thus, the regulation of these other types of products, while not the main topic of this commentary, is timely.…”

Determinants of progression of nicotine dependence symptoms in adolescent waterpipe smokers

“…Although waterpipe smoking commonly is perceived as a safer alternative to cigarettes,1 growing evidence shows that waterpipe smokers are exposed to significant amounts of harmful chemicals such as carbon monoxide,2 benzene,3 tobacco-specific nitrosamines4 and nicotine, a dependence-producing stimulant drug 5 6…”

Metal analysis for non-tobacco smoking alternatives: Steam stone fluids and smoke

“…The smoke that comes from the hookah has been found to contain various toxicants that have proven to cause heart disease, lung cancer, and many other ailments [6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Highly addictive nicotine, carbon monoxide, polycyclic aromatic hydrocarbons (PAHs), aldehydes, phenols, benzene, toluene, nitric oxides, nitroamines, and toxic metals are among the many tobacco smoke constituents (in the gas phase and aerosol droplets) that have been detected in cigarettes.…”