Nicotine, Carbon Monoxide, and Carcinogen Exposure after a Single Use of a Water Pipe

Abstract

Background Smoking tobacco preparations in a waterpipe (hookah) is widespread in many places of the world, including the US, where it is especially popular among young people. Many perceive waterpipe smoking to be less hazardous than cigarette smoking. We studied systemic absorption of nicotine, carbon monoxide, and carcinogens from one waterpipe smoking session. Methods Sixteen subjects smoked a waterpipe on a clinical research ward. Expired carbon monoxide and carboxyhemoglobin were measured, plasma samples were analyzed for nicotine concentrations, and urine samples were analyzed for the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (NNAL) and polycyclic aromatic hydrocarbon (PAH) metabolite biomarker concentrations. Results We found substantial increases in plasma nicotine concentrations, comparable to cigarette smoking, and increases in carbon monoxide levels that are much higher than is typically observed from cigarette smoking, as previously published. Urinary excretion of NNAL and PAH biomarkers increased significantly following waterpipe smoking. Conclusions Absorption of nicotine in amounts comparable to cigarette smoking indicates a potential for addiction, and absorption of significant amounts of carcinogens raises concerns of cancer risk in people who smoke tobacco products in waterpipes. Impact Our data contributes to an understanding of the health impact of waterpipe use.

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“…Hookah, a popular form of tobacco smoking, came into existence about four centuries ago where it was commonly used by people in Asia and Africa (Goodman, 1993;Shihadeh, 2003;World Health Organization, 2005). Other common names for hookah are waterpipe, shisha, hubble-bubble, nargileh and argileh (Chaaya et al, 2004;Maziak et al, 2004;Mohammad et al, 2008).…”