The effect of flavoured and non-flavoured tobacco on subjective experience, topography and toxicant exposure among waterpipe smokers

Abstract

IntroductionFlavoured waterpipe (WP) tobacco is a major factor in the resurgence of WP smoking and a main attractant of WP use among youth. Yet, evidence of the effects of limiting flavour on WP smoker’s experiences and exposures is limited. This study examined the impact of flavour manipulation on WP smokers’ toxicant exposure and smoking experiences.MethodA total of 144 WP smokers attended two, 45 min ad libitum smoking sessions (flavoured vs non-flavoured tobacco) in a crossover design study. Participants completed a battery of questions assessing subjective smoking experiences. Exhaled carbon monoxide (eCO) and plasma nicotine concentrations were measured before and after the smoking sessions. Puff topography was recorded throughout the smoking sessions.ResultsCompared with the non-flavoured WP tobacco, participants reported enhanced subjective smoking measures of satisfaction and enjoyment following smoking flavoured WP tobacco (ps <0.05). Although participants spent a longer time smoking flavoured tobacco, they took on average larger puffs while smoking the non-flavoured tobacco (ps <0.05). Greater levels of eCO were recorded following the non-flavoured tobacco session (p<0.05) compared with flavoured tobacco. No significant differences were observed in plasma nicotine concentrations between the two tobacco conditions. WP harm perception was higher among participants after smoking non-flavoured WP tobacco compared with their preferred flavour (p<0.05).ConclusionSmoking the flavoured tobacco product was associated with enhanced subjective experiences compared with the non-flavoured, suggesting a potential role for flavour regulation in reducing WP use. Mixed results were observed for toxicants exposure in relation to smoking flavoured compared with non-flavoured products suggesting the need for a more comprehensive assessment of the effects of other tobacco constituents and additives on toxicant exposure in WP smokers.

Characteristics of flavored and non-flavored waterpipe tobacco users: a real-world setting study

“…Similarly, in our study, the mean age of smoking initiation among FWT smokers was younger than their non-FWT counterparts, reflecting the attractiveness of flavorings for younger people, as well as its increased popularity among women. Our findings add to the existing evidence base (Ben Taleb et al 2019a) that limiting flavors could have substantial effects on reducing the WP smoking rate among young people and could help keep the prevalence of female tobacco use low in Middle East countries like Iran (Baheiraei et al 2012;Ebrahimi Kalan and Ben Taleb 2018). Numerous studies (Daniels and Roman 2013;Fielder et al 2012;Joveyni et al 2012;Khalil et al 2013;Sabahy et al 2011) have emphasized social motivations for WP use, including having fun, socializing, spending time with friends, curiosity, having a new experience, peer pressure, and feeling of calmness and reduction of stress and fatigue.…”

“…There is well-developed literature showing that WP tobacco flavorings are the main attribute that encourages young people to initiate WP smoking and engage in continued WP use (Ben Taleb et al 2019a;Initiative 2018;Odani et al 2020). Similarly, in our study, the mean age of smoking initiation among FWT smokers was younger than their non-FWT counterparts, reflecting the attractiveness of flavorings for younger people, as well as its increased popularity among women.…”

“…To date, we are unaware of any studies comparing the characteristics of WP smokers who use non-FWT to those who use FWT. A limited number of studies have compared the impact of FWT and non-FWT on smoking behavior, subjective experiences, and toxicant exposure among WP smokers in controlled laboratory settings (Ben Taleb et al 2019b;Leavens et al 2018). However, FWT and non-FWT users may differ in important characteristics that have not yet been investigated in real-world settings.…”

Building the evidence base for waterpipe regulation and policy

“…Nine teams funded under this programme collaborated in presenting their findings in this special issue, and this commentary provides a synopsis of these studies and discusses their potential regulatory and policy implications. [11][12][13][14][15][16][17][18][19] copyright.…”

“…In this special issue, Ben Taleb et al 11 examined the impact of flavoured and non-flavoured waterpipe tobacco on subjective measures of satisfaction, harm perception, withdrawal symptoms and nicotine exposure in a sample of waterpipe smokers. Smoking the flavoured waterpipe tobacco was associated with enhanced subjective experiences compared with the nonflavoured, suggesting a potential role for flavour regulation in reducing waterpipe use.…”