Exhaled Carbon Monoxide With Waterpipe Use in US Students

Abstract Background Exposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters. Methods We surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO. Results In analysis limited to men (93.5% of all surveyed), 42% were daily cigarette; 1% were waterpipe smokers; 94% were exposed to SHS, 29% used coal for heating and 4% used biomass for cooking. The median CO was 4 (interquartile range 3;8) ppm. Age (beta 0.74 per 10 years, p < 0.001), use of biomass fuel for cooking (beta 1.38, p = 0.05), cigarette smoked in the last 12 h (beta 8.22, p < 0.001), waterpipe smoked in the last 12 h (beta 23.10, p < 0.001) were statistically associated with CO, but not time since last fire (≤6 h) (beta 4.12, p = 0.12). There was a significant interaction between older age and firefighting for exhaled CO (p = 0.03). Conclusions Cigarette and recent waterpipe smoking are associated with increased exhaled CO in firefighters. Firefighting itself was a less potent contributor to exhaled CO when measured at an annual screening, but an age interaction was manifested.

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Unreported Research Funding in: Exhaled Carbon Monoxide With Waterpipe Use in US Students

JAMA ◽

10.1001/jama.299.18.2150-b ◽

2008 ◽

Vol 299 (18) ◽

pp. 2150

Keyword(s):

Carbon Monoxide ◽

Research Funding ◽

Exhaled Carbon Monoxide ◽

Waterpipe Use

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Comparison of a preferred versus non-preferred waterpipe tobacco flavour: subjective experience, smoking behaviour and toxicant exposure

Tobacco Control ◽

10.1136/tobaccocontrol-2016-053344 ◽

2017 ◽

Vol 27 (3) ◽

pp. 319-324 ◽

Cited By ~ 13

Author(s):

Eleanor L Leavens ◽

Leslie M Driskill ◽

Neil Molina ◽

Thomas Eissenberg ◽

Alan Shihadeh ◽

...

Keyword(s):

Carbon Monoxide ◽

Subjective Experience ◽

Smoking Behaviour ◽

Toxicant Exposure ◽

P Values ◽

Smoking Topography ◽

Exhaled Carbon Monoxide ◽

Continued Use ◽

The Impact ◽

Survey Questionnaires

IntroductionOne possible reason for the rapid proliferation of waterpipe (WP) smoking is the pervasive use of flavoured WP tobacco. To begin to understand the impact of WP tobacco flavours, the current study examined the impact of a preferred WP tobacco flavour compared with a non-preferred tobacco flavoured control on user’s smoking behaviour, toxicant exposure and subjective smoking experience.MethodThirty-six current WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavour vs non-preferred tobacco flavour control) in a randomised cross-over design. Participants completed survey questionnaires assessing subjective smoking experience, exhaled carbon monoxide (eCO) testing, and provided blood samples for monitoring plasma nicotine. WP smoking topography was measured continuously throughout the smoking session.ResultsWhile participants reported an enhanced subjective smoking experience including greater interest in continued use, greater pleasure derived from smoking, increased liking and enjoyment, and willingness to continue use after smoking their preferred WP tobacco flavour (p values <0.05), no significant differences were observed in nicotine and carbon monoxide boost between flavour preparations. Greater average puff volume (p=0.018) was observed during the non-preferred flavour session. While not significant, measures of flow rate, interpuff interval (IPI), and total number of puffs were trending towards significance (p values <0.10), with decreased IPI and greater total number of puffs during the preferred flavour session.DiscussionThe current study is the first to examine flavours in WP smoking by measuring preferred versus control preparations to understand the impact on subjective experience, smoking behaviour and toxicant exposure. The pattern of results suggests that even this relatively minor manipulation resulted in significant changes in subjective experience. These results indicate a possible need for regulations restricting flavours in WP tobacco as with combustible cigarettes.

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Pictorial health warning labels on the waterpipe device are effective in reducing smoking satisfaction, puffing behaviour and exposure to CO: first evidence from a crossover clinical laboratory study

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054682 ◽

2019 ◽

Vol 28 (e1) ◽

pp. e37-e42 ◽

Cited By ~ 5

Author(s):

Wasim Maziak ◽

Ziyad Ben Taleb ◽

Mohammad Ebrahimi Kalan ◽

Thomas Eissenberg ◽

James Thrasher ◽

...

Keyword(s):

Carbon Monoxide ◽

Clinical Laboratory ◽

Warning Labels ◽

Health Warning ◽

Before And After ◽

Regulatory Approach ◽

The Usa ◽

Exhaled Carbon Monoxide ◽

Positive Experiences ◽

Harmful Effects

ObjectivesThis study examined the effect of pictorial health warning labels (HWLs) on the waterpipe (WP) device on smokers’ experience, puffing behaviour, harm perception and exposure to respiratory toxicants.MethodsThirty WP smokers completed two 45 min ad libitum smoking sessions (WP without HWL vs WP with HWL) in a crossover design study. Exhaled carbon monoxide (eCO) was measured before and after each smoking session. Puff topography was recorded throughout the smoking session, and participants completed survey questionnaires assessing subjective smoking experiences and harm perception.ResultsSignificant differences were observed in eCO levels between the two study conditions, with lower levels of eCO boost recorded following smoking the WP fitted with HWL (16 ppm) compared with WP without HWL (22.7 ppm). Participants had more puffs, shorter interpuff intervals and a higher total puff volume during smoking the WP without HWL relative to WP with HWL (p values <0.05). We documented enhanced reports of satisfaction, taste and puff liking following smoking the WP without HWL compared with the WP with HWL. WP harm perception was significantly higher among participants after smoking the WP with HWL compared with WP without HWL.ConclusionThis pilot study shows that placing HWL on the WP device is effective in reducing WP smoker’s positive experiences, puffing parameters and exposure to carbon monoxide. HWLs lead also to more appreciation of WP harmful effects, making them a promising regulatory approach for addressing the spread of WP smoking among young adults in the USA.

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