Impact of Waterpipe Size and Heating Source on Exposure, Behavior, and Abuse Liability
openNIDA - National Institute on Drug Abuse
Waterpipe (WP) tobacco smoking remains an important public health concern among young adults in the US,
with 1 in 8 reporting past year use. Like cigarettes, WP smoking can lead to cancer, impaired pulmonary function,
and heart disease due to toxicants such as carcinogenic polycyclic aromatic hydrocarbons (PAHs), volatile
aldehydes (VAs), and carbon monoxide (CO). The FDA has taken steps to regulate WP products, but the complex
landscape of WP configurations, including diverse heat sources and varying device sizes, presents regulatory
challenges. Adding to these concerns is the marketing of so-called WP “harm reduction” products like electrical
heaters and “mini hookahs” that lack supportive data and may perpetuate WP use. Our preliminary findings
indicate that electrical heaters can reduce CO and PAH yields but may increase VA emissions and total smoke
inhaled. Additionally, larger WPs are associated with increased CO exposure and higher harm perceptions, while
smaller WPs result in higher nicotine exposure. These findings underscore the need for comprehensive research
on the impact of WP size and heat source on toxicant exposure, smoking behavior, and abuse liability. This R21
project aims to elucidate the effects of WP size and heat source on toxicant exposure, smoking behavior, and
abuse liability through a 2x2 crossover study involving 60 young adult WP smokers (aged 21-39 years).
Participants will undergo four 45-minute WP smoking sessions, each with a different WP size and heat source
configuration (small vs. large WP, charcoal vs. electrical heater). We will measure puff topography, saliva
nicotine, exhaled CO, subjective experiences, and abuse liability pre- and post-smoking. We hypothesize that
smoking a configuration of large WP size with a charcoal heat source will result in higher levels of toxicant
exposure, increased puffing behavior, and greater abuse liability while smoking a configuration of small WP size
with an electrical heat source. Manipulating WP size and heat source is expected to significantly influence harm
perception and subjective experiences. This project will generate novel evidence regarding the impact of WP
size and heat source on smoking behavior, toxicant exposure, and abuse liability. The outcomes will assist
regulatory entities in developing size-specific and heat source-related standards to control the marketing and
sales of WP devices, thereby protecting public health by reducing the harms associated with WP smoking.
Additionally, the study will explore how different WP configurations impact user satisfaction and potential
addiction, providing a more comprehensive understanding of WP smoking behaviors. By examining both
subjective and objective measures, we aim to offer a holistic view of how WP size and heating methods contribute
to health risks. The findings will be crucial for informing public health policies and regulations, ensuring they
address the nuances of WP smoking practices effectively. This research will ultimately support the development
of targeted interventions to mitigate the adverse health effects of WP smoking among young adults.
Up to $248K
health research