Waterpipe tobacco smoke toxicity: the impact of waterpipe size

Abstract

IntroductionWaterpipe tobacco smoking continues to show increasing popularity, especially among individuals between 18 and 22 years old. Waterpipe tobacco smoke (WTS) is a mixture of particulates and gases formed from the combustion of the charcoal and volatilisation and humidification of the tobacco+humectant+flavouring substrate known as shisha or mu’assel. As such, variation in the configuration of the waterpipe may affect the particles produced. Our study focuses on the effects of waterpipe size on the physical properties and cytotoxicity of the smoke produced.MethodsShisha type and headspace volume were held constant and a modified Beirut puff protocol was followed while the size of the waterpipe was varied. Particle concentrations and size distributions were measured using a TSI Engine Exhaust Particle Sizer. Type II alveolar cells were exposed to smoke at the air-liquid interface and two metrics of cell health analysed.ResultsIn a 30 min session, we observed a decrease in total particle concentration (1014–1013) and mass (10 000–2800 mg/m3) and an increase in particle size (125–170 nm) as pipe height increases from 22 to 55 cm and bowl size from 300 to 1250 mL. Smoke from all pipe sizes caused decreases in lysosomal function (>40%) and membrane integrity (>60%) 24 hours post 57 min exposure, and meet the National Institutes of Health definition of a cytotoxic agent (≥30% decrease in cell viability).ConclusionSmoke from waterpipes of all sizes causes significant alveolar cellular harm, indicating that this device needs regulation as a hazard to human health.

Waterpipe Use among Adolescents in Germany: Prevalence, Associated Consumer Characteristics, and Trends (German Health Interview and Examination Survey for Children and Adolescents, KiGGS)

“…The aromatic taste of WP tobacco (e.g., apple, cherry, melon) appeals to young people and can be associated with a more pleasant, longer smoking experience which leads to increased nicotine exposure and dependence potential [ 18 , 19 , 20 ]. Furthermore, the consumption of WP is associated with other harmful health effects similar to those associated with cigarette smoking [ 21 ]. In addition to the increased risk of carbon monoxide poisoning, which can result from combustion of the WP charcoal [ 22 ], smoking WP can cause acute to chronic impairment [ 23 ], negative impacts on executive brain function, or carcinogenic changes in various organs including the lungs and cardiovascular system [ 24 , 25 , 26 ].…”

Waterpipe Tobacco Smoking and Associated Risk Factors among Bangladeshi University Students: An Exploratory Pilot Study

“…Increasing use of waterpipe smoking is also associated with the perception of many young adults concerning its relatively less harmful effects than cigarette smoking (Sidani et al 2019;Cobb et al 2010). Other recent research into waterpipe smoking have examined such areas as toxicity (Hauser et al 2020), waterpipe device cleaning practice and waste disposal (Kassem et al 2020), effects on the cardiovascular system (Qasim et al 2019), and severity of polycythemia (AlQahtany et al 2020), although none of this research has implications for the psychological consequences or risk factors.…”

Wastewater technology attenuates the toxicity of shisha smoking

“…High amounts of smoke toxicants can be stopped by adsorption and solubilization in the water bowl of the hookah waterpipe, thus decreasing the toxicity of the inhaled smoke. Smoke toxicity can be further decreased by changing the water volume and the shisha features (Hauser et al 2020). Toxicity can also be diminished by adding polymers and chelating agents into water to better trap toxicants.…”