Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Mar;24(2):125-7.
doi: 10.1136/tobaccocontrol-2013-051206. Epub 2013 Aug 29.

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

Radwan Al Ali  1 , Samer Rastam  1 , Iman Ibrahim  1 , Asma Bazzi  2 , Sanaa Fayad  2 , Alan L Shihadeh  3 , Ghazi S Zaatari  2 , Wasim Maziak  4
Affiliations
Comparative Study

A comparative study of systemic carcinogen exposure in waterpipe smokers, cigarette smokers and non-smokers

Radwan Al Ali et al. Tob Control. 2015 Mar.

Abstract

Background: In the past decade, waterpipe smoking-also known as hookah, shisha, narghileh-has increased among youth. The scarcity of rigorous studies linking waterpipe smoking to smoking-related diseases has hindered policy and regulatory efforts to confront the waterpipe epidemic. This study compares systemic carcinogen exposure between independent groups of exclusive waterpipe smokers, cigarette smokers and non-smokers.

Methods: This study was conducted at the Syrian Center for Tobacco Studies (SCTS) in Aleppo, Syria, between 2010 and 2011. First morning urinary samples were collected from three groups of subjects; exclusive daily waterpipe smokers (n=24), exclusive daily cigarette smokers (n=23), and non-smokers (n=28). These samples were analysed for carcinogenic tobacco-specific nitrosamines 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (NNAL) using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Results: Our results show that waterpipe smokers are exposed to about 5-10 times greater NNAL than non-smokers. Mean (95% CI) free and total NNAL was 0.7 (0.3 to 1. 4) and 3.9 (1.6 to 9.5) pg/mL urine for non-smokers, 8.4 (4.8 to 14.8) and 33.0 (21.6 to 50.6) pg/mL urine for waterpipe smokers, and 10.7 (5.0 to 22.6) and 46.8 (27.6 to 79.3) pg/mL urine for cigarette smokers (p<0.001 for all comparisons). Daily waterpipe smokers were less exposed to NNAL than daily cigarette smokers, although the difference did not reach statistical significance for all measurements.

Conclusions: These results provide the clearest indication to date about systemic exposure to harmful carcinogens associated with long-term waterpipe smoking. Such evidence can support policy and regulatory efforts designed to confront the emerging global waterpipe epidemic, as well as drive interventions aimed at increasing the public awareness about the cancer risk associated with waterpipe smoking.

Keywords: Carcinogens; Non-cigarette tobacco products; Prevention.

PubMed Disclaimer

References

    1. Maziak W, Nakkash R, Bahelah R, et al. Tobacco use in the Arab World; old and new epidemics amidst policy paralysis. Health Policy Plan. Published Online First: 19 Aug 2013. - PMC - PubMed
    1. Maziak W. The global epidemic of waterpipe smoking. Addict Behav. 2011;36:1–5. - PMC - PubMed
    1. Moh’d Al-Mulla A, Abdou Helmy S, Al-Lawati J, et al. Prevalence of tobacco use among students aged 13–15 years in Health Ministers’ Council/Gulf Cooperation Council Member States 2001–2004. J Sch Health. 2008;78:337–343. - PubMed
    1. Primack BA, Shensa A, Kim KH, et al. Waterpipe smoking among U.S. university students. Nicotine Tob Res. 2013;15:29–35. - PMC - PubMed
    1. Eissenberg T, Ward KD, Smith-Simone S, et al. Waterpipe tobacco smoking on a U.S. College campus: prevalence and correlates. J Adolesc Health. 2008;42:526–529. - PMC - PubMed

Publication types