Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
Am J Prev Med. 2009 Dec;37(6):518-23. doi: 10.1016/j.amepre.2009.07.014.
Waterpipe (hookah, shisha) tobacco smoking has spread worldwide. Many waterpipe smokers believe that, relative to cigarettes, waterpipes are associated with lower smoke toxicant levels and fewer health risks. For physicians to address these beliefs credibly, waterpipe use and cigarette smoking must be compared directly.
The purpose of this study is to provide the first controlled, direct laboratory comparison of the toxicant exposure associated with waterpipe tobacco and cigarette smoking.
Participants (N=31; M=21.4 years, SD=2.3) reporting monthly waterpipe use (M=5.2 uses/month, SD=4.0) and weekly cigarette smoking (M=9.9 cigarettes/day, SD=6.4) completed a crossover study in which they each smoked a waterpipe for a maximum of 45 minutes, or a single cigarette. Outcome measures included expired-air carbon monoxide (CO) 5 minutes after session's end, and blood carboxyhemoglobin (COHb), plasma nicotine, heart rate, and puff topography. Data were collected in 2008-2009 and analyzed in 2009.
On average, CO increased by 23.9 ppm for waterpipe use (SD=19.8) and 2.7 ppm for cigarette smoking (SD=1.8), while peak waterpipe COHb levels (M=3.9%, SD=2.5) were three times those observed for cigarette smoking (M=1.3%, SD=0.5; p's<0.001). Peak nicotine levels did not differ (waterpipe M=10.2 ng/mL, SD=7.0; cigarette M=10.6 ng/mL, SD=7.7). Significant heart rate increases relative to pre-smoking were observed at 5, 10, 15, 20, 25, and 35 minutes during the cigarette session and at 5-minute intervals during the waterpipe session (p's<0.001). Mean total puff volume was 48.6 L for waterpipe use as compared to 1.0 L for cigarette smoking (p<0.001).
Relative to cigarette smoking, waterpipe use is associated with greater CO, similar nicotine, and dramatically more smoke exposure. Physicians should consider advising their patients that waterpipe tobacco smoking exposes them to some of the same toxicants as cigarette smoking and therefore the two tobacco-smoking methods likely share some of the same health risks.
水烟（水烟袋、水烟壶）烟草吸烟在全球范围内蔓延。许多水烟吸食者认为，与香烟相比，水烟与较低的烟雾有毒物质水平和较少的健康风险有关。为了让医生能够有说服力地解决这些信念，必须直接比较水烟使用和香烟吸烟。
本研究的目的是提供首次对水烟烟草和香烟吸烟相关的有毒物质暴露进行的受控、直接实验室比较。
报告每月水烟使用（M=5.2 次/月，SD=4.0）和每周香烟吸烟（M=9.9 支/天，SD=6.4）的 31 名参与者（M=21.4 岁，SD=2.3）完成了一项交叉研究，他们每人最多吸食水烟 45 分钟或一支香烟。结果测量包括会话结束后 5 分钟呼出的一氧化碳（CO）和血液碳氧血红蛋白（COHb）、血浆尼古丁、心率和抽吸地形。数据于 2008-2009 年收集，并于 2009 年进行分析。
平均而言，水烟使用时 CO 增加了 23.9ppm（SD=19.8），香烟吸烟时增加了 2.7ppm（SD=1.8），而水烟使用时的峰值 COHb 水平（M=3.9%，SD=2.5）是香烟吸烟时观察到的三倍（M=1.3%，SD=0.5；p 值<0.001）。尼古丁的峰值水平没有差异（水烟 M=10.2ng/ml，SD=7.0；香烟 M=10.6ng/ml，SD=7.7）。与吸烟前相比，在吸烟过程中，在 5、10、15、20、25 和 35 分钟时以及在水烟吸烟过程中每隔 5 分钟观察到显著的心率增加（p 值<0.001）。水烟使用的平均总抽吸量为 48.6L，而香烟吸烟的平均抽吸量为 1.0L（p 值<0.001）。
与香烟吸烟相比，水烟使用与更高的 CO、相似的尼古丁和显著更多的烟雾暴露有关。医生应该考虑建议他们的患者，水烟烟草吸烟使他们接触到与香烟吸烟相同的一些有毒物质，因此两种吸烟方式可能具有一些相同的健康风险。
