Water pipe smoking causes significant exposure to nicotine and cancer-causing agents

May 16, 2014

PHILADELPHIA -- Young adults who smoked water pipes in hookah bars had elevated levels of nicotine, cotinine, tobacco-related cancer-causing agents, and volatile organic compounds (VOC) in their urine, and this may increase their risk for cancer and other chronic diseases, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"This study reports systemic intake of tobacco-specific nitrosamines and VOCs after a typical water pipe-smoking session in a hookah bar setting, thus making the findings generalizable to most water pipe users in the United States," said Gideon St.Helen, Ph.D., postdoctoral fellow in the Division of Clinical Pharmacology and the Center for Tobacco Control Research and Education at the University of California, San Francisco.

After a single evening of water pipe smoking in a hookah bar, young men and women had in their urine a 73-fold increase in nicotine; fourfold increase in cotinine; twofold increase in NNAL, a breakdown product of a tobacco-specific nitrosamine, NNK, which can cause lung and pancreatic cancers; and 14 to 91 percent increase in the breakdown products of VOC such as benzene and acrolein that are known to cause cancer and cardiovascular and respiratory diseases.

"There was also a substantial increase in nicotine levels, which raises concerns about the potential addictiveness of water pipe smoking and possible effects on the developing brains of children and youths who use water pipes," added St.Helen. "Water pipe smoking is generally perceived to be a safe alternative to cigarette smoking, even for children and youths. Our study shows that water pipe use, particularly chronic use, is not risk-free."

St.Helen and colleagues recruited 55 healthy, experienced water pipe smokers, ages 18 to 48 years, to the study. Participants were instructed to refrain from any type of smoking for a week.

At the end of this period they provided a "before" urine sample and smoked water pipes at a hookah bar of their choice in the San Francisco Bay area. Soon after the visit, they provided the "after" urine sample, and filled a form to provide detailed information on their smoking session including total time spent smoking, number of bowls smoked, and number of shared users. They also provided a first-voided urine sample the next morning, which helped researchers estimate the clearance of the tobacco-related chemicals of interest.

The study participants spent on average 74 minutes smoking water pipes and smoked an average 0.6 bowls of water pipe tobacco per person.

The researchers found that the elevated levels of nicotine, cotinine, and NNAL, which were detected immediately after the water pipe-smoking session, remained significantly elevated in the next-day urine samples, compared with the "before" samples: Nicotine was 10.4-fold higher; cotinine, 3.2-fold; and NNAL, 2.2-fold.

Water pipe-smoking duration correlated significantly with the increase in post-exposure urine nicotine levels, and number of bowls smoked per person significantly correlated with the increase in post-exposure and next-day urine cotinine levels, respectively. The average increase in nicotine levels was comparable to levels obtained after smoking at least one cigarette, explained St.Helen.

"I have seen entire families, including young children, smoking water pipes. I have even been offered a smoke by my friend who thought water pipe smoking was 'totally safe,'" St.Helen added. "Our study provides evidence that water pipe smoking leads to significant intake of tobacco-related addictive and harmful substances, and is therefore not without risk, particularly among children and youths."
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This study was funded by the National Institutes of Health and the California Tobacco-related Disease Research Program. St.Helen declares no conflicts of interest.

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About the American Association for Cancer Research

Founded in 1907, the American Association for Cancer Research (AACR) is the world's oldest and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than 34,000 laboratory, translational, and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis, and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 18,000 attendees. In addition, the AACR publishes eight peer-reviewed scientific journals and a magazine for cancer survivors, patients, and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration, and scientific oversight of team science and individual grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer. For more information about the AACR, visit http://www.AACR.org.

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