Objectives To form population-level comparisons of total smoke volume, tar, carbon monoxide and nicotine consumed from waterpipe tobacco smoking (WTS) and cigarette smoking using data from a nationally representative sample of smokers and non-smokers aged 18–30 years.
Methods In March and April 2013, we surveyed a nationally representative sample of 3254 US young adults to assess the frequency and volume of WTS and cigarette smoking. We used Monte Carlo analyses with 5000 repetitions to estimate the proportions of toxicants originating from WTS and cigarette smoking. Analyses incorporated survey weights and used recent meta-analytic data to estimate toxicant exposures associated with WTS and cigarette smoking.
Results Compared with the additive estimates of WTS and cigarette smoking combined, 54.9% (95% CI 37.5% to 72.2%) of smoke volume was attributed to WTS. The proportions of tar attributable to WTS was 20.8% (95% CI 6.5% to 35.2%), carbon monoxide 10.3% (95% CI 3.3% to 17.3%) and nicotine 2.4% (95% CI 0.9% to 3.8%).
Conclusions WTS accounted for over half of the tobacco smoke volume consumed among young US adult waterpipe and cigarette smokers. Toxicant exposures to tar, carbon monoxide and nicotine were lower, but still substantial, for WTS alone compared with WTS and cigarette smoking. Public health and policy interventions to reduce harm from tobacco smoking in young US adults should explicitly address WTS toxicant exposures.
- harm reduction
- non-cigarette tobacco products
- surveillance and monitoring
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Contributors BAP conceived of the study and wrote the majority of the first draft. BAP, AS, MSR, and MKM conducted analyses. JES, MCT and JBC wrote sections of the initial draft. AEJ and MJF provided supervision. All authors edited the manuscript for important intellectual content. All authors approved the final version.
Funding The study was funded by National Cancer Institute grant R01-CA140150.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was approved by the University of Pittsburgh Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this study are available upon request.
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