RT Journal Article
SR Electronic
T1 Toxicant content, physical properties and biological activity of waterpipe tobacco smoke and its tobacco-free alternatives
JF Tobacco Control
JO Tob Control
FD BMJ Publishing Group Ltd
SP i22
OP i30
DO 10.1136/tobaccocontrol-2014-051907
VO 24
IS Suppl 1
A1 Alan Shihadeh
A1 Jens Schubert
A1 Joanne Klaiany
A1 Marwan El Sabban
A1 Andreas Luch
A1 Najat A Saliba
YR 2015
UL http://tobaccocontrol.bmj.com/content/24/Suppl_1/i22.abstract
AB Objectives Waterpipe smoking using sweetened, flavoured tobacco products has become a widespread global phenomenon. In this paper, we review chemical, physical and biological properties of waterpipe smoke. Data sources Peer-reviewed publications indexed in major databases between 1991 and 2014. Search keywords included a combination of: waterpipe, narghile, hookah, shisha along with names of chemical compounds and classes of compounds, in addition to terms commonly used in cellular biology and aerosol sizing. Study selection The search was limited to articles published in English which reported novel data on waterpipe tobacco smoke (WTS) toxicant content, biological activity or particle size and which met various criteria for analytical rigour including: method specificity and selectivity, precision, accuracy and recovery, linearity, range, and stability. Data extraction Multiple researchers reviewed the reports and collectively agreed on which data were pertinent for inclusion. Data synthesis Waterpipe smoke contains significant concentrations of toxicants thought to cause dependence, heart disease, lung disease and cancer in cigarette smokers, and includes 27 known or suspected carcinogens. Waterpipe smoke is a respirable aerosol that induces cellular responses associated with pulmonary and arterial diseases. Except nicotine, smoke generated using tobacco-free preparations marketed for ‘health conscious’ users contains the same or greater doses of toxicants, with the same cellular effects as conventional products. Toxicant yield data from the analytical laboratory are consistent with studies of exposure biomarkers in waterpipe users. Conclusions A sufficient evidence base exists to support public health interventions that highlight the fact that WTS presents a serious inhalation hazard.