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The effect of flavoured and non-flavoured tobacco on subjective experience, topography and toxicant exposure among waterpipe smokers
  1. Ziyad Ben Taleb1,
  2. Mayra Vargas2,
  3. Mohammad Ebrahimi Kalan2,
  4. Alison Breland3,
  5. Thomas Eissenberg4,
  6. David Brown5,
  7. Wasim Maziak6
  1. 1 Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
  2. 2 Epidemiology, Florida International University, Miami, Florida, USA
  3. 3 Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
  4. 4 Psychology and Inst. for Drug/Alc. Studies, Virginia Commonwealth University, Richmond, Virginia, USA
  5. 5 Division of Family and College of Medicine Community Medicine, Florida International University, Miami, Florida, USA
  6. 6 Epidemiology, Florida International University, Miami, Florida, USA
  1. Correspondence to Dr Wasim Maziak, College of Public Health, Florida International University, Miami, FL 33174, USA; wmaziak{at}


Introduction Flavoured waterpipe (WP) tobacco is a major factor in the resurgence of WP smoking and a main attractant of WP use among youth. Yet, evidence of the effects of limiting flavour on WP smoker’s experiences and exposures is limited. This study examined the impact of flavour manipulation on WP smokers’ toxicant exposure and smoking experiences.

Method A total of 144 WP smokers attended two, 45 min ad libitum smoking sessions (flavoured vs non-flavoured tobacco) in a crossover design study. Participants completed a battery of questions assessing subjective smoking experiences. Exhaled carbon monoxide (eCO) and plasma nicotine concentrations were measured before and after the smoking sessions. Puff topography was recorded throughout the smoking sessions.

Results Compared with the non-flavoured WP tobacco, participants reported enhanced subjective smoking measures of satisfaction and enjoyment following smoking flavoured WP tobacco (ps <0.05). Although participants spent a longer time smoking flavoured tobacco, they took on average larger puffs while smoking the non-flavoured tobacco (ps <0.05). Greater levels of eCO were recorded following the non-flavoured tobacco session (p<0.05) compared with flavoured tobacco. No significant differences were observed in plasma nicotine concentrations between the two tobacco conditions. WP harm perception was higher among participants after smoking non-flavoured WP tobacco compared with their preferred flavour (p<0.05).

Conclusion Smoking the flavoured tobacco product was associated with enhanced subjective experiences compared with the non-flavoured, suggesting a potential role for flavour regulation in reducing WP use. Mixed results were observed for toxicants exposure in relation to smoking flavoured compared with non-flavoured products suggesting the need for a more comprehensive assessment of the effects of other tobacco constituents and additives on toxicant exposure in WP smokers.

  • Nicotine
  • Public policy
  • Smoking topography
  • Addiction
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  • Contributors ZBT and WM conceptualised and designed the study, drafted and revised the manuscript, guided and interpreted the analysis. TE, MEK, DB, MV and AB contributed to the acquisition and interpretation of the data, critically revised the article for important intellectual content.

  • Funding This study was funded by National Institutes of Health (NIH) and the Center for Tobacco Products (CTP) of the the U.S. Food and Drug Administration (FDA) under award R01DA042477. TE is supported by the NIH under Award U54DA036105 and the FDA CTP. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH or the FDA. TE is a paid consultant in litigation against the tobacco industry and is named on a patent for a device that measures the puffing behaviour of electronic cigarette users.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Florida International University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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