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Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use
  1. Theodore L Wagener1,2,
  2. Eleanor L S Leavens3,
  3. Toral Mehta2,
  4. Jessica Hale2,
  5. Alan Shihadeh4,
  6. Thomas Eissenberg5,
  7. Matthew Halquist6,
  8. Marielle C Brinkman2,7,
  9. Amanda L Johnson8,
  10. Evan L Floyd9,
  11. Kai Ding10,
  12. Rachel El Hage11,
  13. Rola Salman4
  1. 1Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  2. 2Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
  3. 3Department of Population Health, University of Kansas School of Medicine, Kasas City, Kansas, United States
  4. 4Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
  5. 5Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
  6. 6Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
  7. 7Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
  8. 8Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
  9. 9Department of Occupational and Environmental Health, University of Oklahoma - Health Sciences Center, Oklahoma City, Oklahoma, USA
  10. 10Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  11. 11Department of Chemistry, American University of Beirut, Beirut, Lebanon
  1. Correspondence to Dr Theodore L Wagener, Center for Tobacco Research, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; Theodore.Wagener{at}osumc.edu

Abstract

Introduction The present study examined how the lack of characterising flavours and low levels of humectants may affect users’ waterpipe tobacco (WT) smoking topography, subjective effects, toxicant exposure and intentions for continued use.

Methods 89 WT smokers completed four ad libitum smoking sessions (characterising flavor/high humectant (+F+H); characterising flavor/low humectant (+F-H); no characterising flavor/high humectant (-F+H); no characterising flavor/low humectant (-F-H)) in a randomised cross-over design. WT was commercially available; same brand but nicotine levels were not held constant. A subsample (n=50) completed a standardised, 10-puff session preceding ad libitum smoking. Participants completed questionnaires, exhaled carbon monoxide (eCO) testing and provided blood samples for plasma nicotine. Smoking topography was measured throughout the session. Post hoc analyses showed that -F+H and -F-H did not differ significantly in humectant levels. Therefore, these groups were collapsed in analyses (-F-H).

Results WT smokers reported significantly greater satisfaction, liking, enjoyment and greater intentions for continued use when smoking +F+H compared with other WT products, with -F-H receiving the lowest ratings. Significant differences in topography were observed during standardised and ad libitum sessions, with the -F-H preparation leading to greater total inhaled volume and eCO boost, but lower nicotine boost compared with +F+H (all p<0.05).

Discussion The findings demonstrate the importance of flavours and humectants on improving WT smoking experience and increasing the likelihood that users will want to initiate and continue smoking. Moreover, it demonstrates that flavours and humectants influence smoking behaviour and toxicant exposure in some unexpected ways that are important for regulatory efforts.

  • addiction
  • non-cigarette tobacco products
  • prevention
  • public policy
  • smoking topography
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Footnotes

  • Twitter @TheodoreWagener

  • Contributors All of the authors contributed to the conceptualisation and preparation of the manuscript. TLW drafted the manuscript. JH conducted data analysis. All authors made revisions to the initial draft. TLW and ELSL incorporated the revisions, and edited and finalised the manuscript.

  • Funding This study was funded by National Institute on Drug Abuse and Center for Tobacco Products of the US Food and Drug Administration (Grant: R03 DA041928, R03 DA041928 02S1).

  • Disclaimer Research reported in this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration

  • Competing interests TE is a paid consultant in litigation against the tobacco industry and the electronic cigarette industry, and is named on a patent for a device that measures the puffing behaviour of electronic cigarette users.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the university’s institutional review board.

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

  • Data availability statement No data are available.

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