PT  - JOURNAL ARTICLE
AU  - Theodore L Wagener
AU  - Eleanor L S Leavens
AU  - Toral Mehta
AU  - Jessica Hale
AU  - Alan Shihadeh
AU  - Thomas Eissenberg
AU  - Matthew Halquist
AU  - Marielle C Brinkman
AU  - Amanda L Johnson
AU  - Evan L Floyd
AU  - Kai Ding
AU  - Rachel El Hage
AU  - Rola Salman
TI  - Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use
AID  - 10.1136/tobaccocontrol-2019-055509
DP  - 2020 May 13
TA  - Tobacco Control
PG  - tobaccocontrol-2019-055509
4099  - http://tobaccocontrol.bmj.com/content/early/2020/05/13/tobaccocontrol-2019-055509.short
4100  - http://tobaccocontrol.bmj.com/content/early/2020/05/13/tobaccocontrol-2019-055509.full
AB  - 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.