RT Journal Article
SR Electronic
T1 Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use
JF Tobacco Control
JO Tob Control
FD BMJ Publishing Group Ltd
SP tobaccocontrol-2019-055509
DO 10.1136/tobaccocontrol-2019-055509
A1 Theodore L Wagener
A1 Eleanor L S Leavens
A1 Toral Mehta
A1 Jessica Hale
A1 Alan Shihadeh
A1 Thomas Eissenberg
A1 Matthew Halquist
A1 Marielle C Brinkman
A1 Amanda L Johnson
A1 Evan L Floyd
A1 Kai Ding
A1 Rachel El Hage
A1 Rola Salman
YR 2020
UL http://tobaccocontrol.bmj.com/content/early/2020/05/13/tobaccocontrol-2019-055509.abstract
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.