Waterpipe tobacco smoke: toxicant exposure and effects

描述（由申请人提供）：在全球范围内，烟草使用每年导致490万人死亡，其中包括美国的40万人。这些死亡是由吸入的烟雾有毒物质如致癌物、一氧化碳（CO）和一氧化氮（NO）引起的。另一种有毒的烟，尼古丁，长期使用会产生依赖性。香烟烟雾有毒物质含量和吸烟者有毒物质暴露已得到很好的表征，因为吸烟的主观和心血管影响。然而，在美国和全球范围内，数百万人使用水管（水烟或水烟）来吸烟：吸烟者用甜味和调味烟草填充“头部”，用穿孔铝箔覆盖，并在铝箔上涂上点燃的木炭。木炭和烟草烟雾通过一个半满的水碗、软管和烟嘴传递给用户。在美国，水烟的吸烟率正在上升，特别是在患病率可能为15- 20%的大学生中。相对于一支香烟，一次水管使用事件可以产生100倍的烟雾，用户有毒物质暴露，影响和烟雾有毒物质含量在很大程度上是未知的。这些结果可能取决于个人的使用频率以及个人是单独使用水管还是与一群人一起使用水管。该项目结合了临床实验室方法，分析化学和细胞生物学，以实现三个具体目标。1)了解个人水管用户有毒暴露，影响和烟雾有毒物质的内容。在两个单独的阶段中，130名水管使用者（65名报告2-5次使用/月，65名报告> 21次使用/月）将使用装有首选品牌/口味的水管烟草或安慰剂的水管。结果指标包括CO和NO、血浆尼古丁、主观、心血管和肺部反应以及抽吸地形图（抽吸次数、体积、持续时间和抽吸间隔）。将在分析实验室中重放地形记录，以研究烟雾毒物含量和细胞毒性/致突变性。2)了解团体使用如何影响水管有毒物质暴露，效果和烟雾有毒物质含量。在一项观察性研究中，训练有素的工作人员将使用严格的采样和数据收集程序来研究当地咖啡馆的水烟吸烟人群。在一项由观察性研究结果提供信息的实验室研究中，65个水管共享组将在实验室中使用水管，在一个阶段中作为一个组，在另一个阶段中作为个体，并将如研究1中那样评估用户毒物暴露和影响以及烟雾毒物含量。3)比较水烟与普通香烟的毒物暴露及影响。在两个阶段中，100名同时吸烟的水管使用者将使用水管或吸烟;结果测量包括暴露于CO，NO和尼古丁，以及心血管，呼吸和主观影响。使用水管在美国年轻人中非常普遍。需要更多关于水管效应的信息，可以从临床实验室研究和烟雾毒物分析中获得。这些信息对于理解这种潜在的危险行为是必要的，同时以增强公共健康的方式塑造知识，意见和态度。该项目与公共卫生有关，因为水烟是一种鲜为人知但在全国烟草使用流行中迅速出现的菌株。该项目将通过揭示使用者接触有毒物质、主观、心血管和肺部影响以及个人和群体产生的水烟烟雾的细胞原性和致突变性，为防止吸食水烟大大增加烟草发病率和死亡率的新努力提供信息;它还将解决关于水管过滤和相对于香烟烟雾较低的有毒物水平的经常但可能是错误的陈述。这类关于吸烟的研究对健康的积极影响有充分的记录;本项目寻求对另一种可能致命的烟草使用形式产生类似的积极结果。

DESCRIPTION (provided by applicant): Globally, tobacco use accounts for 4.9 million deaths each year, including 400,000 in the U.S. These deaths are caused by inhaled smoke toxicants like carcinogens, carbon monoxide (CO), and nitric oxide (NO). Another smoke toxicant, nicotine, produces dependence with prolonged use. Cigarette smoke toxicant content and smoker toxicant exposure has been well characterized, as have the subjective and cardiovascular effects of cigarette smoking. However, in the U.S. and globally, millions of people use waterpipes (hookah or shisha) to smoke tobacco: the smoker fills the "head" with sweetened and flavored tobacco, covers it with perforated aluminum foil, and tops the foil with lit charcoal. Charcoal and tobacco smoke pass to the user via a half-filled water bowl, hose, and mouthpiece. Waterpipe tobacco smoking is increasing in the U.S., especially among college students for whom prevalence rates may be 15-20%. Relative to one cigarette, one waterpipe use episode can generate 100 times the smoke, with user toxicant exposure, effects, and smoke toxicant content that are largely unknown. These outcomes may depend upon an individual's use frequency and whether the individual uses the waterpipe alone or with a group. This project combines clinical laboratory methods, analytical chemistry, and cellular biology to achieve three specific aims. 1) Learn about individual waterpipe user toxicant exposure, effects, and smoke toxicant content. In two separate sessions, 130 waterpipe users (65 reporting 2-5 uses/month and 65 reporting > 21 uses/month) will use a waterpipe loaded with preferred brand/flavor of waterpipe tobacco or placebo. Outcome measures include CO and NO, plasma nicotine, subjective, cardiovascular, and pulmonary response, and puff topography (puff number, volume, duration, and interpuff interval). Topography records will be replayed in an analytical laboratory to study smoke toxicant content and cytotoxicity/mutagenicity. 2) Learn how group use influences waterpipe toxicant exposure, effect, and smoke toxicant content. In an observational study, trained staff will use rigorous sampling and data collection procedures to study group waterpipe tobacco smoking in local cafs. In a laboratory study informed by observational study results, 65 waterpipe- sharing groups will use a waterpipe in the laboratory as a group in one session, and as individuals in another session, and user toxicant exposure and effects, and smoke toxicant content will be assessed as in Study 1. 3) Compare the toxicant exposure and effects of waterpipe tobacco smoking and cigarette smoking. In two sessions, 100 waterpipe users who also smoke cigarettes will either use a waterpipe or smoke a cigarette; outcome measures include exposure to CO, NO, and nicotine, as well as cardiovascular, respiratory, and subjective effects. Waterpipe use is disturbingly common among U.S. young adults. More information is needed about waterpipe effects, and it can be obtained from clinical laboratory studies and smoke toxicant analysis. This information is necessary to understand this potentially dangerous behavior, while shaping knowledge, opinions, and attitudes in a way that enhances public health. This project is relevant to public health because waterpipe tobacco smoking is a little-understood but rapidly emerging strain in the nation's tobacco use epidemic. The project will inform nascent efforts to prevent waterpipe tobacco smoking from contributing substantially to tobacco's morbidity and mortality by revealing the user toxicant exposure, subjective, cardiovascular, and pulmonary effects, and cytogenicity and mutagenicity of waterpipe tobacco smoke produced by individuals and groups; it will also address frequent but probably erroneous statements regarding waterpipe filtering and lower toxicant levels relative to cigarette smoke. The positive health impact of this type of research on tobacco cigarette smoking is well-documented; this project seeks similar positive outcomes on another potentially lethal form of tobacco use.