Understanding the effect of waterpipe size on smoking behavior, toxicant exposures and subjective experiences

水烟管（WP）吸烟-也被称为水烟-仍然是一种流行的烟草方法 吸烟在美国（美国），特别是年轻人。类似香烟，积累证据 研究表明，可湿性粉剂吸烟可导致尼古丁依赖、肺癌和心肺疾病。 认识到WP在美国流行的严重性，食品和药物管理局（FDA）现在 规范WP产品的生产、销售和分销，包括不同的成分， WP设备的配置。然而，针对WP的法规仍然有限。主要监管之一 具有很大潜力的WP控制路线是WP设备的大小。与传统香烟相比， WPs是以标准尺寸制造的，WPs有多种尺寸可供选择，这些尺寸在管道高度上可能会有很大差异 和碗体积。关于与可湿性粉剂吸烟相关的有毒物质暴露的证据趋同 表明WP大小是确定一氧化碳（CO）和其他有毒物质暴露的重要因素 排放此外，公众普遍存在一种误解，即认为 WP吸烟大多数可湿性粉剂吸烟者认为可湿性粉剂比香烟成瘾性小，危害小 smoking.这种误解是加强了营销的较小尺寸的可湿性粉剂。事实上，许多在线WP 美国的零售商们在广告上说，小的可湿性粉剂（又名迷你水烟）是“第一个水烟的绝佳选择”和“最好的 这使得它们看起来像完美的“初学者尺寸”，否则WP天真的个人。 因此，符合逻辑的是，WP本身的维度将影响危害感知和吸烟行为 而这反过来又会改变可湿性粉剂吸烟者接触有毒物质如一氧化碳和尼古丁的水平。然而，在这方面， 关于WP规模影响的经验证据--从监管的角度来看，这是一个关键问题--对WP的影响 吸烟者的经验和暴露仍然缺乏。在本项目中，我们将评估 WP大小对WP吸烟者的吸烟行为、毒物暴露和主观体验的影响。我们 假设抽吸较小尺寸的WP将导致对抽吸参数的更显著的影响， 暴露于CO和尼古丁，伤害感知，满意度和渴望相比，吸烟更大的尺寸WP。 我们将招募40名年轻成年WP吸烟者（21-39岁）进行2X 3交叉研究设计，其中 受试者内因素为时间（WP吸烟前后）和研究条件（小WP vs.中WP vs.大WP WP）。因此，每个参与者将完成三个独立的WP吸烟会议（每次45分钟）， 不同的WP大小，而测量的粉扑地形，主观经验，伤害的看法， 将进行尼古丁和CO暴露。这个项目是创新的，因为它将提供第一个证据， 指导FDA监管WP大小对吸烟者体验和暴露的潜在影响。 最重要的是，该项目将帮助FDA制定特定尺寸的监管标准，以控制 营销和销售WP设备，并保护公众健康。

Waterpipe (WP) tobacco smoking—also known as hookah—continues to be a popular method of tobacco smoking in the United States (US), particularly among young adults. Similar to cigarettes, accumulating evidence shows that WP smoking can lead to nicotine dependence, lung cancer and cardiopulmonary diseases. Recognizing the seriousness of the WP epidemic in the US, the Food and Drug Administration (FDA) now regulates the manufacture, sale, and distribution of WP products, including the different components and configurations of the WP device. However, regulations specific to WP remains limited. One of the main regulatory routes with great potential for WP control is the size of the WP device. Compared with traditional cigarettes that are manufactured in standard sizes, WPs are available in many sizes that can vary significantly in pipe height and bowl volume. Converging lines of evidence regarding the toxicant exposure associated with WP smoking indicate that WP size is an important factor in determining exposures to carbon monoxide (CO) and other toxicant emissions. In addition, there is a prevailing public misconception regarding the perception of harm attributed to WP smoking. The majority of WP smokers believe that WP is less addictive and less harmful than cigarette smoking. Such misconceptions are reinforced by the marketing of smaller sizes of WP. In fact, many online WP retailers in the US advertise small WPs (aka, mini hookahs) as “excellent choice for a first hookah” and “best hookahs for beginners” which make them appear like perfect “starter sizes” for otherwise WP-naïve individuals. Therefore, it is logical that the dimensions of the WP itself will influence harm perception and smoking behavior and in turn will alter the levels of exposure to toxicants such as CO and nicotine among WP smokers. However, empirical evidence regarding the effect of WP size–a key question from a regulatory standpoint–on WP smokers' experiences and exposures continues to be lacking. In this project, we will assess the effect of WP size on smoking behavior, toxicant exposures and subjective experiences among WP smokers. We hypothesize that smoking a smaller size WP will lead to a more pronounced effect on puffing parameters, exposure to CO and nicotine, harm perception, satisfaction and craving compared to smoking a larger size WP. We will enroll 40 young adult WP smokers (21-39 years) to undergo a 2X3 crossover study design, where the within-subject factors are time (pre-post WP smoking) and study condition (small WP vs. medium WP vs. large WP). Accordingly, each participant will complete three independent sessions of WP smoking (45 min each) that differ by WP size, while measurement of puff topography, subjective experiences, harm perception, and exposure to nicotine and CO will be conducted. This project is innovative because it will provide the first evidence to guide the FDA in terms of the potential impact of regulating WP size on smokers’ experiences and exposures. Most importantly, this project will help the FDA in developing size-specific regulatory standards to control the marketing and sales of WP devices and to protect public health.