Waterpipe tobacco smoke: toxicant exposure and effects

描述(申请人提供)：全球范围内，烟草使用每年造成490万人死亡，其中美国有40万人死亡。这些死亡是由吸入的烟雾毒物引起的，如致癌物、一氧化碳(CO)和一氧化氮(NO)。另一种烟雾毒物尼古丁，长时间使用会产生依赖。香烟烟雾毒物含量和吸烟者的毒物暴露已经被很好地表征，吸烟的主观和心血管影响也是如此。然而，在美国和全球，数以百万计的人使用水烟烟斗(水烟或水烟)来吸烟：吸烟者用加糖和调味的烟草填充“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半满的水碗、软管和吸嘴传递给使用者。在美国，吸食水烟的人数正在增加，特别是在大学生中，他们的流行率可能达到15%-20%。相对于一支香烟，一次水烟使用事件可以产生100倍的烟雾，使用者暴露的毒物、影响和吸烟的有毒物质含量基本上是未知的。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团体一起使用。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)了解个别水管使用者接触有毒物质的情况、影响及烟雾有毒物质的含量。在两个单独的会议中，130名水烟使用者(65名报告2-5次/月和65名报告&>21次/月)将使用装有首选品牌/味道的水烟或安慰剂的水烟。结果测量包括CO和NO、血浆尼古丁、主观、心血管和肺反应，以及喷烟地形(喷烟数量、容量、持续时间和喷烟间隔)。地形记录将在分析实验室中重播，以研究烟雾毒物含量和细胞毒性/诱变性。2)了解集体使用如何影响水管毒物的暴露、效果和烟雾毒物含量。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集体水烟吸烟者。在一项由观察性研究结果提供信息的实验室研究中，65个共享水烟斗的小组将在一次会议中作为一组使用实验室中的水烟，在另一次会议中作为个人使用，并将评估使用者的毒物暴露和影响，以及烟雾毒物含量，如研究1)比较水烟吸烟和吸烟的毒物暴露和影响。在两个疗程中，100名也吸烟的水烟斗使用者要么使用水烟斗，要么吸烟；结果测量包括接触一氧化碳、一氧化氮和尼古丁，以及心血管、呼吸系统和主观影响。在美国的年轻人中，使用水管的现象令人不安。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，同时以一种提高公共健康的方式塑造知识、观点和态度。这个项目与公众健康相关，因为在全国烟草使用流行病中，水烟吸烟是一种鲜为人知但迅速出现的菌株。该项目将通过向使用者揭示个人和团体产生的水烟烟雾的毒物暴露、主观、心血管和肺部影响，以及水烟烟雾的细胞遗传学和致突变性，为防止水烟吸烟在很大程度上导致烟草发病率和死亡率的新努力提供信息；它还将解决经常但可能是错误的关于水烟过滤和相对于香烟烟雾的较低毒物水平的陈述。烟草吸烟的这类研究对健康的积极影响是有据可查的；该项目寻求对另一种可能致命的烟草使用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.