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

水烟斗(WP)吸烟--也被称为水烟--仍然是一种流行的烟草方式 在美国吸烟，特别是在年轻人中。类似于香烟，积累了证据 研究表明，吸烟可湿性粉会导致尼古丁依赖、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 管理可湿性粉剂产品的制造、销售和分销，包括不同的组件和 WP设备的配置。然而，针对可湿性粉剂的规定仍然有限。主要监管机构之一 可湿性粉剂控制潜力很大的路线是可湿性粉剂设备的大小。与传统香烟相比， 都是以标准尺寸制造的，WPS有许多尺寸可供选择，这些尺寸在管道高度上可能会有很大差异 和碗的体积。关于与吸食可湿性粉剂有关的毒物暴露的证据趋同 表明可湿性粉尘的大小是决定一氧化碳和其他毒物暴露的重要因素 排放。此外，公众普遍存在一种误解，认为 可湿性粉剂吸烟。大多数吸食可湿性粉剂的人认为可湿性粉剂比香烟更不容易上瘾，危害也更小。 抽烟。小尺寸可湿性粉剂的营销强化了这种误解。事实上，许多在线可湿性粉剂 美国零售商将小型水烟(又名迷你水烟)宣传为“第一个水烟的绝佳选择”和“最佳选择” 初学者水烟“，这使他们看起来像是完美的”初学者大小“，否则WP-天真的个人。 因此，可湿性粉剂本身的维度会影响伤害感知和吸烟行为是合乎逻辑的 进而改变可湿性粉剂吸烟者接触CO和尼古丁等有毒物质的水平。然而， 关于可湿性粉剂大小对可湿性粉剂影响的经验证据--从监管角度来看，这是一个关键问题 吸烟者的经验和暴露仍然缺乏。在这个项目中，我们将评估 可湿性粉剂对吸烟者吸烟行为、毒物暴露和主观体验的影响。我们 假设吸食较小尺寸的可湿性粉会对膨化参数产生更显著的影响， 与吸烟较大的可湿性粉剂相比，暴露在一氧化碳和尼古丁中，对伤害的感知、满足感和渴望。 我们将招募40名年轻的成年可湿性粉剂吸烟者(21-39岁)进行2X3交叉研究设计，其中 受试者内的因素是时间(吸食可湿性粉剂前)和研究条件(小型可湿性粉剂与中等可湿性粉剂与大型可湿性粉剂)。 WP)。因此，每个参与者将完成三次独立的可湿性粉剂吸烟(每次45分钟)， 不同的可湿性粉尘大小，而测量喷雾地形、主观体验、伤害感知和 将进行尼古丁和一氧化碳的接触。这个项目是创新的，因为它将提供第一个证据 就控制可湿性粉剂大小对吸烟者的体验和暴露的潜在影响方面指导FDA。 最重要的是，这个项目将帮助FDA制定特定尺寸的监管标准，以控制 营销和销售可湿性粉剂设备，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.