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。另一种烟雾毒物尼古丁，长期使用会产生依赖性。香烟烟雾中有毒物质的含量和吸烟者接触有毒物质的情况，以及吸烟对主观和心血管的影响，已经得到了很好的描述。然而，在美国和全球范围内，数以百万计的人使用水烟（水烟或水烟）吸烟：吸烟者在“头部”填满甜味和调味烟草，用穿孔铝箔覆盖，并在铝箔上点燃木炭。木炭和烟草烟雾通过半灌满水的碗、软管和吸嘴传递给使用者。水烟吸烟在美国正在增加，尤其是在大学生中，其患病率可能为15-20%。相对于一支香烟，一次使用水烟可以产生100倍的烟雾，使用者接触的有毒物质、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。该项目结合了临床实验室方法、分析化学和细胞生物学来实现三个特定目标。1)了解每个水管使用者的有毒物质暴露、影响和烟雾有毒物质含量。在两个独立的实验中，130名水烟使用者（65名报告每月使用2-5次，65名报告每月使用21次）将使用装有首选品牌/口味的水烟或安慰剂的水烟。结果测量包括一氧化碳和一氧化氮、血浆尼古丁、主观、心血管和肺部反应以及抽吸地形（抽吸次数、体积、持续时间和间隔时间）。地形记录将在分析实验室中重复播放，以研究烟雾毒性含量和细胞毒性/诱变性。2)了解群体使用如何影响水管毒物暴露、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抽样和数据收集程序来研究当地咖啡馆的水烟吸烟情况。在一项由观察性研究结果提供信息的实验室研究中，65个水管共用小组将在实验室中以小组形式使用水管，在另一阶段以个人形式使用水管，并且将像研究1中那样评估使用者有毒物质的暴露和影响，以及烟雾有毒物质的含量。3)比较水烟和卷烟的毒物暴露和影响。在两次会议中，100名同时吸烟的水烟使用者要么使用水烟，要么吸烟；结果测量包括暴露于一氧化碳、一氧化氮和尼古丁，以及心血管、呼吸和主观影响。在美国年轻人中，水管的使用令人不安地普遍。需要更多关于水管效应的信息，这些信息可以从临床实验室研究和烟雾毒性分析中获得。这些信息对于了解这种潜在的危险行为是必要的，同时以一种增强公共卫生的方式形成知识、意见和态度。该项目与公共卫生有关，因为水烟吸烟是一种鲜为人知但迅速出现的国家烟草使用流行病。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诱变性，为防止水烟吸烟大大增加烟草发病率和死亡率的初步努力提供信息；它还将解决关于水管过滤和相对于香烟烟雾的毒性水平较低的常见但可能错误的陈述。这类关于吸烟的研究对健康的积极影响有据可查；该项目寻求在另一种可能致命的烟草使用形式上取得类似的积极成果。

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.