title: Nicotine, carbon monoxide, and carcinogen exposure after a single use of a water pipe.
abstract: BACKGROUND
  Smoking tobacco preparations in a water pipe (hookah) is widespread in many places of the world, including the United States, where it is especially popular among young people. Many perceive water pipe smoking to be less hazardous than cigarette smoking. We studied systemic absorption of nicotine, carbon monoxide, and carcinogens from one water pipe smoking session.
  
  
  METHODS
  Sixteen subjects smoked a water pipe on a clinical research ward. Expired carbon monoxide and carboxyhemoglobin were measured, plasma samples were analyzed for nicotine concentrations, and urine samples were analyzed for the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and polycyclic aromatic hydrocarbon (PAH) metabolite biomarker concentrations.
  
  
  RESULTS
  We found substantial increases in plasma nicotine concentrations, comparable to cigarette smoking, and increases in carbon monoxide levels that are much higher than those typically observed from cigarette smoking, as previously published. Urinary excretion of NNAL and PAH biomarkers increased significantly following water pipe smoking.
  
  
  CONCLUSIONS
  Absorption of nicotine in amounts comparable to cigarette smoking indicates a potential for addiction, and absorption of significant amounts of carcinogens raise concerns of cancer risk in people who smoke tobacco products in water pipes.
  
  
  CONCLUSIONS
  Our data contribute to an understanding of the health impact of water pipe use.
authors: Division of Clinical Pharmacology, University of California, San Francisco, San Francisco General Hospital, Building 100, San Francisco, CA 94110, USA. peyton.jacob@ucsf.edu
authors: Peyton
authors: P
authors: Jacob
authors: Ahmad H
authors: AH
authors: Abu Raddaha
authors: Delia
authors: D
authors: Dempsey
authors: Christopher
authors: C
authors: Havel
authors: Margaret
authors: M
authors: Peng
authors: Lisa
authors: L
authors: Yu
authors: Neal L
authors: NL
authors: Benowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D002248:Carbon Monoxide / Q000032:analysis / Q000493:pharmacokinetics*; D002273:Carcinogens / Q000032:analysis / Q000493:pharmacokinetics*; D002274:Carcinogens, Environmental / Q000032:analysis / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000032:analysis / Q000493:pharmacokinetics*; D011084:Polycyclic Aromatic Hydrocarbons / Q000032:analysis / Q000493:pharmacokinetics; D012906:Smoke; D012907:Smoking / Q000097:blood / Q000378:metabolism*; D011795:Surveys and Questionnaires; D055815:Young Adult; D014026:Nicotiana
chemical_list: D002273:Carcinogens; D002274:Carcinogens, Environmental; D011084:Polycyclic Aromatic Hydrocarbons; D012906:Smoke; D009538:Nicotine; D002248:Carbon Monoxide