title: CO exposure and puff topography are associated with Lebanese waterpipe dependence scale score.
abstract: BACKGROUND
  Waterpipe tobacco smoking involves self-administration of the dependence-producing drug nicotine. Few studies have examined if dependence in waterpipe smokers influences toxicant exposure and smoking behavior.
  
  
  METHODS
  Current waterpipe tobacco smokers were categorized based on Lebanese Waterpipe Dependence Scale-11 (LWDS-11) score (LWDS-11: LOW < 7; N = 59; HIGH > 13; N = 59). Participants abstained from smoking for 12 hr and then completed a single 30-min waterpipe tobacco smoking episode. Expired-air carbon monoxide (CO) was measured before and 5 min after smoking and puff topography was measured during smoking.
  
  
  RESULTS
  Total mean smoking time was 30.9 min (SD = 3.5) and did not differ significantly by LWDS-11 score. CO boost was greater for participants in the HIGH versus LOW groups (62.3 vs. 43.6 ppm, p < .01). Similarly, those in the HIGH versus LOW group took more puffs (198.6 vs. 157.1 puffs, p < .01), longer duration puffs (2.7 vs. 2.3 s, p < .05), puffs with lower flow rate (10.3 vs. 12.6 L/min, p < .01), and less time between puffs (8.0 vs. 12.4 s, p < .001).
  
  
  CONCLUSIONS
  The puff topography of waterpipe tobacco smokers can be predicted by LWDS-11 score, with those scoring higher taking longer duration and lower velocity puffs at a higher frequency. These behavioral differences may underlie the 40% greater CO exposure observed for those with higher LWDS-11 scores. To the extent that waterpipe dependence is associated with more smoke inhalation, more dependent smokers will be exposed to greater amounts of toxic smoke constituents.
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan;
authors.forename: Karem H
authors.initials: KH
authors.lastname: Alzoubi
authors.forename: Omar F
authors.initials: OF
authors.lastname: Khabour
authors.forename: Mohammed
authors.initials: M
authors.lastname: Azab
authors.forename: Dana M
authors.initials: DM
authors.lastname: Shqair
authors.forename: Alan
authors.initials: A
authors.lastname: Shihadeh
authors.forename: Brian
authors.initials: B
authors.lastname: Primack
authors.forename: Thomas
authors.initials: T
authors.lastname: Eissenberg
mesh_terms: D000328:Adult; D002248:Carbon Monoxide / Q000633:toxicity*; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D007861:Lebanon; D008297:Male; D012907:Smoking / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014029:Tobacco Use Disorder / Q000209:etiology*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D002248:Carbon Monoxide