Nicotine and carcinogen exposure after water pipe smoking in hookah bars.
BACKGROUND
Water pipe tobacco smoking is spreading globally and is increasingly becoming popular in the United States, particularly among young people. Although many perceive water pipe smoking to be relatively safe, clinical experimental studies indicate significant exposures to tobacco smoke carcinogens following water pipe use. We investigated biomarkers of nicotine intake and carcinogen exposure from water pipe smoking in the naturalistic setting of hookah bars.


METHODS
Fifty-five experienced water pipe users were studied before and after smoking water pipe in their customary way in a hookah bar. Urine samples were analyzed for nicotine, cotinine, the tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and mercapturic acid metabolites of volatile organic compounds (VOC).


RESULTS
We found an average 73-fold increase in nicotine, 4-fold increase in cotinine, 2-fold increase in NNAL, and 14% to 91% increase in VOC mercapturic acid metabolites immediately following water pipe smoking. We saw moderate to high correlations between changes in tobacco-specific biomarkers (nicotine, cotinine, and NNAL) and several mercapturic acid metabolites of VOCs.


CONCLUSIONS
Water pipe smoking in a hookah bar is associated with significant nicotine intake and carcinogen exposure.


CONCLUSIONS
Given the significant intake of nicotine and carcinogens, chronic water pipe use could place users at increased risk of cancer and other chronic diseases. Cancer Epidemiol Biomarkers Prev; 23(6); 1055-66. ©2014 AACR.
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Gideon
G
St Helen
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Neal L
NL
Benowitz
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Katherine M
KM
Dains
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Christopher
C
Havel
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.
Margaret
M
Peng
Authors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CaliforniaAuthors' Affiliations: Center for Tobacco Control Research and Education, University of California, San Francisco; Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center; Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, California pjacob@medsfgh.ucsf.edu.
Peyton
P
Jacob
D000328:Adult; D002273:Carcinogens / Q000032:analysis*; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000009:adverse effects*; D012907:Smoking / Q000009:adverse effects*; D055549:Volatile Organic Compounds; D055815:Young Adult; D014026:Nicotiana
D002273:Carcinogens; D055549:Volatile Organic Compounds; D009538:Nicotine