Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects

Nicotine Tob Res. 2011 Feb;13(2):78-87. doi: 10.1093/ntr/ntq212. Epub 2010 Dec 2.


Introduction: Waterpipe tobacco smoking is increasing worldwide and is believed by many users to be less harmful and addictive than cigarette smoking. In fact, waterpipe tobacco and cigarette smoke contain many of the same chemicals, and users are exposed to the dependence-producing drug nicotine as well as other smoke toxicants. The subjective effect profile of these 2 tobacco use methods has not been compared directly, though this information is relevant to understanding the risk of dependence development.

Methods: Fifty-four participants who reported waterpipe and cigarette smoking completed 2, 45-min, counter-balanced sessions in which they completed a waterpipe use episode (mean smoking time = 43.3 min) or a cigarette (mean = 6.1 min). Outcome measures included plasma nicotine, carboxyhemoglobin (COHb), and subjective effects, including those relevant to predicting dependence potential.

Results: Mean (±SEM) peak plasma nicotine concentration did not differ by session (waterpipe = 9.8 ± 1.0 ng/ml; cigarette = 9.4 ± 1.0 ng/ml). Mean peak COHb concentration differed significantly (waterpipe = 4.5% ± 0.3%; cigarette = 1.2% ± 0.1%). Subjective effect changes for waterpipe and cigarette were comparable in magnitude but often longer lived for waterpipe.

Conclusions: Relative to a cigarette, waterpipe tobacco smoking was associated with similar peak nicotine exposure, 3.75-fold greater COHb, and 56-fold greater inhaled smoke volume. Waterpipe and cigarette influenced many of the same subjective effect measures. These findings are consistent with the conclusion that waterpipe tobacco smoking presents substantial risk of dependence, disease, and death, and they can be incorporated into prevention interventions that might help deter more adolescents and young adults from experimenting with an almost certainly lethal method of tobacco use.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Inhalation
  • Adult
  • Carbon Monoxide / analysis
  • Carboxyhemoglobin / analysis*
  • Female
  • Humans
  • Inhalation Exposure / analysis*
  • Male
  • Middle Aged
  • Nicotine / analysis*
  • Smoking / adverse effects*
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution / analysis*
  • Tobacco Use Disorder / psychology*
  • Water
  • Young Adult


  • Tobacco Smoke Pollution
  • Water
  • Nicotine
  • Carbon Monoxide
  • Carboxyhemoglobin