Acute effects of waterpipe tobacco smoking: a double-blind, placebo-control study

Abstract

Background: Waterpipe tobacco smoking usually involves heating flavored tobacco with charcoal and inhaling the resulting smoke after it has passed through water. Waterpipe tobacco smoking increases heart rate and produces subjective effects similar to those reported by cigarette smokers. These responses are thought to be nicotine-mediated, though no placebo-control studies exist. Accordingly, this double-blind, placebo-control study compared the acute physiological and subjective effects of waterpipe tobacco smoking to those produced when participants used a waterpipe to smoke a flavor-matched, tobacco-free preparation.

Methods: Occasional waterpipe tobacco smokers (n = 37; 2-5 monthly smoking episodes for ≥ 6 months) completed two double-blind, counterbalanced sessions that differed by product: preferred brand/flavor of waterpipe tobacco or flavor-matched, tobacco-free preparation. For each 45-min, ad lib smoking episode blood and expired air CO were sampled, cardiovascular and respiratory response were measured, and subjective response was assessed.

Results: Waterpipe tobacco smoking significantly increased mean (± SEM) plasma nicotine concentration (3.6 ± 0.7 ng/ml) and heart rate (8.6 ± 1.4 bpm) while placebo did not (0.1 ± 0.0 ng/ml; 1.3 ± 0.9b pm). For carboxyhemoglobin (COHb) and expired air CO, significant increases were observed for tobacco (3.8 ± 0.4%; 27.9 ± 2.6 ppm) and for placebo (3.9 ± 0.4%; 27.7 ± 3.3 ppm) with no differences across condition. Independent of condition, symptoms of nicotine/tobacco abstinence (e.g., "urges to smoke", "anxious") were reduced and direct effects (e.g., "dizzy", "satisfy") increased.

Discussion: These results from the first placebo-control study of waterpipe tobacco smoking demonstrate that waterpipe-induced heart rate increases are almost certainly mediated by nicotine though the subjective effects observed in these occasional smokers were not.

Figure 1

Means (±1 SEM) for plasma nicotine (A), HR (B), COHb (C), and systolic BP (D) for active and placebo waterpipe tobacco conditions. The timepoint “45+” refers to the fact that some participants (n=12) smoked longer than the minimum 45 minute bout. Filled symbols indicate a significant difference from baseline and asterisks (*) indicate a significant difference between active and placebo conditions at that timepoint (Tukey’s HSD; P<.05).

Figure 2

Means (±1 SEM) for Hughes-Hatsukami item “Urges to smoke a waterpipe” (A), Tiffany-Drobes QSU Brief Factor 1 (intention to smoke) (B), and DETS items “Was the waterpipe satisfying?” (C), “Was the waterpipe pleasant?” (D), “Did the waterpipe taste good?” (E), and “Did the waterpipe taste bad?” (F). All items significant for main effect of time (F’s> 6.7; P’s<.05). Item “Was the waterpipe satisfying?” significant for main effect of condition (F = 5.9; P<.05). Filled symbols indicate a significant difference from baseline and asterisks (*) indicate a significant difference between active and placebo at that timepoint (Tukey’s HSD; P<.05).

Figure 3

Means (±1 SEM) for topography variables total puff volume (A), puff volume (B), puff number (C), and IPI (D) Filled symbols indicate a significant difference from baseline (Tukey’s HSD; P<.05). Post-hoc tests failed to reveal any time points at which any topography measure differed by condition.