LAUSR

Waterpipe tobacco smoking (WTS) has been characterized as a global epidemic. Waterpipe smoke has been shown to contain and deliver significant doses of many of the toxicants known to cause cancer, respiratory, and cardiovascular diseases in cigarette smokers. It has also been shown that the charcoal used to heat the tobacco contributes most of the polycyclic aromatic hydrocarbons (PAHs) and carbon monoxide (CO) found in the smoke, two major causative agents in smoking-related lung cancer and heart disease, respectively. Possibly as a result of growing awareness of charcoal as a toxicant source, electrical heating elements (EHEs) are being marketed for waterpipe use as reduced harm charcoal substitutes. We measured thermal performance characteristics (tobacco burned, total aerosolized particulate matter) and toxicant emissions in WTS generated using three commercially available waterpipe EHEs and charcoal to examine the hypothesis that EHEs can function similarly to charcoal while presenting a reduced toxicant profile. Toxicants quantified included total particulate matter, nicotine, PAHs, CO, and volatile aldehydes delivered at the mouthpiece when the waterpipe was machine smoked using a standard protocol. We found that while EHEs involved an 80% reduction in total PAH and a 90% reduction in CO emissions, they also resulted in a several-fold increase in the potent respiratory toxicant acrolein. These mixed findings underscore the complexity of toxicant reduction by product manipulation and suggest that marketing EHEs as reduced harm products may be misleading.