Effect of Alcohol Use on Waterpipe Smoking Patterns and Toxicant Exposure - Project Title: Effect of Alcohol Use on Waterpipe Smoking Patterns and Toxicant Exposure
Project Summary/ Abstract:
Waterpipe (WP) smoking in the US is on the rise and beginning to overtake cigarettes as the most popular
method of tobacco use among young adults. Unfortunately, WP smoking is associated with many of the same
negative health outcomes as cigarettes such as cancer, lung disease, respiratory illness, and cardiovascular
disease. The co-occurrence of alcohol use and WP smoking is quite common among young adults. Relative to
those who do not use WP, WP smokers are estimated to be more than twice as likely to use alcohol and
frequently consume alcohol immediately before or during a WP smoking session. Of concern, the cigarette
smoking literature suggests that smokers smoke more cigarettes when they drink alcohol and have a more
difficult time abstaining from smoking, resulting in more exposure to nicotine and tobacco-related toxicants.
These findings cannot be directly applied to WP smoking due to unique aspects of WP smoking (e.g., smoking
patterns, smoke may be easier to inhale, WP is typically smoked in groups). To date, no study has
experimentally and systematically investigated the impact of alcohol on WP smoking behaviors, resultant
exposure to tobacco-related toxicants, or abuse liability. The proposed study will provide this needed scientific
evidence. Using a randomized crossover-design, 40 current WP smokers will complete two counterbalanced
WP smoking sessions (alcohol vs. placebo) that are preceded by 24 hours of alcohol abstinence and 12-hour
tobacco abstinence. Sessions will be separated by a standard 48-hour washout period, and WP tobacco
nicotine levels will be held constant across sessions. Measures of smoking behavior (puff topography) and
acute toxicant exposure (CO boost and plasma nicotine) will be collected, in addition to self-report measures of
abuse liability, intentions for continued use, and importance of concurrent alcohol consumption for using WP. If
alcohol consumption were determined to influence users to initially try WP, increase their willingness to
continue to use the product, and/or make it more palatable to puff more frequently or take longer/deeper puffs,
then concurrent alcohol use would be contributing to the initiation and maintenance of WP dependence. This
innovative study, in its systematic examination of the impact of co-use of alcohol and WP, will provide the
scientific foundation needed to establish effective regulatory strategies for the distribution and sales of WP
tobacco and alcohol. In addition, this project will serve as an incredibly valuable training experience by
providing an opportunity to learn new assessments of WP smoking and drug-drug interactions while learning
from leading experts in the field of WP smoking and gaining an appreciation for interdisciplinary collaboration.
