Research Article
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Nargile ve sigara içim şekillerinin ve maruz kalım oranlarının karşılaştırılması

Year 2014, Volume: 12 Issue: 3, 140 - 152, 30.12.2014
https://doi.org/10.20518/thsd.21703

Abstract

Amaç: Küresel olarak nargile kullanıcılarının sayısı yaklaşık 100 milyon kişi olmasına karşın, sigara içimi ile kıyaslandığında nargile ile ilgili daha az bilimsel çalışma bulunmaktadır. Bu araştırmanın amacı, nargile kullanımın giderek arttığı düşünülen Türkiye’de, nargile kullanıcılarının sigara kullanıcılarına kıyasla dumana maruz kalım ve içim dinamiklerinin değerlendirilmesidir. 

Yöntem:  İstanbul’dan olasılıklı olmayan örnekleme yöntemi ile nargile (n=20) ve sigara içicisi (n=110) kişiler çalışmaya dahil edilmiştir. Gerek nargile gerekse sigara içicileri benzer protokollerle takip edilerek, iki kez laboratuvar testine tabi tutulmuş, içim dinamikleri ve nefeslerindeki karbon monoksit (CO) oranının yanı sıra tükürük ve idrar örneklerinde sırasıyla kotinin ve 1-hidroksipiren (1-HOP) ölçümleri yapılmıştır. Sigara içenler iki laboratuar izlemi sırasında ve arada geçen 24 saatlik süre zarfında içtikleri bütün sigaralar için, nargile içenler ise özel tasarlanmış benzer bir içim kayıt cihazını iki kez sadece laboratuar ortamında kullanmışlardır. 

Bulgular: Ortalama olarak, her bir nargile içiminde inhale edilen duman hacmi sigara içicilerine göre 20 kat daha fazla olup, ölçümler sırasıyla 1077.63 ml (± 486.03)' ye karşı 55.96 ml (± 15.12)’dir. Nargile içicilerinde sigara içicilerine kıyasla nargile içimini takiben anlamlı olarak daha yüksek CO artışı görülmüştür (ortalamalar: 42.9'a karşı 4.2; p<0.001).  Sigara içicilerine kıyasla nargile içicilerinde daha düşük kotinin ve 1-Hidroksipiren (1-HOP) düzeyleri gözlenmiştir (p<0.001). 

Sonuç: Türkiye’de nargile içimi sırasında kullanıcılar daha fazla miktarda dumana ve daha yüksek CO düzeylerine maruz kalmaktadır. Ancak nargilenin kullanıcılar tarafından rapor edilen daha az sıklıkta içimine bağlı olarak, kullanıcıların diğer duman bileşenlerine sigaraya göre daha az düzeyde maruz kaldığı gözlenmektedir.  Nargile içimi esnasında maruz kalınan yüksek duman hacmi toplum sağlığı açısından endişe vericidir.

References

  • World Health Organisation. Tobacco Control in Turkey. Copenhagen: WHO Publications; 2009 [online]. Available at: http://www.euro.who.int/__data/assets/pd f_file/0004/98446/E93038.pdf. Dec 15, 2014.
  • Accessed 2. Turkish Ministry of Health. Global Adult Tobacco Survey Turkey Report. Ankara: Anil Matbaacilik, 2010 [online]. Available at: http://www.who.int/tobacco/surveillance/ en_tfi_gats_turkey_2009.pdf. Accessed Dec 15, 2014.
  • Erguder T, Çakır B, Aslan D, Warren CW, Jones NR, Asma S. Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey. BMC Public Health 2008;8(Suppl 1):S4.
  • WHO Europe. Tobacco control in Turkey: Story of commitment and leadership. Copenhagen: WHO Publications; 2012 [online].
  • http://www.euro.who.int/__data/assets/pd f_file/0009/163854/e96532.pdf?ua=1.
  • Accessed Dec 15, 2014.
  • at: 5. Adams P. Turkey's transformation. Bulletin of the World Health Organisation. 2012;90(6):408-409.
  • Maziak W. The global epidemic of waterpipe 2011;36(1):1-5. Addict
  • Behav 7. Akl EA, Gunukula SK, Aleem S, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health 2011;11:244. doi:10.1186/1471-2458-11- 244
  • Nakkash RT, Khalil J, Afifi RA. The rise in narghile (shisha, hookah) waterpipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers. BMC Public Health 2011;11(1):315. doi:10.1186/1471- 2458-11-315
  • Poyrazoglu S, Sarli S, Gencer Z, Günay O. Waterpipe (narghile) smoking among medical
  • students in Turkey. Ups J Med Sci 2010;115(3):210-216.
  • university 10. Subasi N, Bilir N, Erkan A, Avluk E, Kirmizigul E. Knowledge and attitudes of narghile 2005;6(2):137-143. Turk Thorax
  • J 11. Roskin J, Aveyard P. Canadian and English students' beliefs about waterpipe smoking: a qualitative study. BMC Public Health 2009;9(1):10. doi:10.1186/1471- 2458-9-10.
  • Smith-Simone S, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two US samples. Nicotine Tob Res 2008;10(2):393-398.
  • Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol 2010;39(3):834-857.
  • Malik S, Singh K. Smoking habits, chronic bronchitis and ventilatory function in rural males. Ind J Chest Dis All Sci 1978;20(2):73-79.
  • Mohammad Y, Kakah M. Chronic respiratory effect of narguileh smoking compared with cigarette smoking in women from the East Mediterranean region. Int J Chron Obstruct Pulmon Dis 2008;3(3):405- 414.
  • Sajid KM, Parveen R, Sabih D, et al. Carcinoembryonic antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers. 2007;57(12):595-599. Pak Med
  • Assoc 17. Sajid KM, Chaouachi K, Mahmood R. Hookah
  • Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduct J 2008;24;5:19. doi: 10.1186/1477- 7517-5-19. and
  • cancer. 18. Al-Kubati M, Al-Kubati A, al'Absi M, Fišer B. The short-term effect of water-pipe smoking on the baroreflex control of heart rate in normotensives. Auton Neurosci 2006;126(June 30):146-149.
  • Al-Safi SA, Ayoub NM, Albalas MA, Al- Doghim I, Aboul-Enein FH. Does shisha smoking affect blood pressure and heart rate? 2009;17(2):121-126. Pub
  • Health 20. Ashmawi M. Some predictive markers of artherosclerosis among smokers. Ain Shams Med J 1993;44(3):633-639.
  • Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics 2005;116(1):e113- e119. doi: 10.1542/peds.2004-2173.
  • Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prevent Med 2009;37(6):518-523.
  • Monzer B, Sepetdjian E, Saliba N, Shihadeh A. Charcoal emissions as a source of CO and carcinogenic PAH in mainstream narghile waterpipe smoke. Food Chem Toxicol 2008;46(9):2991-2995.
  • Shihadeh A, Eissenberg T. Tobacco smoking using a waterpipe: Product, prevalence,
  • pharmacological effects, and health hazards. In: Waterpipe Tobacco Smoking Building the Evidence Base Part 1: the smoke chemistry.
  • Development Research Centre; 2006. p. 1- 36 [online]. Available at: http://idl- bnc.idrc.ca/dspace/bitstream/10625/4588
  • /1/132376.pdf. Accessed Dec 15, 2014.
  • Katurji M, Daher N, Sheheitli H, Saleh R, Shihadeh A. Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique. Inhalation Toxicol 2010;22(13):1101-1109.
  • Jatlow P, Toll BA, Leary V, Krishnan- Sarin S, O’Malley SS. Comparison of expired carbon monoxide and plasma cotinine as markers of cigarette abstinence. Drug Alcohol Depend 2008;98(3):203-209.
  • Jongeneelen FJ. Benchmark guideline for urinary 1-hydroxypyrene as biomarker of occupational exposure to polycyclic aromatic hydrocarbons. Ann Occup Hyg 2001;45(1):3-13.
  • Lu PL, Chen ML, Mao IF. Urinary 1- hydroxypyrene levels in workers exposed to coke oven emissions at various locations in a coke oven plant. Arch Environ Health 2002;57(3):255-261.
  • Benowitz NL, Jacob P. Metabolism of nicotine to cotinine studied by a dual stable isotope method. Clin Pharmacol Ther 1994;56(5):483-493.
  • Cobb CO, Shihadeh A, Weaver MF, Eissenberg T. Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects. Nicotine Tob Res 2011;13(2):78-87.
  • Jacob P, Raddaha AHA, Dempsey D, et al. Nicotine, carbon monoxide, and carcinogen exposure after a single use of a water pipe. Cancer Epimiol Biomarkers Prev 2011;20(11):2345-2353.
  • Sepetdjian E, Saliba N, Shihadeh A. Carcinogenic PAH in waterpipe charcoal products. 2010;48(11):3242-3245. Chem
  • Toxicol 33. Maziak W, Rastam S, Ibrahim I, Ward KD, Shihadeh A, Eissenberg T. CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers. Nicotine Tob Res 2009;11(7):806-811.
  • La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. CJEM 2012;14(1):57-59.
  • Shahab L, West R, McNeill A. Clinical Study: A comparison of exposure to carcinogens among roll‐your‐own and factory‐made cigarette smokers. Addict Biol 2009;14(3):315-320.
  • Bedford Scientific Ltd. Smokerlyzer, Helping People to Stop Smoking with a Smokerlyzer® Available
  • http://www.bedfont.com/smokerlyzer.
  • Accessed Dec 17, 2014. Monitor [online]. at:

Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure

Year 2014, Volume: 12 Issue: 3, 140 - 152, 30.12.2014
https://doi.org/10.20518/thsd.21703

Abstract

Aim: It is estimated that globally there are about 100 million people who smoke waterpipes daily yet exposure resulting from smoking waterpipes is under-researched relative to cigarette smoking. This exploratory study assesses smoke exposure and puffing profiles among waterpipe smokers in comparison with cigarette smokers in Turkey, where there is a concern that waterpipe smoking prevalence is increasing. 

Method: A convenience sample of waterpipe (n=20) and cigarette smokers (n=110) was recruited from Istanbul, Turkey. Both waterpipe and cigarette smokers followed broadly a similar protocol with two visits to the laboratory where puff recordings, measurements of expired air carbon monoxide (CO) as well as saliva and urine samples for measurements of cotinine and 1-hydroxypyrene (1-HOP) were taken. Both group of smokers used specially designed puff recording devices to establish puffing profiles unique for cigarettes and waterpipes.

Results: On average, the volume of smoke inhaled from each puff of a waterpipe was almost 20 times greater than that from a manufactured cigarette: 1077.63 ml (±486.03) versus 55.96 ml (±15.12) respectively. Waterpipe smokers experienced significantly higher boosts of expired air CO following smoking a waterpipe in the laboratory compared with those smoking a cigarette, (means 42.9 versus 4.2; p<0.001). Lower levels of cotinine and 1-HOP were observed in waterpipe smokers compared with cigarette smokers (p<0.001). 

Conclusion: Waterpipe smokers in Turkey are exposed to larger volumes of smoke and higher CO levels, but less frequent nature of their smoking seems to be reflected in lower levels of exposure to other smoke constituents. The high smoke intake during waterpipe smoking is of public health concern.

References

  • World Health Organisation. Tobacco Control in Turkey. Copenhagen: WHO Publications; 2009 [online]. Available at: http://www.euro.who.int/__data/assets/pd f_file/0004/98446/E93038.pdf. Dec 15, 2014.
  • Accessed 2. Turkish Ministry of Health. Global Adult Tobacco Survey Turkey Report. Ankara: Anil Matbaacilik, 2010 [online]. Available at: http://www.who.int/tobacco/surveillance/ en_tfi_gats_turkey_2009.pdf. Accessed Dec 15, 2014.
  • Erguder T, Çakır B, Aslan D, Warren CW, Jones NR, Asma S. Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey. BMC Public Health 2008;8(Suppl 1):S4.
  • WHO Europe. Tobacco control in Turkey: Story of commitment and leadership. Copenhagen: WHO Publications; 2012 [online].
  • http://www.euro.who.int/__data/assets/pd f_file/0009/163854/e96532.pdf?ua=1.
  • Accessed Dec 15, 2014.
  • at: 5. Adams P. Turkey's transformation. Bulletin of the World Health Organisation. 2012;90(6):408-409.
  • Maziak W. The global epidemic of waterpipe 2011;36(1):1-5. Addict
  • Behav 7. Akl EA, Gunukula SK, Aleem S, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health 2011;11:244. doi:10.1186/1471-2458-11- 244
  • Nakkash RT, Khalil J, Afifi RA. The rise in narghile (shisha, hookah) waterpipe tobacco smoking: A qualitative study of perceptions of smokers and non smokers. BMC Public Health 2011;11(1):315. doi:10.1186/1471- 2458-11-315
  • Poyrazoglu S, Sarli S, Gencer Z, Günay O. Waterpipe (narghile) smoking among medical
  • students in Turkey. Ups J Med Sci 2010;115(3):210-216.
  • university 10. Subasi N, Bilir N, Erkan A, Avluk E, Kirmizigul E. Knowledge and attitudes of narghile 2005;6(2):137-143. Turk Thorax
  • J 11. Roskin J, Aveyard P. Canadian and English students' beliefs about waterpipe smoking: a qualitative study. BMC Public Health 2009;9(1):10. doi:10.1186/1471- 2458-9-10.
  • Smith-Simone S, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two US samples. Nicotine Tob Res 2008;10(2):393-398.
  • Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol 2010;39(3):834-857.
  • Malik S, Singh K. Smoking habits, chronic bronchitis and ventilatory function in rural males. Ind J Chest Dis All Sci 1978;20(2):73-79.
  • Mohammad Y, Kakah M. Chronic respiratory effect of narguileh smoking compared with cigarette smoking in women from the East Mediterranean region. Int J Chron Obstruct Pulmon Dis 2008;3(3):405- 414.
  • Sajid KM, Parveen R, Sabih D, et al. Carcinoembryonic antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers. 2007;57(12):595-599. Pak Med
  • Assoc 17. Sajid KM, Chaouachi K, Mahmood R. Hookah
  • Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduct J 2008;24;5:19. doi: 10.1186/1477- 7517-5-19. and
  • cancer. 18. Al-Kubati M, Al-Kubati A, al'Absi M, Fišer B. The short-term effect of water-pipe smoking on the baroreflex control of heart rate in normotensives. Auton Neurosci 2006;126(June 30):146-149.
  • Al-Safi SA, Ayoub NM, Albalas MA, Al- Doghim I, Aboul-Enein FH. Does shisha smoking affect blood pressure and heart rate? 2009;17(2):121-126. Pub
  • Health 20. Ashmawi M. Some predictive markers of artherosclerosis among smokers. Ain Shams Med J 1993;44(3):633-639.
  • Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics 2005;116(1):e113- e119. doi: 10.1542/peds.2004-2173.
  • Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prevent Med 2009;37(6):518-523.
  • Monzer B, Sepetdjian E, Saliba N, Shihadeh A. Charcoal emissions as a source of CO and carcinogenic PAH in mainstream narghile waterpipe smoke. Food Chem Toxicol 2008;46(9):2991-2995.
  • Shihadeh A, Eissenberg T. Tobacco smoking using a waterpipe: Product, prevalence,
  • pharmacological effects, and health hazards. In: Waterpipe Tobacco Smoking Building the Evidence Base Part 1: the smoke chemistry.
  • Development Research Centre; 2006. p. 1- 36 [online]. Available at: http://idl- bnc.idrc.ca/dspace/bitstream/10625/4588
  • /1/132376.pdf. Accessed Dec 15, 2014.
  • Katurji M, Daher N, Sheheitli H, Saleh R, Shihadeh A. Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique. Inhalation Toxicol 2010;22(13):1101-1109.
  • Jatlow P, Toll BA, Leary V, Krishnan- Sarin S, O’Malley SS. Comparison of expired carbon monoxide and plasma cotinine as markers of cigarette abstinence. Drug Alcohol Depend 2008;98(3):203-209.
  • Jongeneelen FJ. Benchmark guideline for urinary 1-hydroxypyrene as biomarker of occupational exposure to polycyclic aromatic hydrocarbons. Ann Occup Hyg 2001;45(1):3-13.
  • Lu PL, Chen ML, Mao IF. Urinary 1- hydroxypyrene levels in workers exposed to coke oven emissions at various locations in a coke oven plant. Arch Environ Health 2002;57(3):255-261.
  • Benowitz NL, Jacob P. Metabolism of nicotine to cotinine studied by a dual stable isotope method. Clin Pharmacol Ther 1994;56(5):483-493.
  • Cobb CO, Shihadeh A, Weaver MF, Eissenberg T. Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects. Nicotine Tob Res 2011;13(2):78-87.
  • Jacob P, Raddaha AHA, Dempsey D, et al. Nicotine, carbon monoxide, and carcinogen exposure after a single use of a water pipe. Cancer Epimiol Biomarkers Prev 2011;20(11):2345-2353.
  • Sepetdjian E, Saliba N, Shihadeh A. Carcinogenic PAH in waterpipe charcoal products. 2010;48(11):3242-3245. Chem
  • Toxicol 33. Maziak W, Rastam S, Ibrahim I, Ward KD, Shihadeh A, Eissenberg T. CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers. Nicotine Tob Res 2009;11(7):806-811.
  • La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. CJEM 2012;14(1):57-59.
  • Shahab L, West R, McNeill A. Clinical Study: A comparison of exposure to carcinogens among roll‐your‐own and factory‐made cigarette smokers. Addict Biol 2009;14(3):315-320.
  • Bedford Scientific Ltd. Smokerlyzer, Helping People to Stop Smoking with a Smokerlyzer® Available
  • http://www.bedfont.com/smokerlyzer.
  • Accessed Dec 17, 2014. Monitor [online]. at:
There are 45 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Erdem Pulcu This is me

Ann Mcneill This is me

Publication Date December 30, 2014
Submission Date December 12, 2015
Published in Issue Year 2014 Volume: 12 Issue: 3

Cite

APA Pulcu, E., & Mcneill, A. (2014). Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure. Turkish Journal of Public Health, 12(3), 140-152. https://doi.org/10.20518/thsd.21703
AMA Pulcu E, Mcneill A. Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure. TJPH. December 2014;12(3):140-152. doi:10.20518/thsd.21703
Chicago Pulcu, Erdem, and Ann Mcneill. “Smoking Patterns in Waterpipe Smokers Compared With Cigarette Smokers: An Exploratory Study of Puffing Dynamics and Smoke Exposure”. Turkish Journal of Public Health 12, no. 3 (December 2014): 140-52. https://doi.org/10.20518/thsd.21703.
EndNote Pulcu E, Mcneill A (December 1, 2014) Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure. Turkish Journal of Public Health 12 3 140–152.
IEEE E. Pulcu and A. Mcneill, “Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure”, TJPH, vol. 12, no. 3, pp. 140–152, 2014, doi: 10.20518/thsd.21703.
ISNAD Pulcu, Erdem - Mcneill, Ann. “Smoking Patterns in Waterpipe Smokers Compared With Cigarette Smokers: An Exploratory Study of Puffing Dynamics and Smoke Exposure”. Turkish Journal of Public Health 12/3 (December 2014), 140-152. https://doi.org/10.20518/thsd.21703.
JAMA Pulcu E, Mcneill A. Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure. TJPH. 2014;12:140–152.
MLA Pulcu, Erdem and Ann Mcneill. “Smoking Patterns in Waterpipe Smokers Compared With Cigarette Smokers: An Exploratory Study of Puffing Dynamics and Smoke Exposure”. Turkish Journal of Public Health, vol. 12, no. 3, 2014, pp. 140-52, doi:10.20518/thsd.21703.
Vancouver Pulcu E, Mcneill A. Smoking patterns in waterpipe smokers compared with cigarette smokers: an exploratory study of puffing dynamics and smoke exposure. TJPH. 2014;12(3):140-52.

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