Table 5.
Studies of systemic and general health effects of WP smoking in adolescents and young adults
| Authors Year | Study design | Study participant characteristics | Exposure measures | Outcomes of interest | Key results | Methodological information |
|---|---|---|---|---|---|---|
| Arziman et al.89 2011 | Case study | N=4; 17–27 years, age not stated for one; 25% male; Turkey | WP smoking | Systemic CO poisoning | COHb of 11.4–21.3% recorded and case presented with various symptoms including nausea, syncope, sinus and physical tachycardia and vertigo. | Case study |
| de Suremain et al.90 2018 | Case study | 13-year-old male; Paris, France | WP smoking | Systemic CO poisoning | COHb of 23.1% recorded and case presented with CO poisoning after WP smoking. | Case study |
| Lim et al.91 2019 | Case study | 19-year-old male; Singapore | WP smoking | Systemic CO poisoning | COHb of 27.8% recorded and case presented with CO poisoning after WP smoking. | Case study |
| van Rappard et al.92 2014 | Case study | N=4; 16–21 years; 50% male; Germany | WP smoking | Systemic CO poisoning | COHb of 16.7–29.6% recorded; 1 asymptomatic, 3 symptomatic presenting with various symptoms including nausea, syncope, headache and paresthesia. | Case study |
| Alomari et al.95 2018 | Cross-sectional | N=475 (WPS 93, CS 44, WP+CS 173, C 165); 12–17 years (mean: 14.6±1); 55% male; Irbid, Jordan | WP smoking | Serum vascular endothelial growth factor (VEGF) | VEGF (WPS + CS < WPS < CS or C) – result due to difference in boys. | Self-reported exposure only; convenience sample used; control for confounding by age, gender, location and BMI in statistical analysis. |
| Alsaad et al.93 2019 | Cross-sectional | N=45 (15 WPS, 15 CS, 15 C); 18–40 years (≥80% of all groups 20–29 years); Riyadh, Saudi Arabia | Frequency of WP smoking | General - oxidative stress, DNA repair gene expression, xenobiotic activating and detoxifying Enzyme gene expression | Blood 8-OHdG (CS > WPS > C); expression of DNA repair genes OGG1 and XRCC (WPS < CS < C); expression of carcinogen activation/metabolism gene CYP1A1 (WPS > CS > C); expression of detoxifying enzyme genes (NQO1 - CS < WPS < C; GSTA1 - WPS < CS, C). | Self-reported exposure only; convenience sample; no control for confounding. |
| Alsatari et al.96 2012 | Cross-sectional | N=68 (50 WPS, 18, CS, 18 C); 26.5±4.2 years for WPS, 25.2±5.4 for CS, 26.3±7.6 for C; 100% male; Irbid City, Jordan | WP smoking; WP frequency (high: ≥1 session/day; medium: 4–5 per week; low: <3 per week) | Systemic genotoxicity | Chromosomal aberrations (CA) chromatid and chromosome gaps and breaks and exchange – WPS (3.7x) > CS (2.7x) > C; CA – WP high > WP medium > WP low | Self-reported exposure; participant selection unspecified; participants matched on age, exclusion of persons with alcohol and/or drug use. |
| Eker et al.22 2016 | Cross-sectional | N=60 (30 WPS and 30 C); 18–25 years; sex distribution of both groups were similar; Turkey | WP smoking | Systemic genotoxicity | Chronic: no statistically significant difference between the WPS and C groups in terms of chromatid and chromosome breakages; WPS > C for fragments and gaps. | Self-reported exposure; participant selection approach not stated; no stated control of confounding. |
| Hawari et al.42 2019 | Cross-sectional | N=738 (135 WPS, 303 CS, 300 C); 18–27 years (mean: 21.5±1.8 for WPS, 21.7±1.9 for CS, 21.6±1.9 for C); 100% male; college campuses in Egypt, Jordan, Morocco, Oman | WP smoking, WP duration, WP frequency | Quality of life (evaluated using Short Form 12) | WPS or CS > C for general health score; WPS > C for emotional limitation domain score. | Self-reported exposure; self-reported outcome; convenience sample; controlled for environmental exposures, BMI, physical activities, excluded persons with chronic diseases. |
| Khabour et al.97 2011 | Cross-sectional | N=86 (50 WPS (18 heavy, 16 medium, 16 light), 18 CS and 18 C); 28.3±2.1 years for WPS heavy, 26.1±1.7 years for WPS medium, 24.9±1.8 years for WPS light, 25.2±1.4 years for CS, amd 26.2±1.8 years for C; 100% males; Irbid city/Jordan | Frequency of WPS per week | Systemic genotoxicity (in lymphocytes) | Frequency of sister chromatid exchange – WPS heavy > CS > C; WPS heavy > WPS medium > WPS Light > C. Mitotic index: WPS + C > C but not statistically different. | Self-reported exposure; convenience sample; no control for confounding. |
| Khalil et al.98 2019 | Cross-sectional | N=50 (25 WPS group and 25 C); Age range between 18–25 years; gender distribution not provided but reported to be similar for both groups; Philadelphia, Jordan | WP smoking (no cigarette but smoke WP for more than 3 times per week for more than 2 years) | Systemic genotoxicity (in blood cells) | WPS > C for chromosome breakage, fragments, and gaps. | Self-reported exposure; convenience sample; stated that gender distribution and sample size were similar among both groups but no control of potential confounding factors otherwise. |
| Muddathir al.94 2018 | Cross-sectional | N=120 (40 WPS, 40 CS, 40 C); WPS 18–48 years (mean: 27.8±3.9); CS 18–47 years (mean: 30.1±5.2); C 19–51 years (mean: 29.6±4.5); Khartoum, Sudan | WP smoking, WP frequency and duration | Systemic – coagulation factors fibrinogen, factor VII and factors VIII | WPS > CS > C for fibrogen, factor VII and factors VIII; fibrinogen and factor VIII greater in WPS for WP use >3 years vs ≤3 years | Self-reported exposure; convenience sample; excluded individuals with history of platelet abnormalities, bleeding or vascular disorders, liver or renal disease, medication affecting platelet function. |
| Rajab et al.99 2019 | Cross-sectional | N=207 (88 WPS, 119 C) 18–25 years. 100% female; Damascus, Syria | WP smoking | Systemic – folate levels Systemic inflammation (hs-CRP levels) |
Folate median WPS < overall group hs-CRP levels not different between smokers and non-smokers. |
Self-reported exposure to WP; convenience sample used; no control for confounding. |
| Strulovici-Barel et al.33 2016 | Cross-sectional | N=40 participants (19 non-smoker C and 21 WPS); all participants ≥18 years (mean: 33±9 years in C group and 25±4 years in WPS group); 90% male in C, 65% male in WPS group; 6/5/8 black/white/other in C group and 8/2/11 black/white/other in WPS group; New York City, USA | WPS smoking | Systemic – plasma endothelial microparticles (EMPs) | WPS > C for total EMP | Self-reported exposure verified with cotinine and nicotine measurements; convenience sample used; no confounder control but study participants in C. |
| Yalcin et al.36 2017 | Cross-sectional, pre-post | N=100 (50 WPS/WPS + CS and 50 C) 18–38 years (26.72±5.2 years for WPS, 27.46±5.3 years for C); 66% male for WPS, 64% male for C; Ankara, Turkey | WP smoking; WP duration; exhaled CO | Systemic oxidative stress | After smoking, total oxidant and total antioxidant statuses and oxidative stress index higher, and salt-stimulated paraoxonase activity lower in WPS. | Controlled WP smoking session; objective exhaled CO used to quantify exposure but association with outcome not analyzed; convenience sample used; no control for confounding. |
*WPS: waterpipe smokers. CS: cigarette smokers. C: control.