Midwakh: Assessment of Levels of Carcinogenic Polycyclic Aromatic Hydrocarbons and Nicotine in Dokha Tobacco Smoke

A nationwide survey of phthalate esters (PAEs) in tobacco leaves across China: Occurrence, spatial distribution and health risk assessment

The widespread use of plastic mulch may lead to the release of phthalate esters (PAEs), which can be absorbed into tobacco leaves by root. In this study, we collected 50 samples of tobacco leaves in 19 provinces across China and determined the concentrations of 6 PAEs in leaves at different parts of tobacco. The total concentrations of 4 PAEs (∑4 PAEs) ranged from 49.0 ng·g-1 to 273 ng·g-1 with a mean of 97.6 ng·g-1. Di-(2-ethylhexyl) phthalate (DEHP) was the predominant chemical in tobacco leaves with an average concentration of 44.4 ng·g-1. High ∑4 PAEs were found in tobacco leaves in Hubei, Fujian and Hebei. Besides, high concentrations of DEHP and di-n-butyl phthalate were found in tobacco leaves grown in economically developed areas of China. High concentrations and leaf-soil translocation factors of PAEs were observed in lower tobacco leaves than middle and upper leaves. The hazard quotients of 4 PAEs were all less than 1, indicating a negligible non-carcinogenic risk to smokers. Moreover, a low carcinogenic risk posed by DEHP was found to smokers. The present study firstly provides comprehensive information on PAE concentrations in tobacco leaves and assesses the health risk posed by PAEs to smokers at a nationwide scale.

Medwakh smoking induces alterations in salivary proteins and cytokine expression: a clinical exploratory proteomics investigation

BACKGROUND

Medwakh smoking has radically expanded among youth in the Middle East and around the world. The rising popularity of medwakh/dokha usage is linked to the onset of several chronic illnesses including cardiovascular diseases and cancers. Medwakh smoking is reported to increase the risk of inflammation in the lower respiratory tract owing to oxidative burden. To date, there are no reported studies investigating the impact of medwakh smoking on salivary protein profile. The current study aims to elucidate alterations in the salivary proteome profile of medwakh smokers.

METHODS

Saliva samples collected from 33 medwakh smokers and 30 non-smokers were subjected to proteomic analysis using UHPLC-ESI-QTOF-MS. Saliva samples were further subjected to validatory experiments involving analysis of inflammatory cytokine profile using LEGENDplex™ Human Essential Immune Response Panel.

RESULTS

Statistical analysis revealed alterations in the abundance of 74 key proteins including immune mediators and inflammatory markers in medwakh smokers (Accession: PXD045901). Proteins involved in building oxidative stress, alterations in cell anchorage, and cell metabolic processes were enhanced in medwakh smokers. Salivary immune response evaluation further validated the proteome findings, revealing significantly higher levels of IL-1β, IL-12p70, IL-23, IFN-γ (Th1 cytokines), IL-6 (Th2 cytokine), and MCP-1 (chemokine) in medwakh smokers. In addition, a substantial increase in abundance of involucrin suggesting a plausible stratified squamous cell differentiation and increased cell lysis in the oral cavity of medwakh smokers akin to chronic obstructive pulmonary diseases (COPD). The protein-metabolite joint pathway analysis further showed significantly enriched differentially expressed proteins and metabolites of glycolysis/gluconeogenesis, pentose phosphate, fructose and mannose, nicotinate and nicotinamide, and glutathione metabolism pathways among medwakh smokers.

CONCLUSIONS

The findings of the study provide valuable insights on potential perturbations in various key immune molecules, cytokines, and signaling pathways among medwakh smokers. Medwakh smokers displayed elevated inflammation, increased oxidative stress and defective antioxidant responses, dysregulated energy metabolism, and alterations in proteins related to cell adhesion, migration, differentiation, and proliferation. The findings of study underscore the urgent need for comprehensive public health interventions among youth by raising awareness, implementing effective smoking cessation programs, and promoting healthy lifestyle to safeguard the well-being of individuals and communities worldwide.

Midwakh smoking as an emerging risky behavior: insight from Qatar 2022

BACKGROUND

Alternative tobacco products like midwakh are gaining popularity as potential substitutes for traditional cigarettes despite a misconception among smokers that they may be less harmful.

OBJECTIVES

To determine the prevalence, knowledge, beliefs, and predictors of midwakh smoking among adult smokers in Qatar during 2022.

METHOD

An analytic cross-sectional study was conducted from January 2022 to July 2022. A simple random sample (N = 1036) was employed to include participants from the list of adults 18 years and above obtained from Qatar's National Health Information System who were invited to participate in a telephone survey.

RESULTS

Among the 806 participants (response rate 77.8%), 9.3% were current midwakh smokers, and 5.2% had ever smoked midwakh. The majority were male (97.2%), non-Qatari (70.9%), and aged over 24 years. Additionally, 66.7% of midwakh smokers reported having at least one family member or friend who smoked any tobacco product. Reasons for midwakh use included enjoyment, experimentation, cessation of other tobacco products, affordability, and lack of odor. Moreover, 70.9% believed midwakh smoking could lead to addiction, while 66.7% perceived it as more dangerous than other tobacco products, potentially causing severe health conditions like lung cancer. Multivariable logistic regression indicated a significant association between midwakh use and nationality, with Qataris being 0.21 times less likely to smoke midwakh than non-Qataris (adjusted odds ratio of 0.214, 95% confidence interval: 1.58-4.225, p value of 0.0001).

CONCLUSION

Midwakh smoking poses health risks comparable to other tobacco products, with peer influence being significant. Urgent action is needed to heighten awareness and allocate resources for effective intervention.

Elucidating nicotine transfer into water environments via cigarette butt remaining parts

Nicotine, the main alkaloid in tobacco, enters water environments through discarded cigarette butts (CBs), possibly causing detrimental effects. However, there is no comprehensive investigation on the long-term leaching of nicotine from the different CBs parts. Therefore, in the present study, the ecological risk and the leachate levels of nicotine from different CBs parts were investigated. Freshly smoked CBs, aged CBs collected from streets, remaining tobacco and ash of freshly smoked CBs, and filter plus paper of freshly smoked CBs were evaluated for the leachate experiments. The order of nicotine leachate from different types of CBs and parts investigated were as remaining tobacco plus ash of freshly smoked CBs > freshly smoked CBs > aged CBs > filter plus paper of freshly smoked CBs with the ranges of 5.73-17.34, 0.36-8.6, 0.31-4.12, and 0.17-2.79 mg of nicotine per g of CB or remaining parts (mg g-1), respectively. The ecological risk assessment revealed that nicotine leachates from all the CBs types or their remaining parts could be highly hazardous to fish, cladocerans, algae, and Daphnia magna. Based on the mean leachate levels of nicotine via freshly smoked CBs at exposure times of 1 min to 1 month and the estimated number of littered CBs every year on a worldwide scale, freshly smoked CBs may release 380-7065 tons of nicotine into water environments.

A literature review addressing midwakh and e-cigarette use in the Gulf region

A notable decrease in conventional cigarette smoking has been witnessed on a global scale. However, this decrease has been accompanied by an equally striking global increase in the consumption of alternative tobacco products (ATPs), namely e-cigarettes and midwakh in the Arabian Gulf region. A literature review was used to outline the chemical composition of these two ATPs and review their impacts on health. The study was conducted using databases like PubMed, Google Scholar, MDPI, and WorldCat. The literature search included terms such as "e-cigarettes," "midwakh," "dokha," "heath impacts," "psychological effects," "social influences," and "cigarette smoking" with emphasis on literature from the Arabian Gulf region. Data shows that midwakh contains markedly high levels of tar, nicotine, and various compounds of notable effects on the human body. Similarly, it was found that e-cigarettes contain non-negligible amounts of nicotine and other chemical compounds that may not have been extensively investigated. Alarming reports of system-specific effects brought about by midwakh, and e-cigarette consumption, have been reported, although further research is needed to deduce the mechanism. We also discussed some of the social and psychological factors leading to their consumption within this population. Hence, this review raises questions around the safety of these two types of ATPs and encourages comprehensive studies globally and regionally.

Biomonitoring of unmetabolized polycyclic aromatic hydrocarbons (PAHs) in urine of waterpipe/cigarette café workers

Fresh tobacco or the smoke resulting from waterpipe and cigarette contains large amounts of polycyclic aromatic hydrocarbons (PAHs), which consumption can cause releasing of these contaminants into the indoor air of cigarette and waterpipe cafés. This study was conducted to investigate the urinary concentrations of unmetabolized PAH compounds among the employed workers as well as the customers in waterpipe and cigarette cafés along with its association with oxidative stress factors plus kidney injury biomarkers. For this, 35 staffs and 35 customers in these cafés (as an exposed group (EG)), 20 staffs in non-smoking cafés (as 1st control group (CG-1)), and 20 of the public population (as 2nd control group 2 (CG-2)) were chosen and their urine specimens were collected. The results indicated that there is a significant difference between urinary concentration of ƩPAHs in the exposed and control groups (P value < 0.05). Also, "type of tobacco" can be considered as an influential and determining factor for the urinary levels of PAHs among the subjects. Considering the contribution of PAHs to the total toxic equivalents, benzo[a]pyrene (BaP), dibenzo[a,h]anthracene (DahA), and fluoranthene (Flrt) with 32.76%, 27.62%, and 18.65% claimed the largest share in waterpipe/cigarette cafés. The results also indicated a positive and significant relationship between some PAHs and oxidative stress biomarkers as well as uKIM-1 (biomarker for assessing and diagnosing glomerular damage) and TIMP-1 (biomarker of stress in primary steps of injury in tubular cell). Thus, it can be expressed that the workers of these smoking cafés are prone to the detrimental health impacts. Accordingly, proper policies and decisions should be taken to limit the activity of these cafés or proper protective strategies should be adopted to protect the health of exposed individuals.

Effects of medwakh smoking on salivary metabolomics and its association with altered oral redox homeostasis among youth

The use of alternative tobacco products, particularly medwakh, has expanded among youth in the Middle East and around the world. The present study is conducted to investigate the biochemical and pathophysiological changes caused by medwakh smoking, and to examine the salivary metabolomics profile of medwakh smokers. Saliva samples were collected from 30 non-smokers and 30 medwakh smokers and subjected to metabolomic analysis by UHPLC-ESI-QTOF-MS. The CRP and Glutathione Peroxidase 1 activity levels in the study samples were quantified by ELISA and the total antioxidant capacity (TAC) by TAC assay kits. Statistical measurements and thorough validation of data obtained from untargeted metabolomics identified 37 uniquely and differentially abundant metabolites in saliva of medwakh smokers. The levels of phthalate, L-sorbose, cytosine, uridine, alpha-hydroxy hippurate, and L-nicotine were noticeably high in medwakh smokers. Likewise, 20 metabolic pathways were differentially altered in medwakh smokers. This study identified a distinctive saliva metabolomics profile in medwakh smokers associated with altered redox homeostasis, metabolic pathways, antioxidant system, and CRP levels. The impact of the altered metabolites in medwakh smokers and their diagnostic utility require further research in large cohorts.

Indoor air pollution from coal combustion and tobacco smoke during the periconceptional period and risk for neural tube defects in offspring in five rural counties of Shanxi Province, China, 2010-2016

Indoor air pollution may increase the risk for neural tube defects (NTDs) in Chinese rural populations. However, this association remains a subject of debate. We conducted a population-based case-control study of 222 NTD and 517 control mothers recruited between 2010 and 2016 in five rural areas in northern China. An indoor air pollution exposure evaluation index (IAPEEI) was used to evaluate mothers' exposure to tobacco-sourced and coal-sourced indoor air pollution. Essential characteristics were collected using structured questionnaires within 10 days of delivery. We found that exposure to indoor air pollution (IAPEEI ≥ 1) can lead to 3.41 times the risk of conceiving NTD fetuses compared with the no-exposure group (IAPEEI = 0) (adjusted odds ratio and 95 % confidence interval: 3.41 [2.34-5.02]). The risk increased with increasing IAPEEI score, indicating a clear dose-response trend (P < 0.001). Using a coal stove for heating (especially in the bedroom) and passive smoking are significantly associated with an increased likelihood of NTD occurrence. Exposure to indoor air pollution is a daily reality for rural women in China, and its impact on reproductive health deserves extensive attention.

Comparison of nicotine emissions rate, 'nicotine flux', from heated, electronic and combustible tobacco products: data, trends and recommendations for regulation

INTRODUCTION

Tobacco smoking is a major cause of disease and premature death worldwide. While nicotine is recognised as the main addictive component in tobacco smoke, the total nicotine amount emitted (nicotine yield) and the rate of nicotine emission per second ('nicotine flux') contribute to the abuse liability of a given product. These variables can be regulated for public health ends and conveniently so for electronic cigarettes or electronic nicotine delivery systems (ENDS).

METHODS

In this study we computed nicotine flux from previously reported values of yield and puff topography for a wide range of tobacco products.

RESULTS

We found that nicotine flux varied widely across tobacco products, from less than 0.1 µg/s to more than 100 µg/s, and that since 2015 the upper limit of the ENDS nicotine flux range has risen significantly and is now approaching that of combustible cigarettes. We also found that products that differ in nicotine flux may exhibit similar nicotine yields due to differences in user puffing behavior. Nicotine flux is a tool that can be used to regulate nicotine emissions of tobacco products, including ENDS.