Trial Outcomes & Findings for Assessing Toxicity of Waterpipe Tobacco Smoking (NCT NCT03253653)

Results Overview

For a smoking session using an electric head to heat the tobacco, investigators will measure diastolic blood pressure levels before and after the waterpipe tobacco smoking session, and compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

85 participants

Primary outcome timeframe

Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration=31 min), or at one point during the non-smoker home visit.

Results posted on

2025-04-09

Participant Flow

We phone-screened 101 waterpipe tobacco (WPT) smoker respondents; 54 were eligible and were enrolled; 4 withdrew before the home visit (due to travel/change of mind). We phone-screened 51 non-smoker respondents; 31 were eligible and were enrolled; 1 non-smoker dropped out before the home visit (due to school/work schedule); 5 were excluded because of potential exposure to tobacco secondhand smoke (SHS) based on exhaled carbon monoxide (eCO) cut-off levels ≥3.6 ppm.(Deveci et al., 2004)

Participant milestones

Participant milestones
Measure	Waterpipe Tobacco (WPT) Smoking In a repeated measures design, 50 adult male and female exclusive waterpipe tobacco (WPT) smokers will smoke weekly over a 3-week study period with 3 WPT smoking practices. WPT smoking: In a repeated measures design, 50 adult male and female exclusive WPT smokers will smoke WPT weekly over a 3-week study period with 3 WPT smoking practices as follows: 1) using room temperature water in the waterpipe (WP) jar, 2) adding ice cubes to the water in the WP jar, and 3) using a charcoal-free electronic WP head to heat the tobacco. Six Spot first morning urine samples will be provided by participants. Two urine samples per each of the 3 smoking sessions. Urine samples will be provided on the day of the WPT smoking session and the following day. Physiological measures will be taken at Baseline during the office visit and before and after each of the 3 WP tobacco smoking sessions.	Control A total of 25 adult male and female nonsmokers will be recruited as a control.
Overall Study STARTED	54	31
Overall Study COMPLETED	50	25
Overall Study NOT COMPLETED	4	6

Reasons for withdrawal

Reasons for withdrawal
Measure	Waterpipe Tobacco (WPT) Smoking In a repeated measures design, 50 adult male and female exclusive waterpipe tobacco (WPT) smokers will smoke weekly over a 3-week study period with 3 WPT smoking practices. WPT smoking: In a repeated measures design, 50 adult male and female exclusive WPT smokers will smoke WPT weekly over a 3-week study period with 3 WPT smoking practices as follows: 1) using room temperature water in the waterpipe (WP) jar, 2) adding ice cubes to the water in the WP jar, and 3) using a charcoal-free electronic WP head to heat the tobacco. Six Spot first morning urine samples will be provided by participants. Two urine samples per each of the 3 smoking sessions. Urine samples will be provided on the day of the WPT smoking session and the following day. Physiological measures will be taken at Baseline during the office visit and before and after each of the 3 WP tobacco smoking sessions.	Control A total of 25 adult male and female nonsmokers will be recruited as a control.
Overall Study Withdrawal by Subject	4	1
Overall Study Protocol Violation	0	5

Baseline Characteristics

Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.

Baseline characteristics by cohort

PRIMARY outcome

Timeframe: On 2 days for each of two smoking sessions, smokers will provide 2 first morning spot urine samples--one urine sample on the morning of the day of the smoking session, and one urine sample on the morning of the following day.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess change in creatinine-adjusted urinary levels of cotinine (a metabolite of the addictive drug nicotine) in ng/mL, from pre-to post, at each of 2 waterpipe tobacco smoking sessions. For each of the 2 smoking sessions, smokers will provide two first morning spot urine samples--the day of the smoking session and the following morning. The two waterpipe tobacco smoking sessions are as follows: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing Cotinine Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	34.9 ng/mL Interval 24.2 to 50.5	26.4 ng/mL Interval 18.3 to 38.0

PRIMARY outcome

Timeframe: On 2 days for each of two smoking sessions, smokers will provide 2 first morning spot urine samples--one urine sample on the morning of the day of the smoking session, and one urine sample on the morning of the following day.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess change in creatinine-adjusted urinary levels of SPMA (a metabolite of the human hematotoxicant and leukemogen benzene) in pmol/mL, from pre-to post, at each of 2 waterpipe tobacco smoking sessions. For each of the 2 smoking sessions, smokers will provide two first morning spot urine samples--the day of the smoking session and the following morning. The two waterpipe tobacco smoking sessions are as follows: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing S-phenyl-mercapturic Acid (SPMA) Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	1.35 pmol/mL Interval 0.78 to 2.3	0.34 pmol/mL Interval 0.2 to 0.57

PRIMARY outcome

Timeframe: On 2 days for each of two smoking sessions, smokers will provide 2 first morning spot urine samples--one urine sample on the morning of the day of the smoking session, and one urine sample on the morning of the following day.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess change in creatinine-adjusted urinary levels of 1-HOP (a metabolite of the genotoxic carcinogen pyrene) in pmol/ML, from pre-to post, at each of 2 waterpipe tobacco smoking sessions. For each of the 2 smoking sessions, smokers will provide two first morning spot urine samples--the day of the smoking session and the following morning. The two waterpipe tobacco smoking sessions are as follows: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing 1-hydroxypyrene (1-HOP) But Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	0.47 pmol/ML Interval 0.34 to 0.65	0.48 pmol/ML Interval 0.35 to 0.66

PRIMARY outcome

Timeframe: Assessment will be taken immediately before starting to smoke, and immediately at conclusion of each of the 2 smoking sessions.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring exhaled CO using a Micro+ Smokerlyzer® carbon monoxide (CO) monitor for exhaled CO before and after each of two waterpipe tobacco smoking sessions, investigators will determine the differential change, pre-to-post waterpipe tobacco smoking, between heating by charcoal vs heating by electric head

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing Exhaled Carbon Monoxide Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	107 Parts per million Interval 84.0 to 136.0	3.5 Parts per million Interval 2.5 to 4.9

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration=31 min).

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will determine the differential effects of WP smoking practices on change in systolic blood pressure in mm/Hg after each of two WP smoking sessions: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing Systolic Blood Pressure Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	122 mmHg (Millimeters of mercury) Interval 118.0 to 125.0	120 mmHg (Millimeters of mercury) Interval 116.0 to 124.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration=31 min).

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will investigate the differential effects of WP smoking practices on change in diastolic blood pressure in mm/Hg after each of two WP smoking sessions: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing Diastolic Blood Pressure Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	79 mmHg (Millimeters of mercury) Interval 77.0 to 81.0	78 mmHg (Millimeters of mercury) Interval 76.0 to 80.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration=31 min).

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will investigate the differential effects of WP smoking practices on change in heart rate in beats per minute after each of two WP smoking sessions: 1) using charcoal to heat the tobacco, and 2) using a charcoal-free electronic waterpipe head to heat the tobacco.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Comparing Heart Rate Pre-to-post Change Between 2 Waterpipe Smoking Sessions: Heating Waterpipe Tobacco by (a) Charcoal vs (b) an Electric Head	80 Heart beats/minute Interval 76.0 to 83.0	77 Heart beats/minute Interval 73.0 to 80.0

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Investigators will assess change in creatinine-adjusted urinary levels of cotinine (a metabolite of nicotine) in ng/mL, For a smoking session using charcoal to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will assess difference in urinary cotinine levels between (a) non-smokers vs. (b) waterpipe tobacco smokers after the waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Cotinine Levels Between (a) Non-smokers vs. (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	34.9 ng/mL Interval 24.2 to 50.5	0.02 ng/mL Interval 0.01 to 0.04

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess change in creatinine-adjusted levels of SPMA (a metabolite of the human hematotoxicant and leukemogen benzene) in pmol/mL, For a smoking session using charcoal to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will assess difference in urinary cotinine levels between (a) non-smokers vs. (b) waterpipe tobacco smokers after the waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in SPMA Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	1.35 pmol/mL Interval 0.78 to 2.3	0.17 pmol/mL Interval 0.11 to 0.27

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess change in creatinine-adjusted urinary levels of 1-HOP (metabolite of the genotoxic carcinogen pyrene in pmol/mL, For a smoking session using charcoal to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will assess difference in urinary cotinine levels between (a) non-smokers vs. (b) waterpipe tobacco smokers after the waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in 1-HOP Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	0.47 pmol/mL Interval 0.34 to 0.65	0.23 pmol/mL Interval 0.16 to 0.35

PRIMARY outcome

Timeframe: For the smokers: Assessment will be taken immediately before starting to smoke, and immediately at conclusion of each of the smoking session. For the non-smokers: Assessment will be taken at the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring exhaled CO using a Micro+ Smokerlyzer® CO monitor for exhaled CO before and after the heating by charcoal waterpipe tobacco smoking session, investigators will compare the levels between (a) non-smokers and (b) waterpipe tobacco smokers after their smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Exhaled Carbon Monoxide Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	107 Parts per million Interval 84.0 to 136.0	2.8 Parts per million Interval 2.1 to 3.6

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration =31 min), or at one point during the non-smoker home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring systolic blood pressure levels before and after the waterpipe tobacco smoking session, investigators will compare the levels between (a) non-smokers and (b) waterpipe tobacco smokers after their smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Systolic Blood Pressure Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	122 Millimeters of mercury Interval 118.0 to 125.0	117 Millimeters of mercury Interval 111.0 to 124.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration =31 min), or at one point during the non-smoker home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring diastolic blood pressure levels before and after the waterpipe tobacco smoking session, investigators will compare the levels between (a) non-smokers and (b) waterpipe tobacco smokers after their smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Diastolic Blood Pressure Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	79 Millimeters of mercury Interval 77.0 to 81.0	75 Millimeters of mercury Interval 73.0 to 78.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration =31 min), or at one point during the non-smoker home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring heart rate levels before and after the waterpipe tobacco smoking session, investigators will compare the levels between (a) non-smokers and (b) waterpipe tobacco smokers after their smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Heart Rate Levels Between (a) Non-smokers and (b) Smokers Post a Waterpipe Smoking Session, Using Tobacco Heated by Charcoal	80 Beats per minute Interval 76.0 to 83.0	76 Beats per minute Interval 71.0 to 81.0

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess creatinine-adjusted urinary levels of cotinine (a metabolite of nicotine) in ng/mL. For a smoking session using an electric head to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Cotinine Levels Between (a) Non-smokers vs. (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	26.4 ng/mL Interval 18.3 to 38.0	0.02 ng/mL Interval 0.01 to 0.04

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess creatinine-adjusted urinary levels of SPMA (a metabolite of benzene) in pmol/mL. For a smoking session using an electric head to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in SPMA Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	0.34 pmol/mL Interval 0.2 to 0.57	0.17 pmol/mL Interval 0.11 to 0.27

PRIMARY outcome

Timeframe: For smokers: Early morning on the smoking session day to early morning the day after. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

Investigators will assess creatinine-adjusted urinary levels of 1-HOP (a metabolite of pyrene, a polycyclic aromatic hydrocarbon) pmol/ML. For a smoking session using an electric head to heat the tobacco, waterpipe smokers will provide two first morning spot urine samples--the morning of the day of the smoking session and the morning of the following day. The investigators will compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in 1-HOP Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	0.48 pmol/mL Interval 0.35 to 0.66	0.23 pmol/mL Interval 0.16 to 0.35

PRIMARY outcome

Timeframe: For the smokers: Assessment will be taken immediately before starting to smoke, and immediately at conclusion of the smoking session. For the non-smokers: Assessment will be taken at the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

measuring exhaled carbon monoxide levels before and after the waterpipe tobacco smoking session, investigators will compare the levels between (a) non-smokers and (b) waterpipe tobacco smokers after their smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Exhaled Carbon Monoxide Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	3.5 Parts per million Interval 2.5 to 4.9	2.8 Parts per million Interval 2.1 to 3.6

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration =31 min), or at one point during the non-smoker home visit.

Population: Waterpipe smoking: 50 adult male and female exclusive waterpipe smokers will smoke waterpipe tobacco during a home smoking session Control: A total of 25 adult male and female nonsmokers were recruited as a control.

For a smoking session using an electric head to heat the tobacco, investigators will measure systolic blood pressure levels before and after the waterpipe tobacco smoking session, and compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Systolic Blood Pressure Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	120 mmHg Interval 116.0 to 124.0	117 mmHg Interval 111.0 to 124.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration=31 min), or at one point during the non-smoker home visit.

For a smoking session using an electric head to heat the tobacco, investigators will measure diastolic blood pressure levels before and after the waterpipe tobacco smoking session, and compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Diastolic Blood Pressure Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	78 mmHg Interval 76.0 to 80.0	75 mmHg Interval 73.0 to 78.0

PRIMARY outcome

Timeframe: Systolic & diastolic blood pressure and heart rate were assessed multiple times (at intervals>1 min) and averaged. Assessments were at the start and end of each smoking session (mean duration =31 min), or at one point during the non-smoker home visit.

For a smoking session using an electric head to heat the tobacco, investigators will measure heart rate levels before and after the waterpipe tobacco smoking session, and compare (a) non-smoker levels with (b) waterpipe tobacco smoker levels after their waterpipe smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Heart Rate Levels Between (a) Non-smokers and (b) Smokers After a Waterpipe Smoking Session, Using Tobacco Heated by an Electric Head	77 Beats per minute Interval 73.0 to 80.0	76 Beats per minute Interval 71.0 to 81.0

SECONDARY outcome

Timeframe: For smokers: Early morning on day 1 to early morning on day 2. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will assess difference in urinary Furan-BDA-NAL levels between non-smokers and post a smoking session for waterpipe tobacco smokers. Furan-BDA-NAL is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples: for smokers, the day of the smoking session and the day following the smoking session; for non-smokers, the day of the home visit.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary L-2-(Acetylamino)-6-(2,5-dihydro-2-oxo-1H-pyrrol-1-yl)-1-hexanoic Acid (Furan-BDA-NAL) Between Levels at Post Waterpipe Tobacco Smoking Versus Non-smoker Levels.	131 pmol/ML Interval 111.0 to 155.0	112 pmol/ML Interval 91.0 to 139.0

SECONDARY outcome

Timeframe: For smokers: Early morning on day 1 to early morning on day 2. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: A adult male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'

The investigators will assess difference in urinary Furan-BDA-Lys levels between non-smokers and post a smoking session for waterpipe tobacco smokers. Furan-BDA-Lysis a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples: for smokers, the day of the smoking session and the day following the smoking session; for non-smokers, the day of the home visit.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-BDA-Lys Between Levels at Post Waterpipe Tobacco Smoking Versus Non-smoker Levels.	47 pmol/ML Interval 36.0 to 60.0	44 pmol/ML Interval 34.0 to 57.0

SECONDARY outcome

Timeframe: For smokers: Early morning on day 1 to early morning on day 2. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will assess difference in urinary Furan-NAC-BDA-NAL levels between non-smokers and post a smoking session for waterpipe tobacco smokers. Furan-NAC-BDA-NAL is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples: for smokers, the day of the smoking session and the day following the smoking session; for non-smokers, the day of the home visit.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary N-acetyl-S-[1-(5-acetylamino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine (Furan-NAC-BDA-NAL) Between Levels at Post Waterpipe Tobacco Smoking Versus Non-smoker Levels.	0.05 pmol/ML Interval 0.04 to 0.07	0.01 pmol/ML Interval 0.0 to 0.03

SECONDARY outcome

Timeframe: For smokers: Early morning on day 1 to early morning on day 2. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will assess difference in urinary Furan-NAC-BDA-Lys levels between non-smokers and post a smoking session for waterpipe tobacco smokers. Furan-BNAC-BDA-Lys is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples: for smokers, the day of the smoking session and the day following the smoking session; for non-smokers, the day of the home visit.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary N-acetyl-S-[1-(5-amino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine (Furan-NAC-BDA-Lys) Between Levels at Post Waterpipe Tobacco Smoking Versus Non-smoker Levels.	4.0 pmol/mL Interval 3.5 to 4.6	2.4 pmol/mL Interval 1.1 to 5.3

SECONDARY outcome

Timeframe: For smokers: Early morning on day 1 to early morning on day 2. For non-smokers: early in the morning of the home visit.

Population: Participants will be recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: 1) Adult waterpipe smoker: A male or female, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'; 2) Adult non-smoker: A male or female, 18 years or older, who lives in a 'non-smoker home'.

The investigators will assess difference in urinary Furan-NAC-BDA-Lys sulfoxide levels between non-smokers and post a smoking session for waterpipe tobacco smokers. Furan-NAC-BDA-Lys sulfoxide is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples: for smokers, the day of the smoking session and the day following the smoking session; for non-smokers, the day of the home visit.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=25 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-NAC-BDA-Lys Sulfoxide' Between Levels at Post Waterpipe Tobacco Smoking Versus Non-smoker Levels.	3.1 pmol/ML Interval 2.6 to 3.6	2.1 pmol/ML Interval 1.8 to 2.5

SECONDARY outcome

Timeframe: Early morning on day 1 to early morning on day 2.

Population: Participants were recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: A male or female adult waterpipe smoker, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'.

Investigators will assess difference between pre-smoking session levels of urinary Furan-BDA-NAL in waterpipe tobacco smokers and post that smoking session. Furan-BDA-NAL is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples, the day of the smoking session and the day following the smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-BDA-NAL Between Levels Pre the Waterpipe Tobacco Smoking Session vs Post the Waterpipe Tobacco Smoking Session.	128 pmol/mL Interval 111.0 to 148.0	131 pmol/mL Interval 111.0 to 155.0

SECONDARY outcome

Timeframe: Early morning on day 1 to early morning on day 2

Population: Participants were recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: A male or female adult waterpipe smoker, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'.

Investigators will assess difference between pre-smoking session levels of urinary Furan-BDA-Lys in waterpipe tobacco smokers and post that smoking session. Furan-BDA-Lys is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples, the day of the smoking session and the day following the smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-BDA-Lys Between Levels Pre the Waterpipe Tobacco Smoking Session vs Post the Waterpipe Tobacco Smoking Session.	42 pmol/mL Interval 32.0 to 55.0	47 pmol/mL Interval 36.0 to 60.0

SECONDARY outcome

Timeframe: Early morning on day 1 to early morning on day 2

Population: Participants were recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: A male or female adult waterpipe smoker, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'.

Investigators will assess difference between pre-smoking session levels of urinary Furan-NAC-BDA-NAL in waterpipe tobacco smokers and post that smoking session. Furan-NAC-BDA-NAL is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples, the day of the smoking session and the day following the smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-NAC-BDA-NAL Between Levels Pre the Waterpipe Tobacco Smoking Session vs Post the Waterpipe Tobacco Smoking Session	0.06 pmol/mL Interval 0.04 to 0.09	0.05 pmol/mL Interval 0.04 to 0.07

SECONDARY outcome

Timeframe: Early morning on day 1 to early morning on day 2

Investigators will assess difference between pre-smoking session levels of urinary Furan-NAC-BDA-Lys in waterpipe tobacco smokers and post that smoking session. Furan-NAC-BDA-Lys is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples, the day of the smoking session and the day following the smoking session.

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-NAC-BDA-Lys Between Levels Pre the Waterpipe Tobacco Smoking Session vs Post the Waterpipe Tobacco Smoking Session	4.0 pmol/mL Interval 3.5 to 4.6	4.0 pmol/mL Interval 3.5 to 4.6

SECONDARY outcome

Timeframe: Early morning on day 1 to early morning on day 2

Population: Participants were recruited via intercept interviews from San Diego County, CA communities. Inclusion Criteria for Participants: A male or female adult waterpipe smoker, 18 years or older, who smokes WP tobacco exclusively, smokes at least 1 WP head per month, and smokes at least 1 WP head per WP smoking session, smokes WP at home, agrees to smoke Starbuzz WP tobacco, and lives in a 'smoker home'.

Investigators will assess difference between pre-smoking session levels of urinary Furan-NAC-BDA-Lys sulfoxide in waterpipe tobacco smokers and post that smoking session. Furan-NAC-BDA-Lys sulfoxide is a metabolite of furan, a liver toxicant and carcinogen. It will be collected for laboratory assay using two first morning spot urine samples, the day of the smoking session and the day following the smoking session

Outcome measures

Outcome measures
Measure	Charcoal-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.	Electric-head-heated Waterpipe Smoking n=50 Participants In a repeated measures design, 50 adult male and female exclusive WP smokers will smoke WP tobacco during the smoking session at their own home, using the traditional charcoal to heat the tobacco. Two spot first morning urine samples will be provided by participants. Urine samples will be provided on the day of the WP tobacco smoking session and on the following day. Physiological measures will be taken before and after the WP tobacco smoking session.
Assess Difference in Urinary Furan-NAC-BDA-Lys Sulfoxide Between Levels Pre the Waterpipe Tobacco Smoking Session vs Post the Waterpipe Tobacco Smoking Session	3.4 pmol/mL Interval 2.9 to 4.1	3.1 pmol/mL Interval 2.6 to 3.6

Adverse Events

Waterpipe Smoking

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Control

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Nada Kassem

San Diego State University Research Foundation

Phone: 619-370-7488

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place

Measure	Waterpipe Smoking n=54 Participants 50 adult male and female exclusive waterpipe smokers will smoke waterpipe tobacco during a home smoking session	Control n=31 Participants A total of 25 adult male and female nonsmokers will act as a control.	Total n=85 Participants Total of all reporting groups
Age, Continuous	25.3 years STANDARD_DEVIATION 3.1 • n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	25.5 years STANDARD_DEVIATION 4.6 • n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	25.3 years STANDARD_DEVIATION 3.13 • n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Sex: Female, Male Female	25 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	13 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	38 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Sex: Female, Male Male	25 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	12 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	37 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Race/Ethnicity, Customized White, Caucasian, European	11 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	5 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	16 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Race/Ethnicity, Customized Mexican, Hispanic, or Latino	16 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	8 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	24 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Race/Ethnicity, Customized Black or African American	5 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	1 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	6 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Race/Ethnicity, Customized Middle Eastern	13 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	0 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	13 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Race/Ethnicity, Customized Asian/Multi-ethnic	5 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	11 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	16 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Highest level of education completed High school	7 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	1 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	8 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Highest level of education completed College, no degree	18 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	8 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	26 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Highest level of education completed College degree	25 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	15 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	40 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Highest level of education completed Missing	0 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	1 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	1 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Type of natural home setting House	30 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	12 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	42 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Type of natural home setting Apartment/Townhouse	19 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	13 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	32 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.
Type of natural home setting Missing Data	1 Participants n=50 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	0 Participants n=25 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.	1 Participants n=75 Participants • Baseline characteristics were collected only for retained participants (50 smokers; 25 non-smokers) in natural home settings (N=75), who were not disqualified or who were dropouts.