Paolo Boffetta

Icahn School of Medicine at Mount Sinai

Professor

PLCO (Learn more about this study)

PLCO-57

Jan 9, 2014

Health effects of cigar, cigarillo, pipe and hookah smoking

Tobacco smoking represents the main single preventable cause of common chronic diseases, including cardiovascular and respiratory diseases and cancer. During the past few decades, the prevalence of cigarette smoking, as the most common type of tobacco use, has been decreasing in the United States and several other high-income countries. However, recent reports have shown an increase in the use of some other tobacco products, including cigarillos and hookah (water-pipe), in the US and many other areas of the world. The smoke from cigars, cigarillos, pipe, and hookah contains many toxic compounds found in cigarette smoke, and even using some of these products may expose the smokers to toxic compounds at higher levels per puff. For example, each puff from hookah has reported to deliver 12-times as much smoke as a single cigarette puff. However, little is known about health effects of cigarillos and hookah, and the evidence for cigar and pipe is limited. The prevalence of cigar and pipe smoking has been modest worldwide and the reported increase in the use of cigarillos and hookah in the US and other countries is fairly recent and mainly includes young people. Therefore, the majority of previous studies that investigated the association between cigarette smoking and disease (which have mainly been conducted in the US and other high-income countries) did not investigate that association for other tobacco smoking products, or when they did, the number of participants using those products was not enough to be reported separately or to make a strong conclusion on the association of those products and health outcomes. The small number of participants in the majority of the studies that investigated the health effects of tobacco smoking other than cigarette smoking precluded the ability to investigate risk among sub-populations, e.g. by gender and ethnicity.

Our study will measure the association between smoking of cigars, cigarillos, pipe, and hookah and incidence and mortality from cancer, cardiovascular disease, respiratory disease, as well as overall mortality within the Cohort Consortium, which can provide a sample size large enough to achieve acceptable statistical power to identify any risk associated with the use of those products, and perhaps in different sub-populations (e.g. by sex, ethnicity, and geographical region). Our protocol has been approved by the Secretariat of the Cohort Consortium. Disease- and cohort-specific confounders will be identified in preliminary analyses. Cohort specific regression coefficients will be combined using random-effects models. Analyses will be stratified by geographic region and time period to explore possible sources of heterogeneity.

Required outcome variables include incidence and mortality of tobacco-related cancers (oral/pharynx, larynx, lung, liver, pancreas, esophagus, stomach, bladder and kidney). Required exposure data includes variables on duration, amount and time since cessation if applicable for smoking of cigarettes, cigars, cigarillos, pipes and hookah). Requested variables for covariates are age, gender, ethnicity, socio-economic/education status, alcohol history, list of chronic illnesses, BMI at baseline, family history of cancer, dietary variables if harmonized and history of occupational exposures if any.

To measure the association between smoking of cigars, cigarillos, pipe, and hookah and incidence and mortality from cancer.

To study the interaction between smoking of cigarettes and of non-cigarette smoking products.

To study differences in risk by type of non-cigarette smoking products by geographic region.

To compare the results obtained from the pooling of prospective studies with those obtained from similar pooling projects of retrospective (case-control) studies.