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The National Cancer Institute (NCI) recently awarded funding to support a collaboration between Virginia Commonwealth University Massey Cancer Center and the Jordan University of Science and Technology (JUST) researchers to study cancer biomarkers associated with hookah smoking, otherwise known as waterpipe tobacco smoking (WTS).  At question is whether hookah smoking causes DNA changes that increase cancer risk. The results of the study will be used to inform public health policy in the U.S., Jordan and other countries where WTS is prevalent.

The $246,553 supplemental award to Massey's NCI Cancer Center Support Grant (CCSG, which provides Massey’s NCI designation) will fund a one-and-a-half-year study involving 300 participants from the JUST student body and the broader Irbid, Jordan community. The study will be led by Massey Cancer Prevention and Control research members and professors in the Psychology Department at the VCU College of Humanities and Sciences Thomas Eissenberg, Ph.D., and Caroline Cobb, Ph.D., as well as JUST researchers Omar Khabour, Ph.D., and Karem Alzoubi, Ph.D. The team will recruit 150 participants who only smoke tobacco from a waterpipe, and another 150 who don't use tobacco at all. Participants will have blood and oral epithelial samples taken to be analyzed for DNA methylation. Epithelial cells are the cells that create the tissue lining the inside of the body, and researchers will collect these cells using a special mouthwash. DNA methylation is a process in which methyl groups are added to DNA, which can "inactivate" a gene without altering the underlying DNA sequence. Methylation is implicated in silencing tumor suppressor genes and promoting carcinogenesis, and it is considered a biomarker for future cancer development. In addition to looking at global DNA methylation in the body, the researchers will also examine specific genes known to be affected by other types of tobacco smoking.

Thomas Eissenberg, Ph.D.

"There is ample evidence that waterpipe tobacco smoking is a global health concern, yet in the U.S., Jordan and many other countries, this type of tobacco is less regulated than cigarettes. This inconsistent regulation combined with potentially deceptive labeling can give the impression of a healthy product," says Eissenberg, who also directs the VCU Center for the Study of Tobacco Products (CSTP). "There is a need for data that policymakers can use to help limit the spread of waterpipe tobacco smoking, and one powerful way to address the issue is to determine if users display the same cancer biomarkers as traditional cigarette smokers."

In Jordan, legislation requires health warnings on all tobacco products, but these warnings appear on cigarette packs only and not on waterpipe tobacco or waterpipes themselves. The same is true in the U.S. where WTS is not yet federally regulated. Additionally, in the U.S. and elsewhere, waterpipe tobacco often carries deceptive labeling such as "0% tar and .05% nicotine," and there are pervasive myths about the ability of water to filter toxicants from tobacco smoke. Also, while all flavored cigarettes with the exception of menthol are banned in the U.S., there are many different flavors of waterpipe tobacco sold that could potentially appeal to youth.

“Waterpipe tobacco smoking has increased so much among U.S. adolescents and young adults that it now rivals cigarette use, and in Jordan nearly 30 percent of all college students report smoking tobacco from waterpipes,” says Eissenberg. “When our project is completed, it will help address accurate labeling and science-based public health interventions designed to reduce the spread of waterpipe tobacco smoking wherever it occurs.”

This new collaboration is the most recent in an established tobacco research partnership between JUST and VCU. VCU’s CSTP is a World Health Organization Collaborating Center for Tobacco Product Testing and Research and partners with international research centers to inform tobacco product regulation. The VCU CSTP is engaged in several other research initiatives aimed at evaluating “modified risk tobacco products” and other novel products such as electronic cigarettes. 

Written by: John Wallace