Nicotine levels in flavoured hookah (waterpipe) tobacco products: discrepancies between labelled and measured levels.

Background: Hookah tobacco smoking is prevalent among youth and young adults. While health warning labels play a critical role in communicating the health risks of tobacco product use to consumers, compliance with US Federal Regulation's nicotine warning requirements on hookah tobacco packaging is low. Some labelling suggests that consumers are exposed to 'only 0.05% nicotine'. Here, this study sought to evaluate the accuracy of nicotine levels advertised on flavoured hookah tobacco packaging.

Methods: We measured nicotine content of commercial hookah tobacco in a total of 15 flavours purchased from five different manufactures, that were selected based on their popularity in the USA and UK markets. Concentrations of nicotine were determined by gas-liquid chromatography with nitrogen phosphorus detection, using 5-methyl nicotine as an internal standard. Nicotine content was expressed as a percentage of tobacco weight.

Results: Out of the 15 flavours tested and as compared with nicotine levels advertised on product packaging (0.05% nicotine), 12 (80%) had higher nicotine levels. Of these 12 flavours, actual nicotine levels ranged between 20% and 160% higher (0.08±0.01% vs 0.05%; mean±SE) than advertised levels. Estimates of determined levels of nicotine ranged from 0.05% to 0.13%.

Conclusion: Nicotine levels cited by leading hookah tobacco manufacturers are misleading. The advertised levels of nicotine do not reflect the quantified dose of nicotine available to consumers of hookah tobacco products. Findings highlight the need for the development of hookah tobacco product regulations and labelling standards, similar to other tobacco products, to avoid misleading vulnerable consumers, including youth and young adults.