Comparative effect of cigarette, cannabis, shisha and vape smoking on blood pressure among school children: Interim results from Hand aufs Herz Study

Background While cigarette smoking is popular worldwide, evidence suggests a growing trend among young people towards other forms of tobacco use or smoking products. Handheld electronic cigarettes or vaping devices, shisha (commonly known as hookah or waterpipe) and cannabis are some of the popular smoking products among young people worldwide. Similar trend reversal from cigarette smoking to alternative products among adolescents and young people have also been reported in Germany. Smoking products have been linked to various health outcomes including cardiovascular morbidities. Elevated blood pressure (BP) is widely recognized as an early indicator for future cardiovascular outcomes in children. While BP has been identified as a potential long-term outcome of cigarette smoking, its association with various kinds of smoking products, especially among young adolescents and children remains limited. Purpose This analysis aimed to assess the effect of different smoking products (cigarette, cannabis, shisha and vape) on BP among school children and adolescents aged 8-19 years from Germany. Methods The ‘Hand aufs Herz’ is an ongoing study in school children. Cross-sectional data on use of smoking products were obtained from 1543 school children and adolescents using a self-reported questionnaire. Systolic and diastolic BP was measured and classified into percentiles based on age, sex and height. Descriptive statistics and linear regression have been used for the analysis using R software (v4.5.1). Results This analysis included 1,453 children aged 8 to 19 years. Of these, 324 students (22% boys and 22% girls) smoked at least one of the four smoking products. The most popular product was cigarette (12%), followed by vape (7.9%), shisha smoking (2.3%), and cannabis (0.1%) (all p>0.05). There was no significant difference between male and female students smoking these substances. Among the smokers, 23% had elevated BP, compared to 25% who did not smoke anything (p>0.05). The mean systolic and diastolic BP in students who did not smoke any of the products were 116 mmHg and 70.6 mmHg respectively. Among those who smoked, systolic BP was approximately 5 mmHg higher than those who did not smoke anything (p<0.05, 95% CI: 115.6-116.8 mmHg). Likewise, diastolic blood pressure was approximately 2 mmHg higher among smokers than in non-smokers (p<0.05, 95% CI: 70.1-71.1). Despite this individual effect on systolic and diastolic BP, no influence of smoking any of the products was found on the risk of hypertension. Conclusion Identification of biological and behavioural factors like smoking which affect BP levels in children and adolescents is important. Early exposure to different smoking products (with or without nicotine) can influence the BP levels. More large-scale studies are required to assess individual effect of trendy smoking product on younger population.