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In a study of Jordanian waterpipe tobacco smokers who either scored low ( 13) on the LWDS-11 and then smoked a waterpipe in a laboratory setting, higher LWDS-11 scores were associated with more puffs, longer puffs, shorter interpuff intervals, lower flow rate (puff velocity), and greater exposure to CO during the smoking session.87 As the authors noted: The observation that smokers with higher LWDS-11 scores are exposed to more CO suggests that these individuals may inhale more smoke and thus be at greater risk for waterpipe-induced cardiovascular and pulmonary disease as well as cancer (ref

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