Carbon Monoxide Levels Among Patrons of Hookah Cafes

Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, 101 S. Newell Drive, Gainesville, FL 32611, USA.
American journal of preventive medicine (Impact Factor: 4.53). 03/2011; 40(3):324-8. DOI: 10.1016/j.amepre.2010.11.004
Source: PubMed


Individuals who use a hookah (water pipe) as a method of tobacco smoking are exposed to high levels of carbon monoxide (CO). Assessing hookah use in one of the venues of its use (hookah bars) will aid the understanding of the toxins and exposure for the user. In Florida, smoking is prohibited in public places under the Florida Clean Indoor Act but permitted in establishments that have less than 10% gross revenue from food.
To assess the CO level of hookah cafe patrons, using traditional bar patrons as a comparison.
After IRB approval, a nighttime field study of patrons (aged >18 years) exiting hookah cafes and traditional bars in 2009 was conducted, using sidewalk locations immediately outside these establishments in a campus community. As hookah cafes and bars are typically entered and exited in groups, every other group of people exiting the establishment was approached. For comparison purposes, the sample collected was similar in number, 173 hookah cafe and 198 traditional bar participants.
Results from analysis conducted in 2010 indicate that patrons of hookah cafes had significantly higher CO levels (mean=30.8 parts per million [ppm]) compared to patrons of traditional bars (mean=8.9 ppm). Respondents who indicate no cigarette use in the past month but had visited a hookah cafe still demonstrated significantly higher CO values (mean=28.5 ppm) compared to those exiting traditional bars (mean=8.0 ppm). Current cigarette smokers also produced significantly more CO if exiting a hookah cafe (mean=34.7 ppm) compared to a traditional bar (mean=13.3 ppm).
CO levels are higher for patrons of hookah cafes, for both current and non-cigarette smokers. Although users report that they perceive hookah to be less harmful than cigarettes, the greater CO exposure for hookah users that was observed in this study is not consistent with that perception.

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    • "- smoking eCO concen - tration was 5 . 1 ppm , and the mean concentration after WP smoking was 37 . 4 ppm . An additional field study of 173 patrons of WP caf es and 198 patrons of traditional bars that was conducted in 2009 in the US indicated that the patrons of WP caf es had significantly higher eCO levels ( mean : 30 . 8 ppm vs . 8 . 9 ppm ) ( Barnett et al . , 2011 ) . In conclusion , WP smokers are exposed to high concentra - tions of CO . This is true to a lesser extent with subjects who are passively exposed to WP smoke ."
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    ABSTRACT: Waterpipe (WP) smoking is growing as an alternative to cigarette smoking, especially in younger age groups. E-cigarette use has also increased in recent years. A majority of smokers mistakenly believe that WP smoking is a social entertainment practice that leads to more social behavior and relaxation and that this type of smoking is safe or less harmful and less addictive than cigarette smoking. In reality, WP smokers are exposed to hundreds of toxic substances that include known carcinogens. High exposures to carbon monoxide and nicotine are major health threats. Persons exposed to secondhand WP smoke are also at risk. There is growing evidence that WP smoke causes adverse effects on the pulmonary and cardiovascular systems and is responsible for cancer.
    Atmospheric Environment 04/2015; 106:429-441. DOI:10.1016/j.atmosenv.2014.08.030 · 3.28 Impact Factor
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    • "Among patrons in a café in Beirut, Lebanon, exhaled CO levels increased by 22 p.p.m. after water pipe use, compared with 11 p.p.m. among cigarette users (Bacha et al., 2007). In the only naturalistic study in the United States, Barnett and colleagues (2011) assessed expired CO levels among patrons exiting water pipe or traditional bars, finding much higher mean CO levels among water pipe bar patrons (30.8 p.p.m. vs. 8.9 p.p.m., respectively). CO levels were not assessed prior to entering the water pipe bar, so within-person change, or CO " boost, " could not be evaluated. "
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    ABSTRACT: Water pipe (also known as "hookah") smoking is increasing around the world, including the United States, where water pipe bars have sprung up rapidly around college campuses. Users are exposed to several toxicants, including carbon monoxide (CO). We evaluated change in exhaled CO and estimated carboxyhemoglobin levels among water pipe bar patrons in Tampa, FL. Exhaled breath samples were obtained immediately before entering and after leaving 6 water pipe bars in Tampa, FL to measure CO boost and factors affecting CO change. Demographics, cigarette use status, and characteristics of water pipe use during the bar visit also were assessed. Among the sample of 166 participants, mean CO increased from 6.5 parts per million (p.p.m.) to 58.2 p.p.m. (a 795% relative boost; p < .001). CO change was higher for patrons who were dual (water pipe plus cigarette) smokers compared with water pipe-only smokers, and significant factors of CO change were frequency of water pipe use, number of charcoals, number of tobacco bowls, and time spent in the bar (all p-values < .05). U.S. water pipe bar patrons are exposed to considerable amounts of CO, which could put them at risk of acute illness and chronic heart and lung diseases. Environmental and policy controls are needed to curb this increasingly popular tobacco use method in the United States.
    Nicotine & Tobacco Research 03/2014; 16(7). DOI:10.1093/ntr/ntu041 · 3.30 Impact Factor
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    • "To broaden the research to include multiple institutions, Sutfin et al. [7] sampled college students from eight universities in one U.S. state; 40.3% of the sample reported ever using hookah and 17.4% of the students reported current (past 30 day) hookah use. Many hookah smokers also reported cigarette use [9]. "
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    ABSTRACT: Background The emergence of hookah is being noted on college campuses and in large U.S. cities and evidence points to an increasing trend for college students. The purpose of this study was to assess hookah use and identify associations with cigarette smoking and demographic factors. Methods An intercept sampling method was used at various locations on a large university campus in the southeastern United States, yielding a high participation rate (52%). A total of 1,203 participants completed a computer-aided survey that assessed the use of tobacco products. The sample characteristics were then weighted to match the University population of students enrolled during the same semester. Bivariate (chi-square and t-test) and multivariate (logistic regression) tests of association were conducted to assess differences between cigarette and hookah users. Results Hookah smoking exceeded cigarette smoking for both ever use (46.4% vs 42.1%) and past year use (28.4% vs 19.6%). Females and males used hookah at similar rates. Hispanic respondents had the highest prevalence of current use of hookah (18.9%) and cigarettes (16.4%). Conclusions As hookah surpasses cigarette use, efforts need to be made to slow the increase in new tobacco products that are attractive to young adults and that pose many of the same health risks as those related to traditional tobacco products. Prevalence of all emerging tobacco products, including hookah, and the relationship with cigarette use needs to be monitored on an ongoing basis.
    BMC Public Health 04/2013; 13(1):302. DOI:10.1186/1471-2458-13-302 · 2.26 Impact Factor
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