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Secondhand smoke exposure from the indoor and outdoor shisha centers located at the perimeter of educational institutions in Malaysia: a cross-sectional study. J Public Health Policy 2022; 43:77-88. [PMID: 35058568 PMCID: PMC8776358 DOI: 10.1057/s41271-021-00329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/21/2022]
Abstract
Shisha is a centuries-old traditional smoking habit rapidly gaining popularity among the students and young adults in Malaysia. The present study evaluated secondhand smoke exposure (SHS) and characteristics of 25 indoor and 25 outdoor shisha centers (SC) operating around the educational institutes such as universities in Petaling Jaya, Malaysia. We observed a significantly higher particulate matter (PM)2.5 concentration in indoor than outdoor SC (3595.28 μg/m3 and 65.12 μg/m3, p < 0.001, respectively). SCs are offering different flavors to attract clients and exposing students and young professionals to a significantly high concentration of SHS. Such exposures may pose a serious health risk. Therefore, policymakers need to strengthen tobacco guidelines and eliminate loopholes in the sale of shisha by enforcing comprehensive and strict smoke-free laws.
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Kassem NOF, Peterson LA, Liles S, Kassem NO, Zaki FK, Lui KJ, Vevang KR, Dodder NG, Hoh E, Hovell MF. Urinary metabolites of furan in waterpipe tobacco smokers compared to non-smokers in home settings in the US. Toxicol Lett 2020; 333:202-210. [PMID: 32814080 PMCID: PMC10883161 DOI: 10.1016/j.toxlet.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Determine uptake of furan, a potential human carcinogen, in waterpipe tobacco (WPT) smokers in home settings. METHODS We analysed data from a US convenience sample of 50 exclusive WPT smokers, mean age 25.3 years, and 25 non-smokers, mean age 25.5 years. For WPT smokers, data were collected at a home visit by research assistants during which participants smoked one WPT head of one brand for a mean of 33.1 min in their homes. Research assistants provided and prepared a WP for participants by weighing and loading 10 g of WPT in the WP head. At the completion of the smoking session, research assistants measured the remaining WPT. Cotinine and six furan metabolites were quantified in first morning urine samples provided on 2 consecutive days for non-smokers, and on the morning of a WPT smoking session and on the following morning for smokers. RESULTS WPT smokers consumed a mean of 2.99 g WPT. In WPT smokers, urinary cotinine levels increased significantly 26.1 times the following morning; however, urinary metabolites of furan did not increase significantly. Compared to non-smokers, 2 furan metabolites, N-acetyl-S-[1-(5-acetylamino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine and N-acetyl-S-[1-(5-amino-5-carboxypentyl)-1H-pyrrol-3-yl]-L-cysteine sulfoxide, were significantly higher in WPT smokers in pre and in post WPT smoking levels. CONCLUSIONS To enable a more rigorous assessment of furan exposure from WPT smoking, future research should determine furan concentrations in WPT smoke, quantify furan metabolites from users of various WPT brands; and extend the investigation to social settings where WPT smoking is habitually practiced.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States.
| | - Lisa A Peterson
- Division of Environmental Health Sciences and the Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Flora K Zaki
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
| | - Kung-Jong Lui
- San Diego State University Research Foundation, 5250 Campanile Dr., San Diego, CA 92182, United States
| | - Karin R Vevang
- Division of Environmental Health Sciences and the Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Nathan G Dodder
- San Diego State University Research Foundation, 5250 Campanile Dr., San Diego, CA 92182, United States
| | - Eunha Hoh
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, United States
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Hookah Tobacco Studies Division, San Diego State University Research Foundation, San Diego, CA, 92123, United States
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Rezk-Hanna M, Nelson MD, Rader F, Benowitz NL, Rosenberry R, Chang LC, Li N, Tashkin DP, Elashoff RM, Victor RG. Peripheral Blood Flow Changes to Cutaneous and Muscular Beds in Response to Acute Hookah Smoking. Am J Cardiol 2020; 125:1725-1731. [PMID: 32278465 DOI: 10.1016/j.amjcard.2020.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
Hookah (waterpipe) smoking is a growing tobacco epidemic. Though perceived as a safer tobacco alternative, hookah smoke contains, in addition to tobacco combustion products, large amounts of charcoal combustion products-implicated in cardiovascular disease-from the burning charcoal used to heat the flavored tobacco. To date, little is known on the vascular effects of hookah smoking. The aim of this study was to characterize the peripheral circulatory response to acute hookah smoking in cutaneous and muscular beds. In 21 healthy young adult habitual hookah smokers who did not smoke cigarettes (age 24 ± 1 years, mean ± SE), we measured plasma nicotine, exhaled carbon monoxide, skin blood flow (laser Doppler velocimetry) and calf muscle blood flow (strain-gauge plethysmography) before and for up to 60 minutes after ad lib hookah smoking. In nine subjects, nonsmoking time-control studies were performed. Hookah smoking, which increased plasma nicotine by 5.8 ng/ml (from 0.6 ± 0.1 to 6.4 ± 1.3, p <0.001) and exhaled carbon monoxide by 27 ppm (from 2.7 ± 0.2 to 29.5 ± 2.2, p <0.001), decreased skin blood flow by 23% (20.1 ± 2.8 to 14.8 ± 1.9 units, p <0.001) and increased skeletal muscle blood flow by 34% (2.3 ± 0.1 to 2.9 ± 0.2 units, p = 0.010). These responses required more than one hour to recover after smoking cessation. All cardiovascular parameters were unchanged in the nonsmoking time-control studies. Although perceived to be innocuous, hookah smoking produces acute cutaneous vasoconstriction with skeletal muscle vasodilation, a dissociated pattern of peripheral blood flow responses that is characteristic of nicotine and carbon monoxide. In conclusion, these findings provide objective evidence to challenge the perception that hookah smoking is a safer tobacco alternative.
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Feliu A, Fu M, Russo M, Martinez C, Sureda X, López MJ, Cortés N, Fernández E. Exposure to second-hand tobacco smoke in waterpipe cafés in Barcelona, Spain: An assessment of airborne nicotine and PM 2.5. ENVIRONMENTAL RESEARCH 2020; 184:109347. [PMID: 32179267 DOI: 10.1016/j.envres.2020.109347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/30/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Waterpipe tobacco smoking has grown in popularity worldwide, with the prevalence of use increasing in Spain from 6.2% to 10.8% in the last decade, despite the smoking ban enacted in 2010 for all hospitality premises. OBJECTIVE To assess exposure to second-hand smoke from waterpipes based on the concentrations of airborne nicotine and particulate matter ≤2.5 μm in diameter (PM2.5) in a sample of waterpipe cafés in the city of Barcelona (Spain). METHODS This cross-sectional study included a sample of 20 waterpipe cafés. Airborne nicotine and PM2.5 were sampled for 30 min in each venue using a nicotine sampling device connected by a tube to a pump and a TSI SidePak Personal Aerosol Monitor. Five outdoor control locations were also measured. We computed medians, interquartile ranges (IQRs), and maximum values and compared them according to venues' and sampling characteristics using the Kruskall-Wallis and U-Mann Whitney tests. Nicotine and PM2.5 were correlated by calculating the Spearman-rank correlation coefficient. RESULTS The median concentration of nicotine and PM2.5 were 1.15 and 230.50 μg/m3 in waterpipe cafés and 0.03 and 10.00 μg/m3 in control locations (p<0.05 in both cases). The Spearman correlation coefficient between both markers was 0.61 (95% confidence interval: 0.18-0.84). No differences were found in nicotine or PM2.5 concentration according to the venues' and sampling characteristics studied, with the exception of area. After stratifying for area, venues >100 m2, located in a tourist area, with >15 lit waterpipes, >8 waterpipes/100 m2, and a ratio of 2 users per waterpipe or less had significantly higher nicotine concentration. DISCUSSION Despite the current smoking ban, which includes hospitality venues, we found nicotine and PM2.5 levels in Barcelona waterpipe cafés that exceeded the threshold recommended by the World Health Organization. This exposure poses serious risks to the health of both workers and customers and constitutes a non-compliance of the legislation.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, l'Hospitalet del Llobregat, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, l'Hospitalet del Llobregat, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Marta Russo
- School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, l'Hospitalet del Llobregat, Barcelona, Spain
| | - Cristina Martinez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, l'Hospitalet del Llobregat, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, USA
| | - Xisca Sureda
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, USA; Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Maria José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Núria Cortés
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, l'Hospitalet del Llobregat, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain.
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Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e917-e936. [PMID: 30845826 DOI: 10.1161/cir.0000000000000671] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.
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Brinkman MC, Kim H, Buehler SS, Adetona AM, Gordon SM, Clark PI. Evidence of compensation among waterpipe smokers using harm reduction components. Tob Control 2020; 29:15-23. [PMID: 30377243 PMCID: PMC7350613 DOI: 10.1136/tobaccocontrol-2018-054502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined two waterpipe tobacco smoking components advertised to reduce harm to determine if they result in lower levels of biomarkers of acute exposure. METHODS We conducted a crossover study of 34 experienced waterpipe smokers smoking a research-grade waterpipe in three configurations ad libitum in a controlled chamber: control (quick-light charcoal), electric (electric heating) and bubble diffuser (quick-light charcoal and bubble diffuser). We collected data on smoking topography, environmental carbon monoxide (CO), subjective effects, heart rate, plasma nicotine and exhaled CO and benzene. RESULTS Smokers' mean plasma nicotine, heart rate, and exhaled benzene and CO boost were all significantly lower for electric compared with control. However, smokers puffed more intensely and took significantly more and larger volume puffs for a larger total puffing volume (2.0 times larger, p<0.0001) when smoking electric; machine yields indicate this was likely due to lower mainstream nicotine. Smokers rated electric smoking experience less satisfying and less pleasant. For charcoal heating, the mean mass of CO emitted into the chamber was ~1 g when participants smoked for a mean of 32 minutes at a typical residential ventilation rate (2.3 hr-1). CONCLUSION Waterpipe smokers engaged in compensation (i.e., increased and more intense puffing) to make up for decreased mainstream nicotine delivery from the same tobacco heated two ways. Waterpipe components can affect human puffing behaviours, exposures and subjective effects. Evidence reported here supports regulation of waterpipe components, smoking bans in multifamily housing and the use of human studies to evaluate modified or reduced risk claims.
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Affiliation(s)
- Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| | - Hyoshin Kim
- Battelle Public Health Center for Tobacco Research, Battelle, Seattle, Washington, USA
| | - Stephanie S Buehler
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Anna M Adetona
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Sydney M Gordon
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Pamela I Clark
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
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Maziak W, Osibogun O, Asfar T. Waterpipe smoking: the pressing need for risk communication. Expert Rev Respir Med 2019; 13:1109-1119. [PMID: 31519113 PMCID: PMC7004232 DOI: 10.1080/17476348.2019.1668271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/21/2023]
Abstract
Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.
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Affiliation(s)
- Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
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Naddafi K, Nabizadeh R, Rostamy R, Ebrahimi Kalan M, Hassanvand MS, Fazlzadeh M. Indoor air quality in waterpipe cafés: exposure level to particulate matter. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:26605-26616. [PMID: 31290048 DOI: 10.1007/s11356-019-05546-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 05/11/2023]
Abstract
Waterpipe is increasingly being used worldwide. Despite waterpipe cafés gaining popularity among Iranian population, there is a paucity of research measuring exposures and assessing the health effects of waterpipe smoke in these places. The objective of the current study was to investigate the exposure to PM10, PM2.5, and PM1 concentrations and risk assessment of PM2.5 exposures in different age groups in the indoor air of waterpipe cafés. The study samples were taken from indoor air of 50 waterpipe cafés in Ardabil, Iran. The PM10, PM2.5, and PM1 concentrations were assessed using a portable GRIMM dust monitors. The mean (±SD) concentrations of indoor air PM10, PM2.5, and PM1 were 765 ± 352, 624 ± 327, and 500 ± 305 μg/m3, respectively. The mean of HQ (hazard quotient) for PM2.5 in all age groups of 16 and older was > 1, which corresponds to an unacceptably high risk for human health. Also, the mean of ELCRs (excess lifetime cancer risk) for PM2.5 in different age groups exceeded the limit value by the USEPA. The results indicated that the PM concentration is significantly influenced by the number of waterpipe smokers, type of ventilation system, and kind of tobacco. Therefore, waterpipe cafés are a potential source for exposure to PM10, PM2.5, and PM1 and increase the risk of respiratory diseases and cardiovascular problems among waterpipe smokers.
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Affiliation(s)
- Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Roohollah Rostamy
- Research Center for Health Sciences and Technologies, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Fazlzadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
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Moon KA, Rule AM, Magid HS, Ferguson JM, Susan J, Sun Z, Torrey C, Abubaker S, Levshin V, Çarkoglu A, Radwan GN, El-Rabbat M, Cohen JE, Strickland P, Breysse PN, Navas-Acien A. Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo. Nicotine Tob Res 2019; 20:482-491. [PMID: 28582531 DOI: 10.1093/ntr/ntx125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/30/2017] [Indexed: 11/12/2022]
Abstract
Background Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62). Conclusions Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs). Implications Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hoda S Magid
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline M Ferguson
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jolie Susan
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Zhuolu Sun
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christine Torrey
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Salahaddin Abubaker
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Asli Çarkoglu
- Department of Psychology, Kadir Has University, Istanbul, Turkey
| | - Ghada Nasr Radwan
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha El-Rabbat
- Department of Psychology, Kadir Has University, Istanbul, Turkey
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Paul Strickland
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Patrick N Breysse
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ana Navas-Acien
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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Heydari G, Taghizdeh F, Fazlzadeh M, Jafari AJ, Asadgol Z, Mehrizi EA, Moradi M, Arfaeinia H. Levels and health risk assessments of particulate matters (PM 2.5 and PM 10) in indoor/outdoor air of waterpipe cafés in Tehran, Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:7205-7215. [PMID: 30656582 DOI: 10.1007/s11356-019-04202-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/08/2019] [Indexed: 05/21/2023]
Abstract
To determine the concentration of particulate matters (PM2.5 and PM10), 36 samples were collected from indoor/outdoor air of hookah cafés (HS), cigarette cafés (CS), both hookah and cigarette (HCS), and no-smoking building (NS) in Tehran City from December 2017 to March 2018. The mean ± SD of PM10 concentration in the indoor air of the cafés in terms of HS, CS, HCS, and NS sites has been 702.35, 220.20, 1156.60, and 60.12 μg/m3, while for PM2.5, the values have been 271.92, 111.80, 619.10, and 22.25 μg/m3, respectively. It was also found that the PM concentration inside the cafés was higher during weekend session (with a higher number of active smokers), than during the weekday sessions. Moreover, the PM levels in the indoor air of the cafés were considerably higher than those of the outdoors (p < 0.05). Based on path analysis, the number of "active smokers" had the highest influence on production of PM inside the cafés, followed by the tobacco type. Finally, the mean excess lifetime cancer risk (ELCR) for PM2.5 in the indoor air of cafés was observed in the range of 0.64 × 10-5-14.98 × 10-5. Also, the mean of hazard quotient (HQ) for PM2.5 and PM10 was calculated in range of 0.82-18.4 and 0.16-3.28, respectively, which corresponds to an unacceptably high risk for human health. The PM levels in the indoor air of smoking cafés in Tehran are significantly high, such that it can cause serious risks for the health of both the customers and personnel. Thus, it is necessary that suitable controlling strategies be adopted for this public health threat.
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Affiliation(s)
- Gholamreza Heydari
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Taghizdeh
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Fazlzadeh
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Asadgol
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Abouee Mehrizi
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Arfaeinia
- Department of Environmental Health Engineering, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran.
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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11
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Air pollutants associated with smoking in indoor/outdoor of waterpipe cafés in Tehran, Iran: Concentrations, affecting factors and health risk assessment. Sci Rep 2019; 9:3110. [PMID: 30816239 PMCID: PMC6395650 DOI: 10.1038/s41598-019-39684-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/29/2019] [Indexed: 11/08/2022] Open
Abstract
Despite increasingly growth in waterpipe smoking in Tehran, so far no study has been conducted on the air quality of the waterpipe and cigarette cafés. Thirty-six cafés were selected and the concentration of three pollutants including formaldehyde, carbon monoxide and nicotine were measured in both indoor and outdoor air of cafés two times (week-day and weekend's session). Air sampling was performed for 180 min for each pollutant. It was observed that the concentration of pollutants inside the cafés was higher during weekend session (with a higher number of "active waterpipe heads") compared with findings during the week-day sessions. Furthermore, the concentration of pollutants in the indoor air of the cafés was significantly higher than that of the outdoors (p < 0.05). According to path analysis, the number of "active waterpipe heads" had the maximum impact on generation of pollutants inside the cafés, followed by the type of tobacco as the second influential factor. The average of lifetime cancer risk (LTCR) resulted by formaldehyde exposure through inhalation in waterpipe (WS), cigarette (CS), waterpipe and cigarette (WCS) and none-smoking (NS) cafés in week-day and weekend sessions were estimated to be 111 × 10-5 and 61.2 × 10-5, 33.7 × 10-5 and 39.4 × 10-5, 271 × 10-5 and 322 × 10-5, and 4.80 × 10-5 and 5.90 × 10-5, respectively, which exceed the limit value by the U.S.EPA and WHO. The concentration of pollutants in the indoor air of smoking cafés in Tehran is significantly high, such that it can pose serious risks for the health of both personnel and customers. Therefore, decision makers are expected to enact applicable and strict policies so as to abate this public health risk.
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12
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Seidenberg AB, Orlan EN, Travers MJ, Sutfin EL. Air quality and presence of air ventilation systems inside waterpipe cafés in North Carolina. Tob Control 2018; 28:356-358. [PMID: 30042230 DOI: 10.1136/tobaccocontrol-2018-054361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND After North Carolina (NC) fire inspectors detected unsafe carbon monoxide (CO) levels inside several waterpipe cafés, the state fire code was amended to include provisions regulating waterpipe cafés, adding a requirement for air ventilation. These regulations apply to new buildings constructed after 1 January 2016, but can be enforced for older buildings where there exists a distinct hazard to life. We measured air quality at a sample of waterpipe cafés before and after the starting date of this regulation and collected information on presence of air ventilation. METHODS Air quality (CO, fine particulate matter (PM2.5)) monitoring was conducted inside and outside of six waterpipe cafés in NC in September of 2015 (time 1) and September of 2016 (time 2). In addition, questionnaires were administered to managers from each waterpipe café at time 2 to determine the presence of air ventilation systems. RESULTS Elevated levels of CO and PM2.5 were found inside waterpipe cafés at time 1 (median CO=42 ppm; median PM2.5=379.3 µg/m3) and time 2 (median CO=65 ppm; median PM2.5=484.0 µg/m3), with no significant differences between time periods (p>0.05). Indoor levels were significantly higher than levels outside cafés at both time periods (p<0.05). All waterpipe cafés reported having an air ventilation system that was installed prior to time 1 air monitoring. CONCLUSIONS Unsafe levels of CO and PM2.5 were observed in waterpipe cafés in NC, despite reported use of air ventilation systems. Prohibiting indoor waterpipe smoking may be necessary to ensure clean air for employees and patrons.
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Affiliation(s)
- Andrew B Seidenberg
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark J Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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13
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Kassem NOF, Kassem NO, Liles S, Zarth AT, Jackson SR, Daffa RM, Chatfield DA, Carmella SG, Hecht SS, Hovell MF. Acrolein Exposure in Hookah Smokers and Non-Smokers Exposed to Hookah Tobacco Secondhand Smoke: Implications for Regulating Hookah Tobacco Products. Nicotine Tob Res 2018; 20:492-501. [PMID: 28591850 PMCID: PMC5896480 DOI: 10.1093/ntr/ntx133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/05/2017] [Indexed: 12/31/2022]
Abstract
Introduction Acrolein is a highly ciliatoxic agent, a toxic respiratory irritant, a cardiotoxicant, and a possible carcinogen present in tobacco smoke including hookah tobacco. Methods 105 hookah smokers and 103 non-smokers attended exclusively hookah smoking social events at either a hookah lounge or private home, and provided urine samples the morning of and the morning after the event. Samples were analyzed for 3-hydroxypropylmercapturic acid (3-HPMA), a metabolite of acrolein. Results Geometric mean (GM) urinary 3-HPMA levels in hookah smokers and non-smokers exposed to secondhand smoke (SHS) increased significantly, 1.41 times, 95% CI = 1.15 to 1.74 and 1.39 times, 95% CI = 1.16 to 1.67, respectively, following a hookah social event. The highest increase (1.68 times, 95% CI = 1.15 to 2.45; p = 0.007) in 3-HPMA post a hookah social event was among daily hookah smokers (GM, from 1991 pmol/mg to 3348 pmol/mg). Pre-to-post event change in urinary 3-HPMA was significantly positively correlated with pre-to-post event change in urinary cotinine among hookah smokers at either location of hookah event, (ρ = 0.359, p = 0.001), and among non-smokers in hookah lounges (ρ = 0.369, p = 0.012). Conclusions Hookah tobacco smoke is a source of acrolein exposure. Findings support regulating hookah tobacco products including reducing humectants and sugar additives, which are precursors of acrolein under certain pyrolysis conditions. We suggest posting health warning signs for indoor smoking in hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes. Implications Our study is the first to quantify the increase in acrolein exposure in hookah smokers and non-smokers exposed to exclusively hookah tobacco SHS at hookah social events in homes or hookah lounges. Our findings provide additional support for regulating hookah tobacco product content, protecting non-smokers' health by posting health warning signs for indoor smoking in hookah lounges, and encouraging home bans on hookah tobacco smoking to safeguard vulnerable residents.
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Affiliation(s)
- Nada O F Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Noura O Kassem
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Adam T Zarth
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Sheila R Jackson
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Reem M Daffa
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
| | - Dale A Chatfield
- San Diego State University Department of Chemistry, San Diego, CA, USA
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (CBEACH), Graduate School of Public Health, Division of Health Promotion, San Diego State University, San Diego, CA, USA
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14
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Travers MJ, Kulak JA, Vogl L. Waterpipe cafés are hazardous to your health: Determination of a waterpipe specific calibration factor. Int J Hyg Environ Health 2018; 221:48-53. [DOI: 10.1016/j.ijheh.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/28/2022]
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15
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Retzky SS, Spiller HA, Callahan-Lyon P. Calls to Poison Centers for hookah smoking exposures. Clin Toxicol (Phila) 2017; 56:442-445. [PMID: 29129117 DOI: 10.1080/15563650.2017.1400556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Over the past decade, smoking behaviors have changed in the US. Hookah or waterpipe smoking is increasing, especially among youth and young adults. Social media sites describe the "hookah high" or "buzz", which may be related to nicotine, carbon monoxide, or other inhalants in hookah smoke. Most important is the risk of carbon monoxide poisoning. Case reports include a high number of victims presenting with loss of consciousness from either syncope or seizures. Anaphylaxis and a very rare respiratory hypersensitivity reaction, acute eosinophilic pneumonia, have also been reported from hookah smoking in previously healthy young adults. This article provides background information on hookah smoking, describes hookah-induced acute injuries that could precipitate poison center calls, and offers suggestions for exposure characterization.
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Affiliation(s)
- Sandra S Retzky
- a Office of Science, Center for Tobacco Products , U.S. Food and Drug Administration , Silver Spring , MD , USA
| | - Henry A Spiller
- b Central Ohio Poison Center , Nationwide Children's Hospital , Columbus , OH , USA
| | - Priscilla Callahan-Lyon
- a Office of Science, Center for Tobacco Products , U.S. Food and Drug Administration , Silver Spring , MD , USA
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16
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Weitzman M, Yusufali AH, Bali F, Vilcassim MJR, Gandhi S, Peltier R, Nadas A, Sherman S, Lee L, Hong Z, Shearston J, Park SH, Gordon T. Effects of hookah smoking on indoor air quality in homes. Tob Control 2016; 26:586-591. [PMID: 27798320 DOI: 10.1136/tobaccocontrol-2016-053165] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/24/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke. METHODS Air samples from 33 homes-11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking-were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room. RESULTS Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different. CONCLUSIONS This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.
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Affiliation(s)
- Michael Weitzman
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA.,College of Global Public Health, New York University, New York, New York, USA.,Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA.,New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
| | - Afzal Hussein Yusufali
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,Hatta Hospital, Dubai Health Authority, Dubai, UAE
| | - Fatma Bali
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,Hatta Hospital, Dubai Health Authority, Dubai, UAE
| | - M J Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA
| | - Shashank Gandhi
- Department of Biology, New York University, New York, New York, USA
| | - Richard Peltier
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Arthur Nadas
- Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA
| | - Scott Sherman
- New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE.,College of Global Public Health, New York University, New York, New York, USA.,Department of Population Health, New York University, School of Medicine, New York, New York, USA
| | - Lily Lee
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA.,Brooklyn College, Brooklyn, New York, USA
| | - Zhang Hong
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA
| | - Jenni Shearston
- Department of Population Health, New York University, School of Medicine, New York, New York, USA
| | - Su Hyun Park
- Department of Pediatrics, New York University, School of Medicine, New York, New York, USA
| | - Terry Gordon
- College of Global Public Health, New York University, New York, New York, USA.,Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA.,New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
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17
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Die Wasserpfeife (Shisha) – Innenraumluftqualität, Human-Biomonitoring und Gesundheitseffekte. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1593-1604. [DOI: 10.1007/s00103-016-2462-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Gurung G, Bradley J, Delgado-Saborit JM. Effects of shisha smoking on carbon monoxide and PM2.5 concentrations in the indoor and outdoor microenvironment of shisha premises. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 548-549:340-346. [PMID: 26803732 DOI: 10.1016/j.scitotenv.2015.12.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/18/2015] [Accepted: 12/20/2015] [Indexed: 06/05/2023]
Abstract
There has been significant rise in shisha premises in the United Kingdom with an unsubstantiated belief that shisha smoking is harmless and relatively safe. This study aimed to assess the public health situation by evaluating the extent of shisha environmental tobacco smoke (ETS) exposure among those that work in, and are customers of shisha businesses. Concentrations of several ETS pollutants such as carbon monoxide (CO) and particulate matter with a diameter of less than 2.5μm (PM2.5) in shisha premises were measured using real-time sensors inside and outside twelve shisha premises and at 5 pubs/restaurants where smoking is prohibited. Mean concentration of CO (7.3±2.4mg/m(3)) and PM2.5 (287±233μg/m(3)) inside active shisha premises was higher than concentrations measured within the vicinity of the shisha premises (CO: 0.9±0.7mg/m(3) and PM2.5: 34±14μg/m(3)) and strongly correlated (PM2.5 R=0.957). Concentrations were higher than indoor concentrations in pubs and restaurants where smoking is not permitted under UK law. The number of shisha pipes was a strong predictor of the PM2.5 concentrations. The study also assessed the risk perception within patrons and managers, with only 25% being aware of the risks associated to shisha smoking. The study identifies owners, employees and consumers within active shisha premises being exposed to concentrations of CO and PM2.5 at levels considered hazardous to human health. The results and outcome of this research serve as a basis to influence a discussion around the need of developing specific policies to protect consumers and employees of such premises.
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Affiliation(s)
- Gam Gurung
- Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK; Environmental Health - Regulation and Enforcement, Birmingham City Council Birmingham, UK
| | - Janet Bradley
- Environmental Health - Regulation and Enforcement, Birmingham City Council Birmingham, UK
| | - Juana Maria Delgado-Saborit
- Division of Environmental Health and Risk Management, School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK.
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19
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Zhou S, Behrooz L, Weitzman M, Pan G, Vilcassim R, Mirowsky JE, Breysee P, Rule A, Gordon T. Secondhand hookah smoke: an occupational hazard for hookah bar employees. Tob Control 2016; 26:40-45. [PMID: 26811352 DOI: 10.1136/tobaccocontrol-2015-052505] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite the increasing popularity of hookah bars, there is a lack of research assessing the health effects of hookah smoke among employees. This study investigated indoor air quality in hookah bars and the health effects of secondhand hookah smoke on hookah bar workers. METHODS Air samples were collected during the work shift of 10 workers in hookah bars in New York City (NYC). Air measurements of fine particulate matter (PM2.5), fine black carbon (BC2.5), carbon monoxide (CO), and nicotine were collected during each work shift. Blood pressure and heart rate, markers of active smoking and secondhand smoke exposure (exhaled CO and saliva cotinine levels), and selected inflammatory cytokines in blood (ineterleukin (IL)-1b, IL-6, IL-8, interferon γ (IFN-γ), tumour necrosis factor (TNF-α)) were assessed in workers immediately prior to and immediately after their work shift. RESULTS The PM2.5 (gravimetric) and BC2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 µg/m3 and 2.2 µg/m3, respectively. The mean CO level was 12.9 ppm with a peak value of 22.5 ppm CO observed in one hookah bar. While heart rate was elevated by 6 bpm after occupational exposure, this change was not statistically significant. Levels of inflammatory cytokines in blood were all increased at postshift compared to preshift testing with IFN-Υ increasing from 0.85 (0.13) to 1.6 (0.25) (mean (standard error of the mean; SEM)) pg/mL (p<0.01). Exhaled CO levels were significantly elevated after the work shift with 2 of 10 workers having values >90 ppm exhaled CO. CONCLUSIONS These results demonstrate that hookah bars have elevated concentrations of indoor air pollutants that appear to cause adverse health effects in employees. These data indicate the need for further research and a marked need for better air quality monitoring and policies in such establishments to improve the indoor air quality for workers and patrons.
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Affiliation(s)
- Sherry Zhou
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA.,Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA.,NYU College of Global Public Health, New York, New York, USA
| | - Grace Pan
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | | | - Patrick Breysee
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ana Rule
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA.,NYU College of Global Public Health, New York, New York, USA
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20
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Zhou S, Weitzman M, Vilcassim R, Wilson J, Legrand N, Saunders E, Travers M, Chen LC, Peltier R, Gordon T. Air quality in New York City hookah bars. Tob Control 2015; 24:e193-8. [PMID: 25232045 PMCID: PMC4390442 DOI: 10.1136/tobaccocontrol-2014-051763] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/26/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hookahs are increasingly being used in the USA and elsewhere. Despite the popularity of hookah bars, there is a paucity of research assessing the health effects of hookah smoke, and although New York City (NYC) bans indoor tobacco smoking, hookah lounges claim that they only use herbal products without tobacco. This study investigated levels of multiple indices of indoor air pollution in hookah bars in NYC. METHODS Air samples were collected in 8 hookah bars in NYC. Along with venue characteristics, real-time measurements of fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO), and total gravimetric PM, elemental carbon (EC), organic carbon (OC), and nicotine were collected in 1-2 hour sessions. RESULTS Overall, levels of indoor air pollution increased with increasing numbers of active hookahs smoked. The mean (SD) real time PM2.5 level was 1179.9 (939.4) µg/m(3), whereas the filter-based total PM mean was 691.3 (592.6) µg/m(3). The mean real time BC level was 4.1 (2.3) µg/m(3), OC was 237.9 (112.3) µg/m(3), and CO was 32 (16) ppm. Airborne nicotine was present in all studied hookah bars (4.2 (1.5) µg/m(3)). CONCLUSIONS These results demonstrate that despite the ban on smoking tobacco products, at the very least, some NYC hookah bars are serving tobacco-based hookahs, and have elevated concentrations of indoor air pollutants that may present a health threat to visitors and employees. Therefore, there is an urgent need for better air quality monitoring in such establishments and policies to combat this emerging public health threat.
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Affiliation(s)
- Sherry Zhou
- New York University School of Medicine, New York, NY
| | - Michael Weitzman
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | | | | | - Eric Saunders
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | | | - Lung-Chi Chen
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
| | - Richard Peltier
- Division of Environmental Health Science, University of Massachusetts, Amherst, MA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, NY
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21
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Al Mulla A, Fanous N, Seidenberg AB, Rees VW. Secondhand smoke emission levels in waterpipe cafes in Doha, Qatar. Tob Control 2015; 24:e227-31. [PMID: 25352562 DOI: 10.1136/tobaccocontrol-2014-051717] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/08/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Exposure to the emissions of a tobacco waterpipe is associated with increased health risks among its users as well as those exposed to its secondhand smoke. Waterpipe use is an emerging concern to the tobacco control community, particularly among countries of the Eastern Mediterranean Region. In 2002, Qatar adopted legislation that prohibited cigarette smoking inside public venues, but exempted tobacco waterpipe smoking. To inform the development and enforcement of effective policy, the impact of cigarette and waterpipe use on indoor air quality was monitored in waterpipe cafes in Doha, Qatar. METHODS Particulate matter (PM2.5) levels were measured inside and outside of a sample of 40 waterpipe cafes and 16 smoke-free venues in Doha, Qatar between July and October 2012. In addition, the number of waterpipes being smoked and the number of cigarette smokers were counted within each venue. Non-paired and paired sample t tests were used to assess differences in mean PM2.5 measurements between venue type (waterpipe vs smoke-free) and environment (indoor vs outdoor). RESULTS The mean PM2.5 level inside waterpipe venues (476 μg/m(3)) was significantly higher than the mean PM2.5 level inside smoke-free venues (17 μg/m(3); p<0.001), and significantly higher than the mean PM2.5 level found immediately outside waterpipe venues (35 μg/m(3); p<0.001). In smoke-free venues, the outside mean PM2.5 level (30 μg/m(3)) did not differ significantly from the mean PM2.5 inside levels inside these venues (p=0.121). CONCLUSIONS Elevated levels of particulate pollution were found in waterpipe cafes in Doha, Qatar, potentially endangering the health of employees and patrons. To protect the public from the dangers of secondhand tobacco smoke, and to change social norms around tobacco use, smoke-free policies that apply to all forms of combusted tobacco products, including the waterpipe, are needed.
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Affiliation(s)
- Ahmad Al Mulla
- Tobacco Control Unit, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Nadia Fanous
- Tobacco Control Unit, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Andrew B Seidenberg
- Department of Social & Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, USA
| | - Vaughan W Rees
- Department of Social & Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, USA
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Moon KA, Magid H, Torrey C, Rule AM, Ferguson J, Susan J, Sun Z, Abubaker S, Levshin V, Çarkoğlu A, Radwan GN, El-Rabbat M, Cohen J, Strickland P, Navas-Acien A, Breysse PN. Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo. ENVIRONMENTAL RESEARCH 2015; 142:568-74. [PMID: 26298558 PMCID: PMC4609287 DOI: 10.1016/j.envres.2015.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. METHODS In 2012-2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM2.5) (N=35), carbon monoxide (CO) (N=23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (N=43), and air nicotine (N=46). RESULTS Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) µg/m(3) for PM2.5, 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m(3) for p-PAHs, 1.0 (0.5, 1.9) ng/m(3) for NNK, and 5.3 (0.7, 14) µg/m(3) for nicotine. PM2.5, CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant. CONCLUSION High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.
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Affiliation(s)
- Katherine A Moon
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hoda Magid
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Torrey
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana M Rule
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacqueline Ferguson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jolie Susan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zhuolu Sun
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salahaddin Abubaker
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Joanna Cohen
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul Strickland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick N Breysse
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Hammal F, Wild TC, Nykiforuk C, Abdullahi K, Mussie D, Finegan BA. Waterpipe (Hookah) Smoking Among Youth and Women in Canada is New, not Traditional. Nicotine Tob Res 2015; 18:757-62. [PMID: 26187392 DOI: 10.1093/ntr/ntv152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/23/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION When asserting the right of individuals to be free to smoke a hookah (waterpipe [WP]) in public places, the "cultural" importance of the practice is often cited. The purpose of this study was to explore the cultural significance of WP smoking. METHODS Qualitative methods were used to elicit the views of groups of WP smokers from different cultural backgrounds. RESULTS Sixteen group discussion sessions with a total of 75 WP smokers aged between 18 and 30 were conducted. A few participants saw culture as a factor supporting WP smoking initiation and maintenance. The vast majority indicated that WPs being perceived as "healthier" than cigarettes, and the availability of flavored shisha as important factors in their initiation and ongoing use. Most started smoking before the age of 18 calling it a "high school thing" and admitted that they had easy access to WP cafés. Many indicated that they did not know if they were smoking tobacco or a "herbal" substance. CONCLUSION Peer influence, availability of flavored products and facile access to WP cafés are major factors in WP initiation. Ethno-cultural traditions play only a minor role. The assertion that cultural traditions and practice are inherent in WP smoking as implied by media and marketing was not supported by our findings. Contemporary use of WP is spreading among new non-traditional users. Lack of knowledge about the harms of WP smoking indicates a need for education and regulation to require packaging and health warning labels and restrictions on access, especially to minors.
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Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Candace Nykiforuk
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Dawit Mussie
- Calgary Chinese Community Services Association, Calgary, AB, Canada
| | - Barry A Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada;
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24
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Torrey CM, Moon KA, Williams DAL, Green T, Cohen JE, Navas-Acien A, Breysse PN. Waterpipe cafes in Baltimore, Maryland: Carbon monoxide, particulate matter, and nicotine exposure. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:405-10. [PMID: 24736103 PMCID: PMC4333110 DOI: 10.1038/jes.2014.19] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/10/2014] [Indexed: 05/20/2023]
Abstract
Waterpipe smoking has been growing in popularity in the United States and worldwide. Most tobacco control regulations remain limited to cigarettes. Few studies have investigated waterpipe tobacco smoke exposures in a real world setting. We measured carbon monoxide (CO), particulate matter (PM)2.5, and airborne nicotine concentrations in seven waterpipe cafes in the greater Baltimore area. Area air samples were collected between two and five hours, with an average sampling duration of three hours. Waterpipe smoking behaviors were observed at each venue. Indoor air samplers for CO, PM2.5, and airborne nicotine were placed in the main seating area 1-2 m above the floor. Indoor airborne concentrations of PM2.5 and CO were markedly elevated in waterpipe cafes and exceeded concentrations that were observed in cigarette smoking bars. Air nicotine concentrations, although not as high as in venues that allow cigarette smoking, were markedly higher than in smoke-free bars and restaurants. Concentrations of PM approached occupational exposure limits and CO exceeded occupational exposure guidelines suggesting that worker protection measures need to be considered. This study adds to the literature indicating that both employees and patrons of waterpipe venues are at increased risk from complex exposures to secondhand waterpipe smoke.
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Affiliation(s)
- Christine M Torrey
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine A Moon
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - D' Ann L Williams
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tim Green
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 21205, USA. Tel.: +410-955-3608. Fax: +410-933-9334. E-mail:
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25
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Haddad L, El-Shahawy O, Ghadban R, Barnett TE, Johnson E. Waterpipe Smoking and Regulation in the United States: A Comprehensive Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6115-35. [PMID: 26110330 PMCID: PMC4483691 DOI: 10.3390/ijerph120606115] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Researchers in tobacco control are concerned about the increasing prevalence of waterpipe smoking in the United States, which may pose similar risks as cigarette smoking. This review explores the prevalence of waterpipe smoking in the United States as well as the shortcomings of current U.S. policy for waterpipe control and regulation. METHODS Researchers conducted a literature review for waterpipe articles dated between 2004 and 2015 using five online databases: MEDLINE, CINHAHL, ScienceDirect, PMC, and Cochrane Library. RESULTS To date, few studies have explored the marketing and regulation of waterpipe smoking in the U.S., which has increased in the last ten years, especially among women, adolescents, and young adults. Data indicate that the majority of waterpipe smokers are unaware of the potential risks of use. In addition, current tobacco control policies do not address waterpipe smoking, enabling tobacco companies to readily market and sell waterpipe products to young adults, who are at risk for becoming lifelong smokers. CONCLUSION Policy makers in the area of public health need to update existing tobacco regulations to include waterpipe smoking. Similarly, public health researchers should develop public health campaigns and interventions to address the increasing rates of waterpipe smoking in the United States.
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Affiliation(s)
- Linda Haddad
- College of Nursing, University of Florida, Gainesville, FL 32610, USA.
| | - Omar El-Shahawy
- Social and Behavioral Health Department, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA.
| | - Roula Ghadban
- School of Nursing, Virginia Commonwealth University, 821 West Franklin Street, Richmond, VA 23284, USA.
| | - Tracey E Barnett
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA.
| | - Emily Johnson
- College of Health and Human Performance, University of Florida, Gainesville, FL 32610, USA.
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26
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Kumar SR, Davies S, Weitzman M, Sherman S. A review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure. Tob Control 2014; 24 Suppl 1:i54-i59. [PMID: 25480544 PMCID: PMC4345792 DOI: 10.1136/tobaccocontrol-2014-052038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective There has been a rapid increase in the use of waterpipe tobacco and non-tobacco based shisha in many countries. Understanding the impact and effects of second-hand smoke (SHS) from cigarette was a crucial factor in reducing cigarette use, leading to clean indoor air laws and smoking bans. This article reviews what is known about the effects of SHS exposure from waterpipes. Data sources We used PubMed and EMBASE to review the literature. Articles were grouped into quantitative measures of air quality and biological markers, health effects, exposure across different settings, different types of shisha and use in different countries. Study selection Criteria for study selection were based on the key words related to SHS: waterpipe, hookah, shisha and third-hand smoke. Data extraction Independent extraction with two reviewers was performed with inclusion criteria applied to articles on SHS and waterpipe/hookah/shisha. We excluded articles related to pregnancy or prenatal exposure to SHS, animal studies, and non-specific source of exposure as well as articles not written in English. Data synthesis A primary literature search yielded 54 articles, of which only 11 were included based on relevance to SHS from a waterpipe/hookah/shisha. Conclusions The negative health consequences of second-hand waterpipe exposure have major implications for clean indoor air laws and for occupational safety. There exists an urgent need for public health campaigns about the effects on children and household members from smoking waterpipe at home, and for further development and implementation of regulations to protect the health of the public from this rapidly emerging threat.
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Affiliation(s)
- Sumit R Kumar
- New York University School of Medicine, New York, New York, USA
| | - Shelby Davies
- New York University School of Medicine, New York, New York, USA
| | - Michael Weitzman
- Departments of Pediatrics and Environmental Medicine, New York University School of Medicine, New York University, New York, New York, USA
| | - Scott Sherman
- Departments of Population Health, Medicine and Psychiatry, New York University School of Medicine, New York University, New York, New York, USA
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