Indoor Air Pollutants of PM2.5, Carbon Monoxide, Nicotine, and Carcinogens in Waterpipe Bars

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

Vol. 119, No. 8 News | ForumOpen AccessHookahs: Hot and Hazardous Carol Potera Carol Potera Search for more papers by this author Published:1 August 2011https://doi.org/10.1289/ehp.119-a339AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Hookah cafes are an increasingly popular venue for socializing. In addition to beverages, appetizers, and desserts, habitués can order different flavors of tobacco that they smoke through waterpipes. Many patrons of hookah cafes believe smoking a waterpipe is safer than smoking cigarettes—an unsubstantiated belief “as old as the waterpipe itself,” according to the World Health Organization.1 A new field trial shows that carbon monoxide (CO) levels were 3 times higher in people visiting hookah cafes than in people who visited traditional bars.2Tracey Barnett, a social and behavioral scientist at the University of Florida, Gainesville, and colleagues measured CO levels of 173 patrons leaving three local hookah cafes and 198 patrons leaving five traditional bars that allow smoking. Hookah cafe patrons had an average CO level of 30.8 ppm compared with 8.9 ppm for traditional bar patrons. Even hookah cafe patrons who did not smoke from the waterpipe had average elevated CO levels of 11.5 ppm, similar to cigarette smokers.2The Occupational Safety and Health Administration established a cutoff of 50 ppm for CO exposure over an 8-hour period;3 18% of hookah cafe patrons had CO levels exceeding this level, and 5% tested above 90 ppm.2 Symptoms of CO poisoning such as lightheadedness and nausea start at about 70 ppm.4 Some hookah smokers claim they experience a “high,” but “they’re probably in the early stages of CO poisoning,” Barnett says. Emergency rooms have reported visits for CO poisoning after hookah smoking.5,6,7Hookah smoke contains toxicants not only from burning tobacco but also from the charcoal used to heat the tobacco in the pipe’s bowl, including CO, heavy metals, and polycyclic aromatic hydrocarbons.8 Shared hookahs also can raise the risk for communicable diseases.9 The water in a waterpipe does absorb some nicotine, so hookah smokers may inhale more smoke seeking a satisfying amount of the drug.1 A hookah session typically lasts 20–80 minutes, and the number and depth of puffs taken means a patron may inhale the smoke equivalent of 100 or more cigarettes.1Hookah cafes are popular in university towns and large cities. By one 2005 estimate, up to 20% of some U.S. populations of young adults engage in hookah smoking.10 Norman Edelman, chief medical officer at the American Lung Association, says his organization is working with states to pass laws to ban hookah smoking. “People realize more and more that this is a dangerous practice,” Edelman says.References1 WHO Study Group on Tobacco Product Regulation (TobReg). Advisory Note. Waterpipe Tobacco Smoking: Health Effects, Research Needs, and Recommended Actions by Regulators. Geneva, Switzerland:World Health Organization (2005). Available: http://tinyurl.com/g27zw[accessed 14 Jul 2011]. Google Scholar2 Barnett TEet al.Carbon monoxide levels among patrons of hookah cafes.Am J Prev Med 40(3):324-3282011. http://dx.doi.org/10.1016/j.amepre.2010.11.00421335264. Crossref, Medline, Google Scholar3 OSHA. Occupational Safety and Health Guidelines for Carbon Monoxide [website]. Washington, DC:Occupational Safety & Health Administration, U.S. Department of Labor. Available: http://tinyurl.com/4pbzg4z[accessed 14 Jul 2011]. Google Scholar4 CPSC. Carbon Monoxide Questions and Answers, CPSC Document #466 [website]. Bethesda, MD:U.S. Consumer Product Safety Commission (updated 13 Jul 2011). Available: http://tinyurl.com/338p85[accessed 14 Jul 2011]. Google Scholar5 Cavus UYet al.Carbon monoxide poisoning associated with narghile use.Emerg Med J 27(5):4062010. http://dx.doi.org/10.1136/emj.2009.07721420442182. Crossref, Medline, Google Scholar6 Lim BL, et al. Case of carbon monoxide poisoning after smoking shisha. Int J Emerg Med 2(2):121-122 (2009); http://dx.doi.org/10.1007/s12245-009-0097-8. Google Scholar7 Uyanik Bet al.Narghile (hookah) smoking and carboxyhemoglobin levels.J Emerg Med 40(6):6792011. http://dx.doi.org/10.1016/j.jemermed2009.05.03219576713. Crossref, Medline, Google Scholar8 Shihadeh A, Saleh R.Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe.Food Chem Toxicol 43(5):655-6612005. http://dx.doi.org/10.1016/j.fct.2004.12.01315778004. Crossref, Medline, Google Scholar9 Knishkowy B, Amitai Y.Water-pipe (narghile) smoking: an emerging health risk behavior.Pediatrics 116(1):e113-e1192005. http://dx.doi.org/10.1542/peds.2004-217315995011. Crossref, Medline, Google Scholar10 Cobb Cet al.Waterpipe tobacco smoking: an emerging health crisis in the United States.Am J Health Behav 34(3):275-2852010.20001185. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Vol. 119, No. 8 August 2011Metrics About Article Metrics Publication History Originally published1 August 2011Published in print1 August 2011 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Endogenous carbon monoxide (CO) levels are recognized to be a surrogate marker of oxidative stress. No study has evaluated both exhaled and blood CO at the same time in obstructive sleep apnea (OSA) patients. Here we provide evidence that exhaled CO levels positively correlated with hypoxia during sleep in OSA patients, but blood CO levels did not, and that continuous positive airway pressure therapy significantly decreased exhaled CO levels in the OSA group, but did not significantly affect blood CO.

Background and Objectives Otorhinolaryngology clinics are frequently exposed to various air pollutants. This can have a potentially harmful effect on the health of the healthcare personnel. However, there is still a lack of studies on the assessment of indoor air quality in otorhinolaryngology clinics. Therefore, this study aimed to measure indoor air quality in otorhinolaryngology clinics.Subjects and Method In this study, we prospectively measured indoor air quality indices [particulate matter (PM), carbon dioxide (CO<sub>2</sub>), total volatile organic compounds (VOCs), PM2.5, Nitrogen dioxide (NO<sub>2</sub>), carbon monoxide (CO), and ozone] using portable passive air quality monitoring sensors in otorhinolaryngology clinics.Results The mean concentrations of PM, CO<sub>2</sub>, VOCs, and NO<sub>2</sub> were significantly higher during office hours than after; however, there was no significant differences in CO and ozone concentration between the two time periods. The proportions of tolerable to poor-quality (exceeding acceptable level) levels of CO<sub>2</sub>, total VOCs, NO<sub>2</sub> was 25%, 25%, 12.5% during office hours, respectively. On the other hand, there was no proportion of tolerable to poor-quality level of PM, CO, ozone during office hours.Conclusion We found that otorhinolaryngology clinics are easily exposed to ambient indoor air pollution. Therefore, we suggest implement health-related protective strategies for ambient indoor air pollution in otorhinolaryngology clinics may be needed for healthcare personnel.

Influence of air pollution on exhaled carbon monoxide levels in smokers and non-smokers. A prospective cross-sectional study

To the Editors: We recently published a secondary analysis of expired breath carbon monoxide (CO) levels (a measure of smoking exposure) in patients with schizoaffective disorder, bipolar subtype, participating in a clinical trial of topiramate for treating psychiatric symptoms (1). Our analysis found that CO levels remained generally unchanged for participants on topiramate and placebo during the course of the trial. In our discussion, we noted that one limitation of the study was the assessment of smoking by CO level only. Khazaal and Zullino (this issue) further discuss concerns about the suitability of CO as a measure of changes in smoking. Khazaal and Zullino suggest that CO may be a poor indicator of smoking reduction because decreases may be attenuated through increased intensity with which those cigarettes are smoked (i.e. compensation). Because it is highly dependent on the recency of smoking, we agree that CO is a more labile measure of smoking exposure than other biochemical measures (e.g., cotinine). However, a significant change in smoking consumption (cigarettes per day, CPD) should still result in a noticeable change in CO levels, even with some change in the intensity of smoking. Studies of the efficacy of transdermal nicotine patch (2) and bupropion (3) for smoking cessation in smokers with schizophrenia have shown parallel decreases in CO level consistent with decreases in CPD. It is possible that topiramate was associated with small changes in CPD that were masked through smoking compensation, our small sample size, or the infrequent CO assessments. However, small changes in smoking consumption that do not result in decreases in CO levels may not be clinically significant in terms of beneficial health outcomes for patients. In other words, it is overall smoke exposure, as indicated by CO, that is the more valid marker of health risk, rather than cigarettes per day, regardless of how they may be smoked. In order to clarify the usefulness of topiramate for smoking cessation with smokers with psychiatric disorders, further research is needed. Clinical trials comparing topiramate to placebo should be conducted in larger samples of smokers with psychiatric disorders using multiple assessments of smoking at frequent time points. Patient-reported changes in smoking consumption (CPD) should be confirmed using CO and cotinine levels. Questions about changes in smoking intensity with topiramate can be assessed through smoking topography techniques. One study (4) has examined changes in smoking topography for topiramate (75mg/day) compared to placebo in nonpsychiatric smokers. Topiramate resulted in decreased puff volume and enhanced reward from smoking, but also no differences in total puffs per cigarette and increased withdrawal during smoking abstinence. Topiramate-induced changes in smoking topography have not been examined for smokers with psychiatric disorders. Finally, the main purpose of the clinical trial was to examine the efficacy of topiramate for mood and psychotic symptoms in patients with schizoaffective disorder. Patients were not necessarily motivated to quit smoking and were not provided with smoking cessation counseling. Future studies should examine the efficacy of topiramate in conjunction to behavioral smoking cessation counseling in patients with current motivation to quit smoking. While our data does not suggest spontaneous decreases in smoking or CO levels for smokers with schizoaffective disorder, future studies that address the limitations of our analysis would provide a clearer picture of the clinical usefulness of topiramate for smoking cessation in this population.

Aims: The aim was to study the indoor air quality (IAQ) levels inside the governmental elementary schools of Dammam City in Kingdom of Saudi Arabia (KSA) and study factors affecting these levels. Materials and Methods: Sixteen schools were selected for this study; 12 of them were representing governmental constructed buildings, while the other 4 schools were representing rental buildings. Levels of dust or total suspended particulates (TSP), carbon monoxide (CO), carbon dioxide (CO 2 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), and benzene; in addition to temperature degree and relative humidity percent were measured during this study at four selected locations inside each school and one location outside it. Results: The highest levels of all pollutants were found inside classrooms that were located directly on the moderate traffic streets compared with low or very low traffic activity ones. Levels of most air pollutants inside the governmental constructed buildings were higher than those inside the rental type of schools. Conclusion: The average levels of TSP, NO 2 and CO inside all selected schools were lower than the air quality guidelines (AQGs). In contrary, all mean levels of CO 2 and nearly 50% of SO 2 and benzene levels were higher than their AQGs. Increasing the efficiency of the mechanical and air condition systems inside classrooms is important for appropriate ventilation and improving IAQ level.

Background The dangers of water-pipe smoking have been documented, but data from water-pipe (WP) cafés is lacking. Assessing carbon monoxide (CO) levels in the air inside WP cafés may aid the understanding of the toxins and exposure of the employees. The results can provide novel information regarding WP's effect on air quality which may help generate regulatory efforts to protect the café employees against WP smoke. We wanted determine the air quality through measurement of CO levels in closed room cafés and restaurants of Karachi, Pakistan. Methods It was a cross sectional study design. 3 WP cafes in the city of Karachi, Pakistan were surveyed during June 2015. All cafés were indoors and air-conditioned. Carbon Monoxide (CO) air samples were collected from the included cafés using CO USB Data logger. The Sampling device was left with café admin managers and was left for 30 hours at venue #1, for almost 7 hours at venue #2, and for 70 hours at venue #3 to measure the CO levels in cafés. The average sampling duration was around 36 hours. The graphs were automatically generated by the device. Results Overall, readings of the CO monitoring samples from all included venues were within / lower than threshold limit value (TLV) of 25 ppm, and MAK maximum workplace value of 30 ppm. Conclusions The findings of this study provide evidence that the air quality in water-pipe cafes is potentially hazardous to the health of its employees, which is critical to inform tobacco control policies and regulations for such venues. The study findings indicate a clear need to extend research to not only focus on the indoor air quality of water-pipe cafes, but also the biological monitoring of employees in water-pipe cafes. Key messages Employees working in waterpipe cafes are exposed to toxic substances that can potentially manifest adverse health effects. Air quality of indoor waterpipe cafes should be assessed to protect employees.

<h3>Background</h3> 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...

Air pollution is a serious issue in the world. Around 98% of cities with a population of over 100,000 people in low and middle-income countries do not meet air quality standards, while in high-income countries, the number has decreased by 52%. Industries and motor vehicles are the biggest contributors to carbon monoxide (CO).Air pollution is a severe issue in the world. The object of research to investigate is the detection of carbon monoxide (CO) levels in an area mapped based on the current CO levels along with the location coordinates via GPS and LBS technology with a microcontroller and sensor-based device.The results of testing the CO level detection devices found that high CO levels are in the afternoon with an average CO level of 49.59656 which means classified as dangerous if we are outdoors more than 30 minutes, can interfere with heart function.

The purpose of the present study was to measure carbon monoxide (CO) levels during the operation of hot water boilers that use liquefied petroleum gas or natural gas, which are widely used in Turkey. In addition, it was intended to determine how much owners of these boilers knew about their use and about CO poisoning. CO levels were measured in the bathrooms of homes in a housing area where two deaths due to CO poisoning had occurred on the same day. CO levels were measured in a total of 197 flats from a total of 400 in an area (49%) where there were such boilers and while the boilers were in operation. The bathrooms were of standard dimensions (2.5 × 3 × 3 m). Assessment of CO levels while the boilers were in operation was carried out using a Gastech standard GT-402 portable gas monitor. In 44 (22.4%) of the bathrooms studied, CO levels were above 9 ppm, which is the 8-hour limit according to the NAAQS. CO levels in 2 bathrooms (0.7%) were found to be above 35 ppm, the maximum 1-hour exposure level. CO levels above 50 ppm, ranging from 54 to 300 ppm, were determined in 12 homes (6%). The inhabitants of these homes were informed and the necessary measures were taken to solve the problem. In 8 of these 12 houses, it was determined that chimneys were blocked. We found that CO levels were higher than risk levels for intoxication in 20.0% of the houses. The level of knowledge of the households was poor concerning dangers of CO intoxication. Since it is not uncommon for CO levels in bathrooms where there are boilers to reach dangerous levels it is recommended that their use be discouraged. There should be more widespread use of central water heating systems to remove this serious public health problem.

The purpose of the present study was to measure carbon monoxide (CO) levels during the operation of hot water boilers that use liquefied petroleum gas or natural gas, which are widely used in Turkey. In addition, it was intended to determine how much owners of these boil ers knew about their use and about CO poisoning. CO levels were measured in the bathrooms of homes in a housing area where two deaths due to CO poisoning had occurred on the same day. CO levels were measured in a total of 197 flats from a total of 400 in an area (49%) where there were such boilers and while the boilers were in operation. The bathrooms were of standard dimen sions (2.5 x 3 x 3 m). Assessment of CO levels while the boilers were in operation was carried out using a Gas- tech standard GT-402 portable gas monitor. In 44 (22.4%) of the bathrooms studied, CO levels were above 9 ppm, which is the 8-hour limit according to the NAAQS. CO levels in 2 bathrooms (0.7%) were found to be above 35 ppm, the maximum 1-hour exposure level. CO levels above 50 ppm, ranging from 54 to 300 ppm, were deter mined in 12 homes (6%). The inhabitants of these homes were informed and the necessary measures were taken to solve the problem. In 8 of these 12 houses, it was determined that chimneys were blocked. We found that CO levels were higher than risk levels for intoxication in 20.0% of the houses. The level of knowledge of the households was poor concerning dangers of CO intoxi cation. Since it is not uncommon for CO levels in bathrooms where there are boilers to reach dangerous levels it is recommended that their use be discouraged. There should be more widespread use of central water heating systems to remove this serious public health problem.

BackgroundDespite 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...

Pregnancy and early childhood are periods with high plasticity in neurological development. Environmental perturbations during these sensitive windows can have lifelong developmental consequences. This review summarizes key findings relevant to the effects of air pollution on neurological development. Mounting evidence suggests that exposure to air pollution, both during pregnancy and childhood, is associated with childhood developmental outcomes ranging from changes in brain structures to subclinical deficits in developmental test scores, and, ultimately, developmental disorders such as attention-deficit/hyperactivity disorders or autism spectrum disorders. Although the biological mechanisms of effects remain to be elucidated, multiple pathways are probably involved and include oxidative stress, inflammation, and/or endocrine disruption. Given the alarming global increase in developmental disorders in recent years, and increased human exposures to pollution, it is critical to reduce personal and community-level exposures through tight collaboration of interdisciplinary and multi-level bodies including community partners, physicians, industry partners, policy makers, public health practitioners, and researchers. WHAT THIS PAPER ADDS: Exposure to air pollution is associated with a range of childhood developmental complications. Biological mechanisms may include oxidative stress, inflammation, and endocrine disruption.

The problem of the “sick” building-facts and implications: Identifying and measuring indoor nonbiologic agents