Waterpipe cafes in Baltimore, Maryland: Carbon monoxide, particulate matter, and nicotine exposure

Christine M Torrey,Ana Navas-Acien,Patrick N Breysse,D' Ann L Williams,Katherine A Moon,Joanna E Cohen,Tim Green

doi:10.1038/jes.2014.19

Christine M Torrey, Ana Navas-Acien + Show 5 more

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https://doi.org/10.1038/jes.2014.19

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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.

Highlights

Tobacco-related research and control efforts have generally focused on cigarettes, while other forms of tobacco products and tobacco uses are common in many countries
Indoor airborne concentrations of PM2.5 and carbon monoxide (CO) were markedly elevated in waterpipe cafes from the Baltimore area, confirming that waterpipe smoking severely affects indoor air quality
The mean PM2.5 concentrations measured in Baltimore water pipe venues, 712 mg/m3, greatly and consistently exceeded the 24-h ambient air quality standards from the United States environmental protection agency (EPA) (35 mg/m3) and the World Health Organization (25 mg/m3)

Summary

Introduction

Tobacco-related research and control efforts have generally focused on cigarettes, while other forms of tobacco products and tobacco uses are common in many countries. Waterpipe cafes and waterpipe tobacco smoking have been growing in popularity in the United States and worldwide, with young adults.. Waterpipe cafes and waterpipe tobacco smoking have been growing in popularity in the United States and worldwide, with young adults.1–4 Despite this increase, most tobacco control regulations remain limited to cigarettes. Some cities and states exempt waterpipe smoking.3 These exemptions may in part be due to the perception that waterpipe smoking is less harmful than cigarette smoking because of the pervasive belief that water removes dangerous tobacco components or because the smell produced seems less noxious.. As a result of this design, there is incomplete combustion of the tobacco Both the incomplete combustion of the tobacco and the charcoal briquette contribute to the levels of carbon monoxide (CO) and particulate matter (PM) in the air.

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