Assessing differences in Carbon Monoxide levels for bar patrons

Hookah use continues to spread in the United States, with early evidence of harm and toxins associated with use. Carbon monoxide (CO) poses elevated risk from hookah compared to cigarettes, resulting not only from the tobacco but the charcoal used to warm the tobacco. Data were collected in night time field studies where research teams recruited outside of known hookah bars (N=173) and traditional bars (N=198) that allowed cigarette smoking. After obtaining verbal consent, participants answered a brief questionnaire with demographic information, tobacco use patterns, and attitudes and knowledge of tobacco harm. Participants also provided a breath carbon monoxide level. Results indicate that patrons of hookah bars had significantly higher CO levels (mean = 30.7) compared to patrons of traditional bars (mean = 8.9; p<.0001). Non-cigarette smokers showed similar differences, hookah café patrons demonstrated significantly higher CO values (mean = 28.1) compared to those exiting traditional bars (mean = 7.1; p<.001). Males produced higher CO levels (mean = 21.7) compared to females (15.7; p<.012). Those who reported not drinking alcohol also had higher CO levels (mean = 27.7) compared to those who did consume alcohol (mean = 15.1; p<.0001). Clearly, CO levels are higher among hookah bar patrons and specifically males, and nearly double for persons not consuming alcohol. Hookah cafes provide a social outlet for tobacco consumption that results in elevated CO levels for the patrons. Understanding the behaviors of hookah smokers, and how these behaviors impact harm perceptions is imperative in understanding the burgeoning hookah cafés.