Air quality monitoring in commercial hookah establishments

Smoking tobacco from a waterpipe or “hookah” is growing in popularity across the U.S. and worldwide, especially among young adults and college students. Many smoke-free air policies either have exemptions for hookahs or do not include hookahs in their policies. Few scientific studies have assessed levels of secondhand smoke (SHS) in commercial hookah venues. SHS, a known carcinogen, contains fine particles smaller than 2.5 microns in diameter (PM2.5) that are breathed deeply into the lungs, which causes asthma and other respiratory diseases. The goal of this preliminary study was to measure the level of PM2.5 in ambient air in commercial hookah establishments and bars around college campuses. Using a TSI SidePak AM 510, we visited 12 bars and 5 hookah establishments adjacent to the campus of 5 colleges in North Carolina prior to the implementation of a statewide smoke-free air law. Measures of PM2.5 were taken continuously during the 30 minutes in each establishment; room size, number of people, and number of burning cigarettes and/or hookahs (measured every 15 minutes) were also assessed. Mean PM2.5 for hookah establishments was 329 ug/m3 (range 11-2524 ug/m3), while mean PM2.5 for bars was 156 ug/m3 (range 10-430 ug/m3). Levels of PM2.5 were significantly higher in hookah establishments than bars (p<.0001). Results showed that ambient air in commercial hookah establishments contains hazardous levels of particulate matter, even higher than in bars with only cigarette smoking. Future studies including more commercial hookah establishments are needed.