title: Waterpipe cafes in Baltimore, Maryland: Carbon monoxide, particulate matter, and nicotine exposure.
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.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Torrey
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Moon
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: D' Ann L
authors.initials: DA
authors.lastname: Williams
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Green
authors.affiliation: Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: 1] Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA [2] Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Breysse
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000032:analysis / Q000706:statistics & numerical data*; D015142:Baltimore; D002248:Carbon Monoxide / Q000032:analysis; D004781:Environmental Exposure / Q000032:analysis / Q000706:statistics & numerical data*; D004784:Environmental Monitoring; D006801:Humans; D009538:Nicotine / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D012147:Restaurants; D012907:Smoking; D014028:Tobacco Smoke Pollution / Q000032:analysis / Q000706:statistics & numerical data*
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D014028:Tobacco Smoke Pollution; D009538:Nicotine; D002248:Carbon Monoxide
references.citation: Am J Public Health. 2012 Nov;102(11):2043-5
references.pmid: 22994168
references.citation: Tob Control. 2013 Sep;22(5):308-14
references.pmid: 22273689
references.citation: Atmos Environ (1994). 2010 Jan 1;44(1):8-14
references.pmid: 20161525
references.citation: Ann Behav Med. 2008 Aug;36(1):81-6
references.pmid: 18719977
references.citation: Tob Control. 2005 Feb;14(1):60-3
references.pmid: 15735302
references.citation: Food Chem Toxicol. 2008 Nov;46(11):3546-9
references.pmid: 18834915
references.citation: Nicotine Tob Res. 2011 Feb;13(2):78-87
references.pmid: 21127030
references.citation: Tob Control. 2007 Dec;16(6):390-3
references.pmid: 18048615
references.citation: Food Chem Toxicol. 2005 May;43(5):655-61
references.pmid: 15778004
references.citation: J Adolesc Health. 2008 May;42(5):526-9
references.pmid: 18407049
references.citation: Tob Control. 2008 Jun;17(3):159-65
references.pmid: 18303089
references.citation: Tob Control. 2013 May;22(3):147-55
references.pmid: 22949497
references.citation: Nicotine Tob Res. 2013 Jun;15(6):1107-12
references.pmid: 23178319
references.citation: Food Chem Toxicol. 2008 May;46(5):1582-90
references.pmid: 18308445
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Nov;20(11):2345-53
references.pmid: 21908725
references.citation: Environ Sci Technol. 1987 May 1;21(5):494-7
references.pmid: 22296139
references.citation: MMWR Morb Mortal Wkly Rep. 2004 Nov 12;53(44):1038-41
references.pmid: 15538318
references.citation: Tob Control. 2004 Dec;13(4):327-33
references.pmid: 15564614
references.citation: Public Health Nurs. 2010 Jan-Feb;27(1):49-53
references.pmid: 20055968
references.citation: Tob Control. 2013 Sep;22(5):338-43
references.pmid: 22447194
references.citation: Tob Control. 2015 Mar;24(2):175-81
references.pmid: 24161999
references.citation: J Ky Med Assoc. 2006 Jul;104(7):281-8
references.pmid: 16886880
references.citation: JAMA. 2008 Jan 2;299(1):36-8
references.pmid: 18167404