title: Secondhand smoke in waterpipe tobacco venues in Istanbul, Moscow, and Cairo.
abstract: OBJECTIVE
  The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues.
  
  
  METHODS
  In 2012-2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM2.5) (N=35), carbon monoxide (CO) (N=23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (N=43), and air nicotine (N=46).
  
  
  RESULTS
  Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) µg/m(3) for PM2.5, 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m(3) for p-PAHs, 1.0 (0.5, 1.9) ng/m(3) for NNK, and 5.3 (0.7, 14) µg/m(3) for nicotine. PM2.5, CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant.
  
  
  CONCLUSIONS
  High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: kmoon9@jhu.edu.
authors: Katherine A
authors: KA
authors: Moon
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Hoda
authors: H
authors: Magid
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Christine
authors: C
authors: Torrey
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ana M
authors: AM
authors: Rule
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Jacqueline
authors: J
authors: Ferguson
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Jolie
authors: J
authors: Susan
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Zhuolu
authors: Z
authors: Sun
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Salahaddin
authors: S
authors: Abubaker
authors: Russian Cancer Research Center, Moscow, Russian Federation.
authors: Vladimir
authors: V
authors: Levshin
authors: Kadir Has University, Istanbul, Turkey.
authors: Aslı
authors: A
authors: Çarkoğlu
authors: Cairo University, Cairo, Egypt.
authors: Ghada Nasr
authors: GN
authors: Radwan
authors: Cairo University, Cairo, Egypt.
authors: Maha
authors: M
authors: El-Rabbat
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Joanna
authors: J
authors: Cohen
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Paul
authors: P
authors: Strickland
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ana
authors: A
authors: Navas-Acien
authors: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Patrick N
authors: PN
authors: Breysse
mesh_terms: D002849:Chromatography, Gas; D003132:Commerce; D004534:Egypt; D009031:Moscow; D014028:Tobacco Smoke Pollution / Q000032:analysis*; D014421:Turkey; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Indoor air pollution; Secondhand smoke; Tobacco smoke pollution; Waterpipe smoking