Hookah smoking hikes CO levels

U. FLORIDA (US) — Patrons who frequent hookah cafés have carbon monoxide levels more than three times higher than those who visit traditional bars.

The social nature of hookah smoking, which is often shared in groups, makes it appealing to young people, says Tracey Barnett, assistant professor of social and behavioral sciences at the University of Florida. “There is also a common misperception that hookah smoking is a harmless alternative to cigarette smoking.”

Carbon monoxide reduces the blood’s ability to carry oxygen to tissues, and long-term exposure has been linked to cardiovascular disease.

Hookah pipes have a head to hold lit charcoal and tobacco, a body with a water bowl, and a hose. Air is drawn through the tobacco and into the pipe body where it passes through the water before being inhaled through the hose.

Eleven percent of Florida high school students and 4 percent of middle school students surveyed in 2007 had tried hookah smoking. An earlier study estimated that 10 percent to 20 percent of some young adult populations are current hookah users.

“Our study is unique because we were actually getting participants as they were leaving these establishments,” Barnett says. “There’s been a lot of great lab work on hookah and carbon monoxide levels, but doing a behavior in the lab is not the same as when young adults are out with their friends in an environment where there’s also drinking and socializing, so with this study we were catching them in a real-world moment as best we could.”

The study is published in the American Journal of Preventative Medicine.

Using a breath carbon monoxide tester, researchers measured the carbon monoxide levels of 173 hookah café patrons and 198 patrons of traditional bars that allow smoking. Florida’s Clean Indoor Air Act permits smoking in establishments that generate less than 10 percent of revenue from food sales.

The average carbon monoxide level of hookah patrons was 30.8 parts per million while traditional bar-goers had an average carbon monoxide reading of 8.9 ppm. Even hookah café patrons who reported not engaging in hookah smoking while in the café demonstrated elevated carbon monoxide levels: on average 11.5 ppm, an amount comparable to a carbon monoxide level of a regular cigarette smoker.

The Occupational Safety and Health Administration’s maximum level for carbon monoxide exposure is 50 ppm over an eight-hour period.

In the new study, 18 percent of hookah café patrons had carbon monoxide levels above 50 ppm compared with 1.5 percent of traditional bar patrons. Eight hookah café patrons involved in the study, or 5 percent, tested above 90 ppm.

Symptoms of carbon monoxide poisoning include headache, fatigue, and nausea at 70 ppm and sustained exposure at 150 ppm to 200 ppm leads to disorientation and unconsciousness.

The high levels of carbon monoxide associated with hookah smoking can be attributed to the tobacco, the piece of burning charcoal used to warm the tobacco, and the nature of hookah use, in which users may smoke continuously for an hour or more.

“This study underlies the importance of understanding harmful exposures associated with water pipe smoking venues and calls for the need to close existing loopholes in clean indoor air laws,” says Wasim Maziak, professor at the University of Memphis, who was not involved in the study. “The next step would be to demonstrate harmful exposures in those working in non-smoke free venues or patrons of such venues who are nonsmokers.”

Barnett says educating users who say hookah smoking is not harmful is essential. “This study demonstrates that even one hookah smoking session is exposing participants to high levels of carbon monoxide. There is no safe way to use tobacco.”

Researchers from the University of North Texas contributed to the study.

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