Social Hookah Smoking Elevates Carbon Monoxide Levels

A new study shows that patrons leaving hookah cafés had carbon monoxide (CO) levels more than three times higher than patrons exiting traditional bars did.

Researchers at the University of Florida (UFL; Gainesville, USA) conducted a nighttime field study of patrons aged 18 years and older exiting hookah cafes and traditional bars in 2009, using sidewalk locations immediately outside these establishments in a campus community. As hookah cafes and bars are typically entered and exited in groups, every other group of people exiting the establishment was approached. For comparison purposes, the sample collected was similar in number, 173 hookah cafe, and 198 traditional bar participants.

The results indicated that patrons of hookah cafes had significantly higher CO levels, with a mean 30.8 parts per million (PPM) compared to patrons of traditional bars, who had mean CO levels of 8.9 PPM; 18% of hookah café patrons had CO levels above 50 ppm, compared with 1.5% percent of traditional bar patrons. Eight hookah café patrons involved in the study (5%) tested above 90 PPM. Current cigarette smokers also produced significantly more CO if exiting a hookah café, with a mean 34.7 PPM, compared to a traditional bar (mean 13.3 PPM). The study was published in the March 2011 issue of the American Journal of Preventive Medicine.

"The social nature of hookah smoking, which is often shared in groups, makes it appealing to young people. There is also a common misperception that hookah smoking is a harmless alternative to cigarette smoking,” said lead researcher Tracey Barnett, PhD, of the department of behavioral science and community health. "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.”

A hookah, also known as a waterpipe, is a single or multistemmed instrument for smoking, in which the smoke is cooled and filtered by passing through water. Hookah pipes are composed of a head, where lit charcoal and tobacco sit, a body with 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.

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