Waterpipe cafés are hazardous to your health: Determination of a waterpipe specific calibration factor

Indoor Exposure and Regional Inhaled Deposited Dose Rate during Smoking and Incense Stick Burning-The Jordanian Case as an Example for Eastern Mediterranean Conditions

Tobacco smoking and incense burning are commonly used in Jordanian microenvironments. While smoking in Jordan is prohibited inside closed spaces, incense burning remains uncontrolled. In this study, particle size distributions (diameter 0.01-25 µm) were measured and inhaled deposited dose rates were calculated during typical smoking and incense stick-burning scenarios inside a closed room, and the exposure was summarized in terms of number and mass concentrations of submicron (PN_Sub) and fine particles (PM_2.5). During cigarette smoking and incense stick-burning scenarios, the particle number concentrations exceeded 3 × 10⁵ cm^-3. They exceeded 5 × 10⁵ cm^-3 during shisha smoking. The emission rates were 1.9 × 10¹⁰, 6.8 × 10¹⁰, and 1.7 × 10¹⁰ particles/s, respectively, for incense, cigarettes, and shisha. That corresponded to about 7, 80, and 120 µg/s, respectively. Males received higher dose rates than females, with about 75% and 55% in the pulmonary/alveolar during walking and standing, respectively. The total dose rates were in the order of 10¹²-10¹³ #/h (10³-10⁴ µg/h), respectively, for PN_Sub and PM_2.5. The above reported concentrations, emissions rates, and dose rates are considered seriously high, recalling the fact that aerosols emitted during such scenarios consist of a vast range of toxicant compounds.

Non-commercial Air Purifier—The Effectiveness and Safety

(1) Background: On the Internet, we can find the guidelines for homemade air purifiers. One of the solutions includes the use of a low-cost ozone generator to decrease the level of odors and biological contaminants. However, the authors do not notify about hazardous effects of ozone generation on human health; (2) Methods: We elaborated our test results on the bacterial and fungal aerosol reduction by the use of two technical solutions of homemade air purifiers. First, including a mesh filter and ozone generator, second including an ozone generator, mesh filter, and carbon filter. (3) Conclusions: After 20 min of ozone generation, the concentration of bacteria decreased by 78% and 48% without and with a carbon filter, while fungi concentration was reduced in the lower range 63% and 40%, respectively. Based on our test results, we proposed a precise periodical operation of homemade air purifier to maintain the permissible level of ozone for the occupants.

Exposure to second-hand tobacco smoke in waterpipe cafés in Barcelona, Spain: An assessment of airborne nicotine and PM2.5

BACKGROUND

Waterpipe tobacco smoking has grown in popularity worldwide, with the prevalence of use increasing in Spain from 6.2% to 10.8% in the last decade, despite the smoking ban enacted in 2010 for all hospitality premises.

OBJECTIVE

To assess exposure to second-hand smoke from waterpipes based on the concentrations of airborne nicotine and particulate matter ≤2.5 μm in diameter (PM_2.5) in a sample of waterpipe cafés in the city of Barcelona (Spain).

METHODS

This cross-sectional study included a sample of 20 waterpipe cafés. Airborne nicotine and PM_2.5 were sampled for 30 min in each venue using a nicotine sampling device connected by a tube to a pump and a TSI SidePak Personal Aerosol Monitor. Five outdoor control locations were also measured. We computed medians, interquartile ranges (IQRs), and maximum values and compared them according to venues' and sampling characteristics using the Kruskall-Wallis and U-Mann Whitney tests. Nicotine and PM_2.5 were correlated by calculating the Spearman-rank correlation coefficient.

RESULTS

The median concentration of nicotine and PM_2.5 were 1.15 and 230.50 μg/m³ in waterpipe cafés and 0.03 and 10.00 μg/m³ in control locations (p<0.05 in both cases). The Spearman correlation coefficient between both markers was 0.61 (95% confidence interval: 0.18-0.84). No differences were found in nicotine or PM_2.5 concentration according to the venues' and sampling characteristics studied, with the exception of area. After stratifying for area, venues >100 m², located in a tourist area, with >15 lit waterpipes, >8 waterpipes/100 m², and a ratio of 2 users per waterpipe or less had significantly higher nicotine concentration.

DISCUSSION

Despite the current smoking ban, which includes hospitality venues, we found nicotine and PM_2.5 levels in Barcelona waterpipe cafés that exceeded the threshold recommended by the World Health Organization. This exposure poses serious risks to the health of both workers and customers and constitutes a non-compliance of the legislation.

Differential Trends in Hookah Use Among New Jersey Youth

Introduction

Use of 2 or more types of tobacco products is common among youth and young adults, highlighting the need for monitoring and intervention activities to encompass products beyond combustible cigarettes. This study documented patterns and trends of ever, current, and frequent hookah use among high school students in New Jersey by other tobacco product use status.

Methods

We analyzed data from the 2008, 2010, 2012, 2014, 2016 waves of the New Jersey Youth Tobacco Survey. Point estimates and 95% confidence intervals described hookah use stratified by use of other tobacco products. Multivariable logistic regression models assessed trends and correlates of hookah use, controlling for the use of other tobacco products and users’ sociodemographic characteristics. Negative binomial regression models examined the association between total number of tobacco products used and hookah use while controlling for sociodemographic variables and survey year.

Results

The adjusted odds of current and frequent hookah use among New Jersey high school students were significantly higher in 2014, but not in 2016, compared to 2008. In recent years, hookah use among students who had ever smoked hookah, currently smoked hookah, or frequently smoked hookah was more common among students who had ever or currently smoked cigarettes or e-cigarettes. Hookah users consumed a wider variety of other tobacco products than those who did not use hookah.

Conclusion

Hookah use remains a public health concern for adolescents; it is more common among users of other tobacco products, especially cigarette and e-cigarette smokers. Questions remain as to whether users of multiple tobacco products are being adequately reached by existing policies and regulations.

Indoor air quality in waterpipe cafés: exposure level to particulate matter

Waterpipe is increasingly being used worldwide. Despite waterpipe cafés gaining popularity among Iranian population, there is a paucity of research measuring exposures and assessing the health effects of waterpipe smoke in these places. The objective of the current study was to investigate the exposure to PM10, PM2.5, and PM1 concentrations and risk assessment of PM2.5 exposures in different age groups in the indoor air of waterpipe cafés. The study samples were taken from indoor air of 50 waterpipe cafés in Ardabil, Iran. The PM10, PM2.5, and PM1 concentrations were assessed using a portable GRIMM dust monitors. The mean (±SD) concentrations of indoor air PM10, PM2.5, and PM1 were 765 ± 352, 624 ± 327, and 500 ± 305 μg/m3, respectively. The mean of HQ (hazard quotient) for PM2.5 in all age groups of 16 and older was > 1, which corresponds to an unacceptably high risk for human health. Also, the mean of ELCRs (excess lifetime cancer risk) for PM2.5 in different age groups exceeded the limit value by the USEPA. The results indicated that the PM concentration is significantly influenced by the number of waterpipe smokers, type of ventilation system, and kind of tobacco. Therefore, waterpipe cafés are a potential source for exposure to PM10, PM2.5, and PM1 and increase the risk of respiratory diseases and cardiovascular problems among waterpipe smokers.

Epidemiology and Adverse Consequences of Hookah/Waterpipe Use: A Systematic Review

Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the misconception prevalent in society that hookah smoking is less harmful than cigarette smoking. Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants, and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia, and worse outcomes including mortality related to these diseases. The objectives of the review are to assess the factor associated with the increasing use of hookah, its health effects, options for hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.

Air quality and presence of air ventilation systems inside waterpipe cafés in North Carolina

BACKGROUND

After North Carolina (NC) fire inspectors detected unsafe carbon monoxide (CO) levels inside several waterpipe cafés, the state fire code was amended to include provisions regulating waterpipe cafés, adding a requirement for air ventilation. These regulations apply to new buildings constructed after 1 January 2016, but can be enforced for older buildings where there exists a distinct hazard to life. We measured air quality at a sample of waterpipe cafés before and after the starting date of this regulation and collected information on presence of air ventilation.

METHODS

Air quality (CO, fine particulate matter (PM_2.5)) monitoring was conducted inside and outside of six waterpipe cafés in NC in September of 2015 (time 1) and September of 2016 (time 2). In addition, questionnaires were administered to managers from each waterpipe café at time 2 to determine the presence of air ventilation systems.

RESULTS

Elevated levels of CO and PM_2.5 were found inside waterpipe cafés at time 1 (median CO=42 ppm; median PM_2.5=379.3 µg/m³) and time 2 (median CO=65 ppm; median PM_2.5=484.0 µg/m³), with no significant differences between time periods (p>0.05). Indoor levels were significantly higher than levels outside cafés at both time periods (p<0.05). All waterpipe cafés reported having an air ventilation system that was installed prior to time 1 air monitoring.

CONCLUSIONS

Unsafe levels of CO and PM_2.5 were observed in waterpipe cafés in NC, despite reported use of air ventilation systems. Prohibiting indoor waterpipe smoking may be necessary to ensure clean air for employees and patrons.