Effects of shisha smoking on carbon monoxide and PM2.5 concentrations in the indoor and outdoor microenvironment of shisha premises

Coverage of Indoor Smoking and Vaping Restrictions in the U.S., 1990-2021

INTRODUCTION

Secondhand smoke exposure increases the risk of premature death and disease in children and non-smoking adults. As a result, many U.S. states and local jurisdictions have enacted comprehensive indoor smoking restrictions (ISR). Indoor vaping restrictions (IVR) have also been adopted to protect against exposure to secondhand e-cigarette aerosol. This study aimed to quantify state and national U.S. coverage of policies restricting indoor cigarette and e-cigarette use over time.

METHODS

Data from the American Nonsmokers Rights' Foundation on U.S. ISR from 1990 to 2021 and IVR from 2006 to 2021 were analyzed. Combining these data with 2015 U.S. Census population estimates, the percentage of state and national residents covered by partial and comprehensive restrictions in bars, restaurants, and workplaces, were calculated (analysis in 2023-2024) over time.

RESULTS

Between 1990 and 2021, national coverage of comprehensive ISR increased for bars (0% to 67.3%), restaurants (0%-78.2%), and workplaces (0%-77.5%). Partial ISR coverage decreased for bars (14.8%-13.9%), restaurants (40.2%-15.4%) and workplaces (40.2%-22.5%). From 2006 to 2021, comprehensive IVR coverage increased for bars (0%-43.5%), restaurants (0%-51.5%), and workplaces (0%-53.2%). Despite these increases in coverage, by the end of 2021, <50% of the population was protected by comprehensive ISR for bars, restaurants, and workplaces in 19, 12, and 14 states, respectively.

DISCUSSION

The percentage of the U.S. population protected by ISR and IVR has increased over time. However, gaps in coverage remain, which may contribute to disparities in tobacco-related disease and death.

Impact of secondhand smoke on air quality in partially enclosed outdoor hospitality venues: a review

BACKGROUND

Smoking is a leading cause of premature mortality and morbidity globally. The pollutants generated from smoke are not only harmful to smokers, but also to those exposed to secondhand smoke. As a result of increasingly restrictive indoor smoke-free policies in many countries, there is a tendency for tobacco smoking to move outdoors into partially enclosed settings in hospitality venues. The aim of this systematic review was to evaluate the impact of secondhand smoke on air quality in outdoor hospitality venues.

METHODS

Two electronic databases PubMed and Scopus were searched from 1 January 2010 to 30 June 2022 for studies of air quality impacts from tobacco smoking in outdoor hospitality venues. A total of 625 studies were screened and 13 studies were included in this review.

RESULTS

The majority (9 studies) of reviewed studies monitored PM2.5 concentration as an indicator of secondhand smoke. PM2.5 was reported from 10.9 µg/m3 to 91.0 µg/m3 in outdoor smoking areas, compared to 4.0 µg/m3 to 20.4 µg/m3 in outdoor control sites unaffected by smoking. Secondhand smoke can also drift into adjacent outdoor areas or infiltrate into indoor environments thus affecting air quality in spaces where smoking is not permitted.

CONCLUSIONS

The reviewed studies indicated that air quality within outdoor hospitality venues where smoking is permitted is unlikely to meet current World Health Organization (WHO) ambient air quality guidelines for PM2.5. Customers and staff in outdoor hospitality venues with active smoking, and in adjacent outdoor and indoor non-smoking areas, are potentially exposed to secondhand smoke at levels exceeding WHO guidelines. Stronger smoking control policies are recommended for outdoor hospitality venues to protect the health of customers and staff from harmful secondhand smoke exposure.

PROSPERO REGISTRATION

CRD42022342417.

Biomonitoring of unmetabolized polycyclic aromatic hydrocarbons (PAHs) in urine of waterpipe/cigarette café workers

Fresh tobacco or the smoke resulting from waterpipe and cigarette contains large amounts of polycyclic aromatic hydrocarbons (PAHs), which consumption can cause releasing of these contaminants into the indoor air of cigarette and waterpipe cafés. This study was conducted to investigate the urinary concentrations of unmetabolized PAH compounds among the employed workers as well as the customers in waterpipe and cigarette cafés along with its association with oxidative stress factors plus kidney injury biomarkers. For this, 35 staffs and 35 customers in these cafés (as an exposed group (EG)), 20 staffs in non-smoking cafés (as 1st control group (CG-1)), and 20 of the public population (as 2nd control group 2 (CG-2)) were chosen and their urine specimens were collected. The results indicated that there is a significant difference between urinary concentration of ƩPAHs in the exposed and control groups (P value < 0.05). Also, "type of tobacco" can be considered as an influential and determining factor for the urinary levels of PAHs among the subjects. Considering the contribution of PAHs to the total toxic equivalents, benzo[a]pyrene (BaP), dibenzo[a,h]anthracene (DahA), and fluoranthene (Flrt) with 32.76%, 27.62%, and 18.65% claimed the largest share in waterpipe/cigarette cafés. The results also indicated a positive and significant relationship between some PAHs and oxidative stress biomarkers as well as uKIM-1 (biomarker for assessing and diagnosing glomerular damage) and TIMP-1 (biomarker of stress in primary steps of injury in tubular cell). Thus, it can be expressed that the workers of these smoking cafés are prone to the detrimental health impacts. Accordingly, proper policies and decisions should be taken to limit the activity of these cafés or proper protective strategies should be adopted to protect the health of exposed individuals.

Stable C and N isotopes of PM2.5 and size-segregated particles emitted from incense stick and cigarette burning

This work measured the δ¹³C and δ¹⁵N signatures in PM_2.5 and size-segregated particles emitted from incense stick and cigarette burning in different brands or nicotine contents for pollution source identification indoors. Three popular brands of incense stick and cigarette were selected for experiments. A personal environmental monitoring sampler and a Sioutas cascade impactor were used to collect PM_2.5 and size-segregated particles, respectively, for isotopic signatures analyses. Our data showed that both δ¹³C and δ¹⁵N values were heavier from incense stick burning (δ¹³C: 27.3 ± 0.5; δ¹⁵N: 8.63 ± 1.35) than cigarette (δ¹³C: 28.5 ± 0.2; δ¹⁵N: 4.15 ± 0.69). The scatter plots of δ¹³C and TC/PM_2.5 and of δ¹⁵N and TN/PM_2.5 can be applied to distinguish particle pollution sources and assess the influence of cigarette burning to PM_2.5 according to different nicotine contents. The δ¹³C values in size-segregated particles were similar to incense stick or cigarette burning; the δ¹³C values in PM_2.5 were significantly higher than those in size-segregated particles. However, the nitrogen amount was too low in most of the size-segregated particles to analyze δ¹⁵N from incense stick and cigarette burning. These results suggest that the δ¹³C signatures on PM_2.5 cannot represent the isotopic characteristics of size-segregated particles and δ¹⁵N has limitation for pollution source identification of different particle sizes.

Urinary level of heavy metals in people working in smoking cafés

Previous researches have reported significant levels of heavy metals in indoor air of smoking cafés. The current research aimed to evaluate the potential exposure of smoking cafés workers to heavy metals through quantifying amounts of these pollutants in urine samples. To this end, 35 waterpipe/cigarette cafés workers were selected as the exposed population, 35 employees from non-smoking cafe' as the control group 1 (CG1) and 25 cases of the normal citizens as the control group 2 (CG2); and their urine samples were taken. Samples were then prepared by acid digestion approach and measured by the ICP in order to determine amount of heavy metals in them. The findings of the current work show the significant difference among urinary levels of metals in the exposed and both CG1 and CG2 (P value < 0.05). Furthermore, urinary metal levels in samples collected from smoking café workers after the exposure were considerably higher than those were collected before the exposure (P-value <0.05). According to the findings, "tobacco type" could be considered as a leading factor for heavy metal exposure in studied smokers. Additionally, a positive and significant association was found between urinary metals and urinary levels of 8-OHdG (a markers of DNA degradation through oxidative stress). Therefore, workers in waterpipe/cigarette café can be classified as high risk people in terms of DNA oxidative damage.

The effect of emerging tobacco related products and their toxic constituents on thrombosis

Although conventional cigarette smoking is declining, emerging tobacco related products (ETRPs) are currently gaining ground, especially among the youth. These products include electronic cigarettes, waterpipes/hookah, cigars/cigarillo, smokeless tobacco, and heat-not-burn cigarettes. The observed increase in the use of ETRPs is multifactorial and complex but appears to be mainly driven by efforts from the major tobacco companies to reinvent themselves, and present more appealing and allegedly safe(r) tobacco products. However, it is becoming apparent that these products produce substantial amounts of toxic chemicals, many of which have been shown to exert negative health effects, including in the context of the cardiovascular system. Thus, there has been research efforts, albeit limited in general, to characterize the health impact of these products on occlusive/thrombotic cardiovascular diseases (CVD). In this review, we will discuss the potential impact of ETRPs on thrombosis-based CVD. Specifically, we will review how these products and the major chemicals they produce and/or emit can trigger key players in the process of thrombosis, namely inflammation, oxidative stress, platelets, coagulation, and the vascular endothelium, and the relationship between these effects.

Use of toenail-bounded heavy metals to characterize occupational exposure and oxidative stress in workers of waterpipe/cigarette cafés

Tobacco smoke is known for releasing metals in indoor air of waterpipe/cigarette cafés. However, the worker exposure to metals, and its association with oxidative stress in these cafés are still unclear. To this end, 54 workers and 38 customers from waterpipe/cigarette cafés (the exposed group), 30 workers from non-smoking cafés (the control group 1 (CG_1)) and 32 individuals from the general population (the control group 2 (CG_2)) were selected and toenails samples were then taken from them. Our findings revealed a significant difference in terms of toenail-bounded metal levels between the exposure and control groups (CG_1 and CG_2) (Mann-Whitney U test, Pvalue < 0.05). This study has also indicated that "type of tobacco" could be considered as a predictor for toenail-bounded heavy metals. Furthermore, our research's results suggest that toenail-bounded heavy metals are positively and significantly correlated with urinary levels of 8- hydroxy-2'-deoxyguanosine (8-OHdG, as a biomarker for the degradation of deoxyribonucleic acid (DNA) oxidative stress). Therefore, it can be concluded that workers of waterpipe/cigarette cafés are at high risks of adverse health of DNA oxidative degradation.

An overview of methods of fine and ultrafine particle collection for physicochemical characterisation and toxicity assessments

Particulate matter (PM) is a crucial health risk factor for respiratory and cardiovascular diseases. The smaller size fractions, ≤2.5 μm (PM_2.5; fine particles) and ≤0.1 μm (PM_0.1; ultrafine particles), show the highest bioactivity but acquiring sufficient mass for in vitro and in vivo toxicological studies is challenging. We review the suitability of available instrumentation to collect the PM mass required for these assessments. Five different microenvironments representing the diverse exposure conditions in urban environments are considered in order to establish the typical PM concentrations present. The highest concentrations of PM_2.5 and PM_0.1 were found near traffic (i.e. roadsides and traffic intersections), followed by indoor environments, parks and behind roadside vegetation. We identify key factors to consider when selecting sampling instrumentation. These include PM concentration on-site (low concentrations increase sampling time), nature of sampling sites (e.g. indoors; noise and space will be an issue), equipment handling and power supply. Physicochemical characterisation requires micro- to milli-gram quantities of PM and it may increase according to the processing methods (e.g. digestion or sonication). Toxicological assessments of PM involve numerous mechanisms (e.g. inflammatory processes and oxidative stress) requiring significant amounts of PM to obtain accurate results. Optimising air sampling techniques are therefore important for the appropriate collection medium/filter which have innate physical properties and the potential to interact with samples. An evaluation of methods and instrumentation used for airborne virus collection concludes that samplers operating cyclone sampling techniques (using centrifugal forces) are effective in collecting airborne viruses. We highlight that predictive modelling can help to identify pollution hotspots in an urban environment for the efficient collection of PM mass. This review provides guidance to prepare and plan efficient sampling campaigns to collect sufficient PM mass for various purposes in a reasonable timeframe.

Urinary metabolites of furan in waterpipe tobacco smokers compared to non-smokers in home settings in the US

OBJECTIVES

Determine uptake of furan, a potential human carcinogen, in waterpipe tobacco (WPT) smokers in home settings.

METHODS

We analysed data from a US convenience sample of 50 exclusive WPT smokers, mean age 25.3 years, and 25 non-smokers, mean age 25.5 years. For WPT smokers, data were collected at a home visit by research assistants during which participants smoked one WPT head of one brand for a mean of 33.1 min in their homes. Research assistants provided and prepared a WP for participants by weighing and loading 10 g of WPT in the WP head. At the completion of the smoking session, research assistants measured the remaining WPT. Cotinine and six furan metabolites were quantified in first morning urine samples provided on 2 consecutive days for non-smokers, and on the morning of a WPT smoking session and on the following morning for smokers.

RESULTS

WPT smokers consumed a mean of 2.99 g WPT. In WPT smokers, urinary cotinine levels increased significantly 26.1 times the following morning; however, urinary metabolites of furan did not increase significantly. Compared to non-smokers, 2 furan metabolites, N-acetyl-S-[1-(5-acetylamino-5-carboxylpentyl)-1H-pyrrol-3-yl]-L-cysteine and N-acetyl-S-[1-(5-amino-5-carboxypentyl)-1H-pyrrol-3-yl]-L-cysteine sulfoxide, were significantly higher in WPT smokers in pre and in post WPT smoking levels.

CONCLUSIONS

To enable a more rigorous assessment of furan exposure from WPT smoking, future research should determine furan concentrations in WPT smoke, quantify furan metabolites from users of various WPT brands; and extend the investigation to social settings where WPT smoking is habitually practiced.

The effects of ventilation and building characteristics on indoor air quality in waterpipe cafés

To determine the concentration of carbon monoxide (CO) and particulate matter (PMs), indoor air samples were collected from 60 waterpipe cafés in Ardabil city of Iran. Moreover, the influence of several structural, operational, and ventilation system were evaluated on the concentration of the selected pollutants. The results showed that the mean concentration of CO (12.0 ± 7.2 mg/m³) and PMs (PM₁ = 171.5 ± 119.6 μg/m³, PM_2.5 = 303.3 ± 201.9 μg/m³, PM₁₀ = 440.3 ± 272.2 μg/m³) were notably higher than the guideline levels. According to the results, open face/café area was influenced by the natural ventilation rate and the mean air exchange rate was 3.1 ± 1.1 min^-1. The natural ventilation has a functional role on air quality of the cafes, and fan-type mechanical ventilation was influencing factor on CO concentration when the natural ventilation was restricted. "Type of used charcoal" had the highest influence on the releasing of pollutants inside the cafés as the pollutant concentrations were lower for simple (raw) charcoal compared with the favored (aromatic) one. The results indicated that the building characteristics and natural ventilation considerably affect air quality of the cafes.

Development of Hourly Indoor PM2.5 Concentration Prediction Model: The Role of Outdoor Air, Ventilation, Building Characteristic, and Human Activity

Exposure to indoor particulate matter less than 2.5 µm in diameter (PM2.5) is a critical health risk factor. Therefore, measuring indoor PM2.5 concentrations is important for assessing their health risks and further investigating the sources and influential factors. However, installing monitoring instruments to collect indoor PM2.5 data is difficult and expensive. Therefore, several indoor PM2.5 concentration prediction models have been developed. However, these prediction models only assess the daily average PM2.5 concentrations in cold or temperate regions. The factors that influence PM2.5 concentration differ according to climatic conditions. In this study, we developed a prediction model for hourly indoor PM2.5 concentrations in Taiwan (tropical and subtropical region) by using a multiple linear regression model and investigated the impact factor. The sample comprised 93 study cases (1979 measurements) and 25 potential predictor variables. Cross-validation was performed to assess performance. The prediction model explained 74% of the variation, and outdoor PM2.5 concentrations, the difference between indoor and outdoor CO2 levels, building type, building floor level, bed sheet cleaning, bed sheet replacement, and mosquito coil burning were included in the prediction model. Cross-validation explained 75% of variation on average. The results also confirm that the prediction model can be used to estimate indoor PM2.5 concentrations across seasons and areas. In summary, we developed a prediction model of hourly indoor PM2.5 concentrations and suggested that outdoor PM2.5 concentrations, ventilation, building characteristics, and human activities should be considered. Moreover, it is important to consider outdoor air quality while occupants open or close windows or doors for regulating ventilation rate and human activities changing also can reduce indoor PM2.5 concentrations.

Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes.

Waterpipe smoking: the pressing need for risk communication

Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking. Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking. Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.

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.

Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul, Moscow, and Cairo

Background

Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees.

Methods

We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul, Moscow, and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO), hair nicotine, saliva cotinine, urine cotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures.

Results

There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers, the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2, 40.9) µg/g creatinine urine cotinine, 5.5 (2, 15) ng/mL saliva cotinine, 0.95 (0.36, 5.02) ng/mg hair nicotine, 1.48 (0.98, 3.97) pg/mg creatinine urine NNAL, 0.54 (0.25, 0.97) pmol/mg creatinine urine 1-OHPG, and 1.67 (1.33, 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68, 95% CI: 1.20, 2.37) and hair nicotine (GMR: 1.22, 95% CI: 1.05, 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83, 95% CI: 1.05, 7.62).

Conclusions

Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS, including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs).

Implications

Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

Levels and health risk assessments of particulate matters (PM2.5 and PM10) in indoor/outdoor air of waterpipe cafés in Tehran, Iran

To determine the concentration of particulate matters (PM2.5 and PM10), 36 samples were collected from indoor/outdoor air of hookah cafés (HS), cigarette cafés (CS), both hookah and cigarette (HCS), and no-smoking building (NS) in Tehran City from December 2017 to March 2018. The mean ± SD of PM10 concentration in the indoor air of the cafés in terms of HS, CS, HCS, and NS sites has been 702.35, 220.20, 1156.60, and 60.12 μg/m3, while for PM2.5, the values have been 271.92, 111.80, 619.10, and 22.25 μg/m3, respectively. It was also found that the PM concentration inside the cafés was higher during weekend session (with a higher number of active smokers), than during the weekday sessions. Moreover, the PM levels in the indoor air of the cafés were considerably higher than those of the outdoors (p < 0.05). Based on path analysis, the number of "active smokers" had the highest influence on production of PM inside the cafés, followed by the tobacco type. Finally, the mean excess lifetime cancer risk (ELCR) for PM2.5 in the indoor air of cafés was observed in the range of 0.64 × 10-5-14.98 × 10-5. Also, the mean of hazard quotient (HQ) for PM2.5 and PM10 was calculated in range of 0.82-18.4 and 0.16-3.28, respectively, which corresponds to an unacceptably high risk for human health. The PM levels in the indoor air of smoking cafés in Tehran are significantly high, such that it can cause serious risks for the health of both the customers and personnel. Thus, it is necessary that suitable controlling strategies be adopted for this public health threat.

Environmental and lifestyle factors affecting exposure to polycyclic aromatic hydrocarbons in the general population in a Middle Eastern area

The aim of this study was to investigate environmental and lifestyle factors affecting exposure to PAHs in the general population in a large city of the Middle East (Tehran) by measuring urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and establishing relationships between PAHs exposure and related factors. Urine samples were collected from 222 randomly chosen subjects who were living in the urban area of Tehran, Iran. Subjects were required to complete a detailed questionnaire aimed to document their personal and sociodemographic information, activities, cooking-related appliances, smoking history/exposure, and consumed foodstuff. Identification and quantification of six OH-PAHs was carried out using a gas chromatography with mass spectrometry (GC-MS). The geometric means for 1-OHP, 1-NAP, 2-NAP, 2-FLU, 9-FLU, and 9-PHE for whole population study were 310, 1220, 3070, 530, 330, and 130 ng/g creatinine, respectively. The two naphthalene metabolites contributed on average 77% of the total concentration of six measured OH-PAHs, followed by the 2-FLU, 1-OHP, 9-FLU, and 9-PHE. The most important predictors of urinary PAHs were consumption of grilled/barbecued foods, smoking, and exposure to environmental tobacco smoking. Water pipe smoking was linked to urinary OH-PAH metabolite in a dose-response function. Residential traffic was also related with OH-PAH metabolite concentrations. Other factors including gender, age, exposure to common house insecticides, open burning, and candle burning were found to be statistically associated with the urinary levels of some OH-PAHs. High exposure to PAHs among general population in Middle Eastern large cities and its associated health implications calls for public health measures to reduce PAHs exposure.

Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk

Introduction

Smoking is a major cause of cardiovascular morbidity and mortality worldwide. Hookah (ie, waterpipe) smoking is a centuries-old revived yet understudied global epidemic of tobacco use. Because of the traditional set-up of a hookah-pipe, in addition to inhaling tobacco-combustion products, smokers are also exposed to large amounts of charcoal combustion products from the burning charcoal briquettes used to heat the hookah flavored tobacco. Despite being heavily advertised and actively glamorized in the mass media as a healthier tobacco alternative, the toxicological constituents of hookah smoke—including nicotine, carbon monoxide, particulates, oxidants, heavy metals, phenols and flavorants—indicate the potential to cause adverse cardiovascular events.

Methods

Herein, we review evidence on hookah smoke toxicological constituents, cardiovascular effects and potential mechanisms by which hookah smoke aerosol could cause cardiovascular disease.

Results

The evidence reviewed here indicates that contrary to the widespread popular belief that hookah is a healthier tobacco alternative, the constituents of hookah smoke aerosol contains similar chemicals compared to cigarette smoke, many of which are known to be harmful to cardiovascular health and mediated by similar pathophysiologic processes. Because the burning charcoal briquettes are a unique source of toxicant emissions specific to hookah smoking, some constituents differ in their quantities from cigarettes with some of their cardiovascular effects unknown.

Conclusions

To date, much more is known about the constituents and their toxicology than about the effects of hookah smoking on human cardiovascular health. Further research on long-term consequences of hookah use is needed.

Implications

This review provides an overview on the potential impact of hookah smoking on cardiovascular health. Readers will gain an insight into evidence on its toxicological constituents, human health effects, and pathophysiological mechanisms by which hookah smoking might cause cardiovascular disease. The review also highlights current research gaps regarding the cardiovascular consequences of hookah smoking, specifically the long-term consequences in the United States and Europe among flavored-hookah tobacco users.

Acrolein Exposure in Hookah Smokers and Non-Smokers Exposed to Hookah Tobacco Secondhand Smoke: Implications for Regulating Hookah Tobacco Products

Introduction

Acrolein is a highly ciliatoxic agent, a toxic respiratory irritant, a cardiotoxicant, and a possible carcinogen present in tobacco smoke including hookah tobacco.

Methods

105 hookah smokers and 103 non-smokers attended exclusively hookah smoking social events at either a hookah lounge or private home, and provided urine samples the morning of and the morning after the event. Samples were analyzed for 3-hydroxypropylmercapturic acid (3-HPMA), a metabolite of acrolein.

Results

Geometric mean (GM) urinary 3-HPMA levels in hookah smokers and non-smokers exposed to secondhand smoke (SHS) increased significantly, 1.41 times, 95% CI = 1.15 to 1.74 and 1.39 times, 95% CI = 1.16 to 1.67, respectively, following a hookah social event. The highest increase (1.68 times, 95% CI = 1.15 to 2.45; p = 0.007) in 3-HPMA post a hookah social event was among daily hookah smokers (GM, from 1991 pmol/mg to 3348 pmol/mg). Pre-to-post event change in urinary 3-HPMA was significantly positively correlated with pre-to-post event change in urinary cotinine among hookah smokers at either location of hookah event, (ρ = 0.359, p = 0.001), and among non-smokers in hookah lounges (ρ = 0.369, p = 0.012).

Conclusions

Hookah tobacco smoke is a source of acrolein exposure. Findings support regulating hookah tobacco products including reducing humectants and sugar additives, which are precursors of acrolein under certain pyrolysis conditions. We suggest posting health warning signs for indoor smoking in hookah lounges, and encouraging voluntary bans of smoking hookah tobacco in private homes.

Implications

Our study is the first to quantify the increase in acrolein exposure in hookah smokers and non-smokers exposed to exclusively hookah tobacco SHS at hookah social events in homes or hookah lounges. Our findings provide additional support for regulating hookah tobacco product content, protecting non-smokers' health by posting health warning signs for indoor smoking in hookah lounges, and encouraging home bans on hookah tobacco smoking to safeguard vulnerable residents.

Sources, health effects and control strategies of indoor fine particulate matter (PM2.5): A review

Indoor air quality is directly influenced by indoor PM_2.5. Short-term and long-term exposure of PM_2.5 in the micro environment would severely detriment the health of both humans and animals. The researches both at home and abroad dating from 2000 were analyzed and summarized mainly in the following 3 sections: source apportionment, health effects and control methods. Health effects were illustrated in both epidemiology and toxicology. The epidemiology was explicated in morbidity and mortality, the toxicology was illuminated in inflammatory reaction, oxidative stress, genotoxicity, mutagenicity and carcinogenicity. Control methods were showed in two aspects (sources and means of transmission), of which each was resolved by corresponding control strategy. Abundant investigations indicated that comprehensive control strategies were needed for sources decrement and health burden mitigation of indoor PM_2.5. Based on the increasingly wide research of indoor PM_2.5, the concept of indoors was essentially expanded, and on the basis of the summary of all the aspects mentioned above, both the scope and depth of indoor PM_2.5 research were found insufficiently. Meantime, the potential direction of development in indoor PM_2.5 research were projected, in hope of contributing to further relevant study of engineers in ambient environment and building environment.

Statistical modeling of O3, NOx, CO, PM2.5, VOCs and noise levels in commercial complex and associated health risk assessment in an academic institution

Indoor Air Quality (IAQ) is considered to be of great concern due to its adverse impact on the human health nowadays. The presence of different air pollutants along with noise may aggravate the IAQ. The present study attempts to examine IAQ in terms of major criteria air pollutants (O₃, NOx=NO+NO₂, CO and PM_2.5) along with total volatile organic compound (TVOC), individual VOC and noise pollution in indoor and outdoor environment of a Commercial Shopping Complex (CSC) in Delhi. Real time measurements have been carried out for O₃, NOx, CO, PM_2.5, TVOC and noise while thirteen individual VOCs have been estimated using NIOSH method was performed using Gas Chromatograph. The study also aimed to find out the relationship among VOCs, source estimation using Principal Component Analysis. The observed results for the targeted pollutants were also compared with international and national recommended permissible values. The mean values of O₃, NOx, CO, PM_2.5 and TVOC are found to be 17.6/(15.0) ppb, 15.8/(14.1) ppb, 8.4/(1.9) ppm, 125.4/(74.6) μg/m³ and 412.5/(226.5) μg/m³ for indoor/(outdoor), respectively. Among the individual VOC, toluene was the most abundant followed by xylene-isomers and benzene. The noise pollution level in Indoor/outdoor were found to be 51.5/46.4dB which is below the guideline value (65dB) provided by the WHO. Most of the pollutants were found to have indoor sources. The different kinds of pollutants and noise may have synergistic effect and aggravate the health of the people working and visiting the CSC.