Secondhand smoke puts hookah bar employees at risk, new study shows.

hookah bar
Hookah bars run over night. (Chencheng Zhao/MEDILL)

By Chencheng Zhao

Employees in hookah bars face health risks from secondhand smoke from the water pipes, New York University researchers are reporting.

Environmental medicine researcher Terry Gordon and his colleagues investigated indoor air quality in some popular hookah bars in New York and the health effects of secondhand hookah smoke on the bar workers.

Gordon reported in the January edition of Tobacco Control that there was an overall elevation in fine particulate matter, known as PM2.5, fine black carbon, BC2.5, and carbon monoxide of indoor air during the work shift.

Bar workers were tested before and after their work shift reported a general increase in heart rate, inflammatory cytokines levels in blood and exhaled CO levels after occupational exposure.

Gordon said, “Tobacco-based and non-tobacco shisha [an herbal syrup] produce very similar combustion products with the obvious exception of nicotine. People should not have the misperception that one is safer than the other, just as they should not believe that bubbling the hookah smoke through water makes it safe to inhale.”

Anti-smoking activist Joel Dunnington, who retired recently as a radiologist at the M.D. Anderson Cancer Center in Houston, said smokers who smoke and work in places with tobacco smoke pollution are getting “a double whammy.”

“The effects of secondhand smoke (I call it tobacco smoke pollution) affect nonsmokers, who have not chosen to commit slow motion suicide by smoking cigarettes,” he added.
During the air sampling periods in the hookah bars, the mean level of PM2.5 among the hookah bars was 363.8 mg/m3 with a range of 62.5–912.5 mg/m3.

“[T]he EPA considers a PM 2.5 level of 0-50 as good … when you get close to 1,000, it is really, really bad,” said Dunnington. “The only places I have seen that are higher is when parents light up in cars with their kids,” he added.

The Hookah Industry Association in Temple Terrace, Florida, did not respond to requests for comment on the NYU research.

Medill Reports visited hookah bars for comment.

Tim Delisi runs Kush Hookah Lounge in Skokie. He said he has 10 fans to ventilate his bar.

“I’ve been running this business for six years and I’m very healthy,” he said. He added that he has no health issues at all, nor does his sister, the only employee on duty that night.

Gordon and his colleagues said in the study that they have no insights about potential long-term deleterious effects on the health of hookah bar workers.

Dunnington pointed out that there are two different timelines on the diseases caused by secondhand smoke:

First, there are the immediate effects of heart attacks and asthma in people exposed to the smoke for short durations. Secondly, there are the long-term effects including lung cancer, breast cancer, other cancers, chronic obstructive pulmonary disease and atherosclerosis.
Dunnington said secondhand smoke has less concentrated chemicals than chemicals inhaled directly from primary smoking.

“However, the chemicals produced when tobacco is burned at lower temperatures when sitting in an ashtray or sitting in a hookah, are actually worse than the chemicals produced when inhaled because [they are] burning more completely at higher temperatures,” said Dunnington.

Indeed, hookah smoking is becoming an increasing popular social event that people spend time together, talking as they pass the pipe around. Among U.S. high school students, cigarette use has dropped 33 percent during the last decade, while use of non-cigarette combustible tobacco products, including hookah, has increased by 123 percent, according to the Centers for Disease Control and Prevention.

Many large cities have smoke-free laws applicable to cigarette smoking but not to water pipe tobacco smoking, due to the fact that water pipe serving premises are classified as tobacco retail shops, according to a 2012 report in the American Journal of Public Health. In addition, water pipe tobacco is taxed at a lower rate than cigarette tobacco, according to researchers from the University of Beirut.

Researchers from Virginia Commonwealth University found that hookah tobacco contains the same toxic chemicals and carcinogens as any tobacco product and its smoke. They said charcoal used to heat tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals. Just as cigarette smoking, hookah smoking can lead to respiratory disease, heart disease, and various types of cancer, researchers said.

Two recent international conferences on water pipe tobacco research have issued declarations recommending immediate action on several fronts to get ahead of this epidemic, including “banning of flavored water pipe tobacco, specific inclusion of water pipe smoking in clean indoor air regulations, and elimination of water pipe tobacco product advertising and marketing.”

Pediatrician and policy expert Michael Weitzman, a co-author of the NYU study, was a key witness in the Department of Justice’s federal racketeering case against the tobacco industry.

“Water pipes should NOT be considered as a safe alternative to smoking cigarettes as they appear to be far more dangerous than cigarettes. That, however, does not mean that anyone should smoke cigarettes…they are the leading preventable cause of death worldwide…but hookahs may actually turn out to be more dangerous than cigarettes,” said Weitzman in an email.­­­­­­­­

Photo at top: Hookah bars run overnight. (Chencheng Zhao/MEDILL)