Change in carbon monoxide exposure among waterpipe bar patrons

Nicotine Tob Res. 2014 Jul;16(7):1014-9. doi: 10.1093/ntr/ntu041. Epub 2014 Mar 18.


Introduction: Waterpipe (also known as hookah) smoking is increasing around the world, including the United States, where waterpipe bars have sprung up rapidly around college campuses. Users are exposed to several toxicants, including carbon monoxide (CO). We evaluated change in exhaled CO and estimated carboxyhemoglobin levels among waterpipe bar patrons in Tampa, FL.

Methods: Exhaled breath samples were obtained immediately before entering and after leaving 6 waterpipe bars in Tampa, FL to measure CO boost and factors affecting CO change. Demographics, cigarette use status, and characteristics of waterpipe use during the bar visit also were assessed.

Results: Among the sample of 166 participants, mean CO increased from 6.5 parts per million (ppm) to 58.2 ppm (a 795% relative boost; p < .001). CO change was higher for patrons who were dual (waterpipe plus cigarette) smokers compared with waterpipe-only smokers, and significant factors of CO change were frequency of waterpipe use, number of charcoals, number of tobacco bowls, and time spent in the bar (all p values < .05).

Conclusion: U.S. waterpipe bar patrons are exposed to considerable amounts of CO, which could put them at risk of acute illness and chronic heart and lung diseases. Environmental and policy controls are needed to curb this increasingly popular tobacco use method in the United States.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Breath Tests
  • Carbon Monoxide / analysis*
  • Carboxyhemoglobin / chemistry
  • Female
  • Florida
  • Humans
  • Male
  • Smoking / adverse effects*
  • Tobacco Smoke Pollution / analysis*
  • Young Adult


  • Tobacco Smoke Pollution
  • Carbon Monoxide
  • Carboxyhemoglobin