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Hookah Use Raises Carbon Monoxide Levels, Cardiac Risk


Patrons of hookah cafes and bars may be walking out with more than they bargained for: dangerously high levels of carbon monoxide in their blood. A University of Florida study reports that hookah smoking raises carbon monoxide levels more than threefold when compared with patrons who go to traditional bars.

Carbon monoxide is linked to cardiovascular disease

Hookah smoking has been gaining in popularity in the United States. A hookah is a waterpipe consisting of a smoke chamber, a bowl where flavored tobacco is burned with charcoal, a pipe, and a hose. To use a hookah, you inhale the flavored smoke, which has been cooled with water, through a mouthpiece that is attached to the hose.

According to Tracey Barnett, PhD, assistant professor in the University of Florida College of Public Health and Health Professions’ department of behavioral science and community health, hookah smoking is especially popular among young people, who often enjoy it as a group activity.

In Barnett’s previous work, she showed that 11 percent of high school students in Florida and 4 percent of middle school students had used a hookah. A recent study by Wake Forest Baptist Medical Center reported that 17.4 percent of nearly 4,000 college students said they used a hookah, while a University of Memphis study estimated hookah use to be 5 to 17 percent among adolescents.

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In the new study, Barnett and her team measured carbon monoxide levels in individuals as they left hookah establishments, which is the first time a study of hookah smokers has been done in this manner. Barnett explained that although other studies have looked at hookah smokers and carbon monoxide levels in the lab, in this study “we were catching them in a real-world moment as best we could.”

The investigators used a breath carbon monoxide tester to collect levels from 173 hookah café patrons and 198 patrons of traditional bars that allowed smoking. Hookah patrons had an average carbon monoxide level of 30.8 parts per million (ppm) compared with an average of 8.9 ppm from traditional bar patrons. Hookah café patrons who said they did not smoke also had an elevated carbon monoxide level on average of 11.5 ppm.

The maximum level for carbon monoxide exposure is 50 ppm over eight hours, as established by the Occupational Safety and Health Administration (OSHA). In the Florida study, 18 percent of hookah café patrons had carbon monoxide levels greater than 50 ppm while only 1.5 percent of traditional bar patrons had such elevated levels. Five percent of hookah patrons had levels exceeding 90 ppm.

Carbon monoxide reduces the ability of the blood to transport oxygen to the body’s tissues. Symptoms of carbon monoxide poisoning include headache, fatigue, and nausea, and sustained exposure at 150 ppm to 200 ppm can cause disorientation and unconsciousness. Cardiovascular disease has been linked to long-term exposure, although even short-term exposure can be harmful for anyone who has pre-existing cardiovascular or respiratory problems.

Hookah smoking is an alternative way to smoke tobacco, and because the smoke is less irritating than cigarette smoke, many people believe it is less harmful than smoking a cigarette. However, this current study and previous ones highlight the dangers of hookah smoking, including high carbon monoxide levels and cardiac risk, which can be attributed to burning charcoal and the tendency of hookah users to smoke continuously for an hour or longer.

Maziak W. Addictive Behaviors 2011 Jan-Feb; 36(1-2): 1-5
Sutfin EL et al. Drug and Alcohol Dependence 2011; doi: 10.1016/j.drugalcdep.2011.01.018
University of Florida Health Science Center