Author/Authors :
Kassem, Nada O F Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A , Kassem, v Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A , Liles, Sandy Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A , Jackson, heila R Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A , B Posis, Alexander Ivan Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A , Chatfield, Dale A Department of Chemistry- san Diego State University, San Diego, California, U.S.A , Chatfield, Dale A Department of Chemistry- San Diego State University, San Diego, California, U.S.A. , Hovell, Melbourne F Center for Behavioral Epidemiology and Community Health (CBEACH)- Graduate School of Public Health-Division of Health Promotion- San Diego State University, San Diego, California, U.S.A
Abstract :
Background: Nicotine, an addictive drug, is present in all forms of tobacco products, including hookah tobacco, which is not yet
regulated in the United States.
Objectives: This study aimed to investigate the uptake of nicotine in hookah smokers and non-smokers exposed to secondhand
smoke (SHS) at indoor hookah social events in natural settings where hookah tobacco was smoked exclusively.
Patients and Methods:We quantified cotinine, a metabolite of nicotine, in the urine of 105 hookah smokers and 103 non-smokers.
Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social
event at a hookah lounge or in a private home.
Results: Following a social event where exclusively hookah tobacco was smoked, urinary cotinine levels increased significantly 8.5
times (geometric mean (GM): 16.0 ng/mg to 136.1 ng/mg) among hookah smokers, and 2.5 times (GM: 0.4 ng/mg to 1.0 ng/mg) among
non-smokers exposed exclusively to hookah tobacco SHS. Among hookah smokers, the highest increase in urinary cotinine levels
post a hookah event was found in occasional hookah smokers in which GM levels increased significantly 31.2 times post smoking
(from 2.0 ng/mg to 62.3 ng/mg). Reported reasons for preference to smoke hookah at home by hookah smokers who attended a
hookah social event in a private home included recreational purposes, socializing with friends and family, ‘Me’ time and relaxing
at home, more comfortable to smoke hookah at home, owning a hookah and hookah tobacco, eating and drinking while smoking
hookah, and saving money by smoking at home and not going to hookah lounges.
Conclusions: Hookah tobacco smoke is a source of substantial nicotine exposure. Our results call for protecting hookah smokers’
and non-smokers’ health by requiring accurate hookah tobacco labels, raising taxes on hookah tobacco, reducing the spread of
hookah lounges, and encouraging voluntary bans on smoking hookah tobacco in private homes.
Keywords :
Hookah Smoking , Waterpipe Smoking , Cotinine , Secondhand Smoke , Nicotine
