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

Change in carbon monoxide exposure among waterpipe bar patrons.

Author information

  • 1Department of Health Sciences and Human Performance, University of Tampa, Tampa, FL;
  • 2Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN;
  • 3Public Health Intern, University of Tampa, Tampa, FL.



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.


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.


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).


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.

© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail:

[PubMed - indexed for MEDLINE]
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