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Indoor air quality in Virginia waterpipe cafés
  1. Caroline Oates Cobb1,
  2. Andrea Rae Vansickel2,
  3. Melissa D Blank3,
  4. Kade Jentink3,
  5. Mark J Travers4,
  6. Thomas Eissenberg1,5
  1. 1Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
  2. 2Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3Tobacco Research and Intervention Program, Moffitt Cancer Center, Tampa, Florida, USA
  4. 4Department of Health Behavior and Aerosol Pollution Exposure Research Laboratory, Roswell Park Cancer Institute, Buffalo, New York, USA
  5. 5Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
  1. Correspondence to Dr Thomas Eissenberg, Department of Psychology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, PO Box 980205, Richmond, VA 23298, USA; teissenb{at}


Introduction A revised indoor air quality law has been implemented in Virginia to protect the public from the harmful effects of secondhand smoke exposure. This legislation contains exemptions that include allowances for smoking in a room that is structurally separated and separately ventilated. The objective of the current study was to examine the impact of this law on air quality in waterpipe cafés, as well as to compare the air quality in these cafés to restaurants that allow cigarette smoking and those where no smoking is permitted.

Methods Indoor air quality in 28 venues (17 waterpipe cafés, five cigarette smoking-permitted restaurants and six smoke-free restaurants (five with valid data)) in Virginia was assessed during 4 March to 27 May 2011. Real-time measurements of particulate matter (PM) with 2.5 μm aerodynamic diameter or smaller (PM2.5) were obtained and occupant behaviour/venue characteristics were assessed.

Results The highest mean PM2.5 concentration was observed for waterpipe café smoking rooms (374 μg/m3, n=17) followed by waterpipe café non-smoking rooms (123 μg/m3, n=11), cigarette smoking-permitted restaurant smoking rooms (119 μg/m3, n=5), cigarette smoking-permitted restaurant non-smoking rooms (26 μg/m3, n=5) and smoke-free restaurants (9 μg/m3, n=5). Smoking density was positively correlated with PM2.5 across smoking rooms and the smoke-free restaurants. In addition, PM2.5 was positively correlated between smoking and non-smoking rooms of venues.

Conclusions The PM2.5 concentrations observed among the waterpipe cafés sampled here indicated air quality in the waterpipe café smoking rooms was worse than restaurant rooms in which cigarette smoking was permitted, and state-required non-smoking rooms in waterpipe cafés may expose patrons and employees to PM2.5 concentrations above national and international air quality standards. Reducing the health risks of secondhand smoke may require smoke-free establishments in which tobacco smoking sources such as water pipes are, like cigarettes, prohibited.

  • Secondhand smoke
  • waterpipe
  • cigarette
  • air quality
  • non-cigarette tobacco products
  • nicotine
  • harm reduction
  • electronic nicotine delivery devices
  • addiction
  • toxicology
  • environmental tobacco smoke
  • exposure assessment (ETS)
  • taxation and price
  • withdrawal
  • dependence
  • behavioural pharmacology

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  • Funding This work was supported by USA Public Health Service grants R01CA120142, R01DA025659, R01DA024876, T32DA007027-34 and F31DA028102 and Flight Attendant Medical Research Institute grant YCSA052333.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The manuscript includes all data collected for this study except for minor venue characteristics observed. Data are available by email request to the corresponding author TE.