Article Text

Download PDFPDF
Secondhand hookah smoke: an occupational hazard for hookah bar employees
  1. Sherry Zhou1,
  2. Leili Behrooz2,
  3. Michael Weitzman3,4,5,
  4. Grace Pan4,
  5. Ruzmyn Vilcassim4,
  6. Jaime E Mirowsky6,
  7. Patrick Breysee7,
  8. Ana Rule7,
  9. Terry Gordon4,5
  1. 1Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  2. 2New York University, New York, New York, USA
  3. 3Department of Pediatrics, New York University School of Medicine, New York, New York, USA
  4. 4Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
  5. 5NYU College of Global Public Health, New York, New York, USA
  6. 6University of North Carolina, Chapel Hill, North Carolina, USA
  7. 7Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Terry Gordon, NYU School of Medicine, 57 Old Forge Rd, Tuxedo, NY 10987, USA; terry.gordon{at}


Background Despite the increasing popularity of hookah bars, there is a lack of research assessing the health effects of hookah smoke among employees. This study investigated indoor air quality in hookah bars and the health effects of secondhand hookah smoke on hookah bar workers.

Methods Air samples were collected during the work shift of 10 workers in hookah bars in New York City (NYC). Air measurements of fine particulate matter (PM2.5), fine black carbon (BC2.5), carbon monoxide (CO), and nicotine were collected during each work shift. Blood pressure and heart rate, markers of active smoking and secondhand smoke exposure (exhaled CO and saliva cotinine levels), and selected inflammatory cytokines in blood (ineterleukin (IL)-1b, IL-6, IL-8, interferon γ (IFN-γ), tumour necrosis factor (TNF-α)) were assessed in workers immediately prior to and immediately after their work shift.

Results The PM2.5 (gravimetric) and BC2.5 concentrations in indoor air varied greatly among the work shifts with mean levels of 363.8 µg/m3 and 2.2 µg/m3, respectively. The mean CO level was 12.9 ppm with a peak value of 22.5 ppm CO observed in one hookah bar. While heart rate was elevated by 6 bpm after occupational exposure, this change was not statistically significant. Levels of inflammatory cytokines in blood were all increased at postshift compared to preshift testing with IFN-Υ increasing from 0.85 (0.13) to 1.6 (0.25) (mean (standard error of the mean; SEM)) pg/mL (p<0.01). Exhaled CO levels were significantly elevated after the work shift with 2 of 10 workers having values >90 ppm exhaled CO.

Conclusions These results demonstrate that hookah bars have elevated concentrations of indoor air pollutants that appear to cause adverse health effects in employees. These data indicate the need for further research and a marked need for better air quality monitoring and policies in such establishments to improve the indoor air quality for workers and patrons.

  • Secondhand smoke
  • Toxicology
  • Smoking Caused Disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • All authors participated in the writing and editing of the manuscript.

  • Funding This work was supported in part by New York Universtiy/Abu Dhabi Public Health Research Institute: NIH/NCI 3 P30 CA016087-33S1; NIH/NIEHS 5 P30 ES000260-50.

  • Competing interests None declared.

  • Ethics approval NYU School of Medicine's IRB.

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

  • Data sharing statement Air pollution samples are available for analyses.