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Effects of hookah smoking on indoor air quality in homes
  1. Michael Weitzman1,2,3,4,
  2. Afzal Hussein Yusufali4,5,
  3. Fatma Bali4,5,
  4. M J Ruzmyn Vilcassim3,
  5. Shashank Gandhi6,
  6. Richard Peltier7,
  7. Arthur Nadas3,
  8. Scott Sherman4,2,8,
  9. Lily Lee1,9,
  10. Zhang Hong1,
  11. Jenni Shearston8,
  12. Su Hyun Park1,
  13. Terry Gordon2,3,4
  1. 1 Department of Pediatrics, New York University, School of Medicine, New York, New York, USA
  2. 2 College of Global Public Health, New York University, New York, New York, USA
  3. 3 Department of Environmental Medicine, New York University, School of Medicine, New York, New York, USA
  4. 4 New York University/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
  5. 5 Hatta Hospital, Dubai Health Authority, Dubai, UAE
  6. 6 Department of Biology, New York University, New York, New York, USA
  7. 7 Department of Environmental Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
  8. 8 Department of Population Health, New York University, School of Medicine, New York, New York, USA
  9. 9 Brooklyn College, Brooklyn, New York, USA
  1. Correspondence to Dr Michael Weitzman, New York University School of Medicine, 1 Park Avenue, Lower Level 16, New York, NY 10016, USA;


Introduction Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke.

Methods Air samples from 33 homes—11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking—were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room.

Results Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different.

Conclusions This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.

  • Environment
  • Non-cigarette tobacco products
  • Secondhand smoke

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  • Contributors MW, SS, TG, AHY, FB, RP are responsible for conception, design, analysis and interpretation of data. LL and SG drafted the article. ZH, SHP, AN and MJRV conducted statistical analysis of data. JS revised the manuscript critically for important intellectual content. All authors read and approved the final draft of the manuscript.

  • Funding This research was supported in part by the NYU/Abu Dhabi Public Health Research Center (MW, TG and SS), NIH/NIDA 1K24DA038345 (SS), NIH/NIEHS 5 P30 ES000260–49 (TG), and NIH/NCI 3 P30 CA016087–33S1 (TG and MW).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Dubai Health Authority's Institutional Review Boards.

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