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Waterpipe device cleaning practices and disposal of waste associated with waterpipe tobacco smoking in homes in the USA
  1. Nada OF Kassem,
  2. Noura O Kassem,
  3. Sandy Liles,
  4. Erin Reilly,
  5. Flora Kas-Petrus,
  6. Alexander Ivan B Posis,
  7. Melbourne F Hovell
  1. San Diego State University Research Foundation, San Diego, California, USA
  1. Correspondence to Dr Nada OF Kassem, San Diego State University Research Foundation, San Diego, CA 92123, USA; nkassem{at}


Objectives To quantify postsmoking waterpipe tobacco (WPT) waste and describe postsmoking waterpipe (WP) device cleaning practices and disposal of associated waste in home settings.

Methods We analysed data from a US convenience sample of 50 exclusive WPT smokers, mean age 25.3 years. Data were collected at a home visit during which participants smoked one WPT head and completed a self-administered questionnaire on WP cleaning practices and disposal of waste associated with WPT use. Research assistants provided and prepared a WP for participants by weighing and loading 10 g of WPT in the WP head and placing 470 mL of water in the WP bowl. At the completion of the smoking session, research assistants measured the remaining WPT and water. Descriptive analyses were performed.

Results Of the 10 g of fresh WPT used for each smoking session, 70.1% (mean=7.01 g) was discarded postsmoking as waste; for each 470 mL of water used in the WP bowl, 94.3% (mean=443 mL) was discarded. WP device cleaning practices ranged from never cleaning the device to cleaning it after each smoking session. Respondents reported discarding smoked WPT residue in the trash (81.6%) or the kitchen sink (14.3%) and discarding postsmoking charcoal in the trash (57.6%), the kitchen sink (27.3%) or backyard soil (9.1%). Respondents reported discarding smoked WP water in the kitchen sink (76.5%), bathroom sink (14.7%), toilet (2.9%) and backyard soil (5.9%).

Conclusions Interventions and regulations are needed to inform proper WP device cleaning practices and disposal of waste associated with WPT use.

Trial registration number NCT03253653.

  • waterpipe tobacco
  • hookah
  • environmental waste
  • nargile
  • shisha

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  • Contributors Conception, design and development of methodology: NOFK and NOK. Recruitment, acquisition of data, study supervision and administrative, technical or material support: NOFK, NOK, SL, ER, FK-P and AIBP. Data analysis and interpretation of data: NOFK, SL, ER, NOK and MFH. All authors contributed to manuscript preparation and approved the final version prior to submission.

  • Funding Research reported in this publication was supported by the US Food and Drug Administration (FDA) Center for Tobacco Products and the National Institute on Drug Abuse of the National Institutes of Health (NIH) under Award Number R01DA042471 to Nada OF Kassem.

  • Disclaimer The content is solely the responsibiliy of the authors and does not necessarily represent the official views of the Food and Drug Administration or the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by San Diego State University’s Institutional Review Board (IRB# 2445100).

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

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.