Background Recent years showed sharp proliferation of hookah bars worldwide with scarcity of workplace safety regulations. Hookah server employees are at high risk for elevated harm. This study reported hookah smoke exposure, assessed acute problems and evaluated factors related to knowledge of hookah-smoking harm and toxicity among high-risk hookah servers.
Methods A mixed methods design was employed. A self-reported questionnaire was distributed online, and semistructured in-depth interviews were used. Hookah server employees were recruited using snowball sampling, with 52 participants included in quantitative analyses and 10 participating in semistructured interviews.
Results Hookah server employees took a median 389 hookah puffs per workday compared with 169–170 per session for customers. Servers were limited in knowledge of potential hookah harms and smoke toxicant exposure. Almost all believed that hookah water bowls filtered out toxicants. Smoking with family members (p=0.012) was associated with lower knowledge scores for hookah harms and exposure. Hookah server employees reported carbon monoxide-poisoning symptoms of dizziness, headaches and fainting during work but believed their bodies would adapt. Home remedies were taken to alleviate symptoms. Work environment and salary attracted hookah server employees to their position and none considered quitting for reasons of harm.
Conclusion Findings demonstrate need for workplace policies and regulations to protect hookah server employees and provide targets for educational interventions for high-risk hookah server employees.
- smoking topography
- smoking caused disease
- non-cigarette tobacco products
- global health
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Contributors BLC provided overall direction, study design, analysis, writing and paper review. TY provided design, conducted the study, writing and paper review. KK provided study design and field direction and paper review. AG designed and conducted the statistical modelling and paper review. DS provided the development of idea, field support for study and paper review.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Nazarbayev University School of Medicine’s Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The deidentified participant data are secured under password protection on the work computer of the first and second authors. Permission will be granted for use of the quantitative and qualitative data per reasonable requests by other researchers.
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