RT Journal Article SR Electronic T1 ‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served JF Tobacco Control JO Tob Control FD BMJ Publishing Group Ltd SP 290 OP 297 DO 10.1136/tobaccocontrol-2013-051169 VO 24 IS 3 A1 Fadi Hammal A1 Alyssa Chappell A1 T Cameron Wild A1 Warren Kindzierski A1 Alan Shihadeh A1 Amanda Vanderhoek A1 Cong Khanh Huynh A1 Gregory Plateel A1 Barry A Finegan YR 2015 UL http://tobaccocontrol.bmj.com/content/24/3/290.abstract AB Background There are limited data on the composition and smoke emissions of ‘herbal’ shisha products and the air quality of establishments where they are smoked. Methods Three studies of ‘herbal’ shisha were conducted: (1) samples of ‘herbal’ shisha products were chemically analysed; (2) ‘herbal’ and tobacco shisha were burned in a waterpipe smoking machine and main and sidestream smoke analysed by standard methods and (3) the air quality of six waterpipe cafés was assessed by measurement of CO, particulate and nicotine vapour content. Results We found considerable variation in heavy metal content between the three products sampled, one being particularly high in lead, chromium, nickel and arsenic. A similar pattern emerged for polycyclic aromatic hydrocarbons. Smoke emission analyses indicated that toxic byproducts produced by the combustion of ‘herbal’ shisha were equivalent or greater than those produced by tobacco shisha. The results of our air quality assessment demonstrated that mean PM2.5 levels and CO content were significantly higher in waterpipe establishments compared to a casino where cigarette smoking was permitted. Nicotine vapour was detected in one of the waterpipe cafés. Conclusions ‘Herbal’ shisha products tested contained toxic trace metals and PAHs levels equivalent to, or in excess of, that found in cigarettes. Their mainstream and sidestream smoke emissions contained carcinogens equivalent to, or in excess of, those of tobacco products. The content of the air in the waterpipe cafés tested was potentially hazardous. These data, in aggregate, suggest that smoking ‘herbal’ shisha may well be dangerous to health.