Measuring Indoor Air Quality of Hookah Lounges

Abstract

Many states have implemented smoke-free workplace laws to protect employees and customers from exposure to secondhand smoke. However, exemptions in these laws have allowed indoor tobacco smoking in hookah lounges to proliferate in recent years. To describe the amount of secondhand smoke in hookah lounges, we measured the indoor air quality of 10 hookah lounges in Oregon. Air quality measurements ranged from “unhealthy” to “hazardous” according to Environmental Protection Agency standards, indicating a potential health risk for patrons and employees.

Hookahs are pipes used to smoke flavored, sweetened tobacco. Hookah tobacco smoke contains tar, carbon monoxide and other toxins found in cigarette smoke, and in a typical hookah session, smokers inhale more than 40 times the volume of smoke produced by a cigarette.^1–3 Hookah lounges are businesses that provide an indoor environment for hookah smoking and sell hookah tobacco in dozens of candy and fruit flavors.⁴ Indoor smoking in hookah lounges can expose employees and customers to secondhand smoke. Many states have implemented comprehensive smoke-free workplace laws that protect employees and patrons from exposure to secondhand smoke.⁵ Whereas some laws ban all tobacco use, others include exemptions which have allowed hookah lounges to proliferate.^6,7

Tobacco smoke is a mixture of chemical compounds that are bound to aerosol particles or are free in the gas phase.⁸ The concentration of particulate matter in the air is a strong indicator of pollution from tobacco smoke. Studies have measured particulate matter from cigarette smoke in bars and restaurants that allow indoor smoking, revealing employees and customers were exposed to hazardous levels of air pollution.^9–11 Hookah smoke contains many of the same toxins as cigarette smoke^2,3 and has been associated with lung cancer, respiratory illness, low birth weight, and periodontal disease.¹² Laboratory studies have measured the chemical components of hookah smoke, and carbon monoxide levels have been measured in patrons exiting a hookah lounge.^1–3,13 However, no study to date has described the concentration of particulate matter in the air inside hookah lounges. This study fills a research gap by analyzing the air quality inside hookah lounges in Oregon.

METHODS

The study was conducted during July and August 2010. The study sample included all 10 indoor hookah lounges operating in Oregon during that time. Hookah lounges were identified through business records, Internet searches, and reports from county tobacco prevention programs. Indoor air quality measurements were recorded using a TSI SidePak AM510 Personal Aerosol Monitor (SidePak; TSI Incorporated, Shoreview, MN). This is a standard method for measuring indoor air pollution from tobacco smoking.^9–11 The SidePak measures particulate matter smaller than 2.5 microns in diameter (PM_2.5). Particles of this size are produced from combustion (such as burning hookah tobacco), are easily inhaled deep into the lungs, and are associated with premature death from heart and lung diseases.¹⁴

Hookah lounges were assessed at peak hours of operation on Fridays and Saturdays between 9:30 pm and 1:00 am. We concealed the SidePak in a bag or purse with the tube extended outside of the bag; concealing the SidePak in this manner did not affect measurements. To replicate the secondhand smoke exposure of patrons and employees in typical indoor hookah lounges, we obtained air quality measurements while walking through and standing in various areas of the hookah lounge and while sitting at tables where hookah use was occurring. Air quality measurements lasted an average of 30 minutes. To discriminate between the quality of outdoor ambient air and air within the hookah lounges, we began collecting air quality measurements prior to entering the hookah lounges and ceased collection after exiting the hookah lounges. Hookah lounge employees were not informed of the study so as to maintain the integrity of the air quality measurements. Study methods are described in detail elsewhere.⁴

Air quality measurements from hookah lounges were interpreted using the United States Environmental Protection Agency (EPA) Air Quality Index. The Air Quality Index categorizes outdoor PM_2.5 concentrations into levels ranging from “good” to “hazardous.”¹⁵ Other studies measuring air quality in indoor smoking environments have used the Air Quality Index to contextualize their results^9–11 because there are currently no government standards for indoor air quality.¹⁶

RESULTS

Peak PM_2.5 measurements for each of the 10 hookah lounges sampled are displayed in Table 1. Two hookah lounges had peak PM_2.5 measurements in the “hazardous” EPA air quality category, air in 4 hookah lounges was “very unhealthy,” and air in another 4 hookah lounges was “unhealthy.” None of the lounges had “good” air quality. The hookah lounge with the worst air quality had a concentration of PM_2.5 that was 50 times greater than the maximum threshold for “good” air quality (Figure 1). There was a notable difference in PM_2.5 levels between the air inside lounges and the air outside.

TABLE 1—

Peak PM_2.5 Measurements in 10 Oregon Hookah Lounges: 2010

Peak PM2.5 (μg/m3)	Level of Health Concerna	EPA Health Advisory for Outdoor Air Quality
750	Hazardous( ≥ 211 μg/m3)	People with heart or lung disease, older adults, and children should remain indoors and keep activity levels low. Everyone else should avoid all physical activity outdoors.
220
177	Very unhealthy (141–210 μg/m3)	People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.
172
166
156
117	Unhealthy (56–140 μg/m3)	People with heart or lung disease, older adults, and children should avoid prolonged or heavy exertion. Everyone else should reduce prolonged or heavy exertion.
83
76
67

Note. PM_2.5 = particulate matter < 2.5 μm in diameter.

^aAccording to the United States Environmental Protection Agency Air Quality Index.

FIGURE 1—

Indoor air quality in a hookah lounge: Oregon, 2010

Note. PM_2.5 = particulate matter < 2.5 μm in diameter. Dotted line indicates “good” air quality of PM_2.5 < 15μg/m³.

DISCUSSION

Our study found that the air inside hookah lounges contains high concentrations of particulate matter from tobacco smoke, with air quality ranging from “unhealthy” to “hazardous” by EPA standards. Air quality in these ranges is known to pose health risks to people with cardiovascular disease or lung disease, and to other vulnerable populations.¹⁵ These results clearly indicate that hookah lounges pose a potential health hazard for patrons as well as workers, who can be exposed to secondhand smoke on a daily basis for extended periods of time. This study did not account for factors such as open windows and doors in the hookah lounges, which may explain variation in air quality measurements between lounges. However, our findings indicate that unhealthy or hazardous air quality exists in hookah lounges under normal conditions.

Hookah lounges are allowed to exist in some states because of exemptions in clean indoor air laws.⁷ In Oregon, lounges operate under an exemption for smoke shops, which was instituted to allow customers of tobacco stores to sample products before purchasing them. Implementing indoor smoking bans without these exemptions would protect all patrons and employees from the harmful effects of secondhand smoke exposure. However, if exemptions in state laws do allow hookah lounges to operate, communities may be able to pass local ordinances that prohibit hookah lounges within their jurisdictions.¹⁷