Waterpipes - hookahs - create hazardous concentrations of indoor air pollution and poses increased risk from diminished air quality for both employees and patrons of waterpipe bars, according to a new paper from Johns Hopkins, which did an analysis of air quality in seven Baltimore waterpipe bars and found that airborne particulate matter and carbon monoxide exceeded concentrations common in public places that allowed cigarette smoking. Air nicotine was markedly higher than in smoke-free establishments. 

Because campaigns against smoking are funded by money levied by taxes on cigarette companies, tobacco-related research and tobacco control efforts in the United States have focused on cigarettes.

In other countries, other forms of tobacco use, such as hookah bars, are popular, and they have have grown in popularity among the hipster community in the U.S. For that reason, the scholars surveyed seven waterpipe cafes in Baltimore, Maryland, from December 2011 to August 2012. They measured carbon monoxide levels, airborne nicotine content and respirable particulate matter with a mean particle diameter of less than 2.5 microns (PM2.5). A micron is approximately 1/30th the width of a strand of human hair.

"There is a mistaken notion that tobacco smoking in a water pipe is safer than cigarettes," said Patrick Breysse, PhD, professor in the Department of Environmental Health Sciences and the study's senior author. "Our results suggest that this is not the case. Our study found that waterpipe smoking creates higher levels of indoor air pollution than cigarette smoking, placing patrons and employees at increased health risk from secondhand smoke exposure."

Indoor airborne concentrations of PM2.5 and carbon monoxide were markedly elevated in Baltimore waterpipe cafes, confirming that waterpipe smoking severely affects indoor air quality. Air nicotine concentrations, although not as high as in hospitality venues that allow cigarette smoking, were also elevated and markedly higher than levels previously found in smoke-free bars and restaurants. Some of these measurements consistently exceeded air quality standards set by the U.S. Environmental Protection Agency and the World Health Organization.

"Public education efforts need to be developed to educate users about the hazards of water pipe use and tobacco control policies need to be strengthened to include water pipes," said Christine Torrey, BA, senior research specialist in the Department of Environmental Health Sciences and the study's lead author.