Biomarkers of Secondhand Smoke Exposure in Waterpipe Tobacco Venue Employees in Istanbul Moscow and Cairo
Background: Most smoke-free legislation to reduce secondhand smoke (SHS) exposure exempts waterpipe (hookah) smoking venues. Few studies have examined SHS exposure in waterpipe venues and their employees. Methods: We surveyed 276 employees of 46 waterpipe tobacco venues in Istanbul Moscow and Cairo. We interviewed venue managers and employees and collected biological samples from employees to measure exhaled carbon monoxide (CO) hair nicotine saliva cotinine urine cotinine urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and urine 1-hydroxypyrene glucuronide (1-OHPG). We estimated adjusted geometric mean ratios (GMR) of each SHS biomarker by employee characteristics and indoor air SHS measures. Results: There were 73 nonsmoking employees and 203 current smokers of cigarettes or waterpipe. In nonsmokers the median (interquartile) range concentrations of SHS biomarkers were 1.1 (0.2 40.9) mu g/g creatinine urine cotinine 5.5 (2 15) ng/mL saliva cotinine 0.95 (0.36 5.02) ng/mg hair nicotine 1.48 (0.98 3.97) pg/mg creatinine urine NNAL 0.54 (0.25 0.97) pmol/mg creatinine urine 1-OHPG and 1.67 (1.33 2.33) ppm exhaled CO. An 8-hour increase in work hours was associated with higher urine cotinine (GMR: 1.68 95% CI: 1.20 2.37) and hair nicotine (GMR: 1.22 95% CI: 1.05 1.43). Lighting waterpipes was associated with higher saliva cotinine (GMR: 2.83 95% CI: 1.05 7.62). Conclusions: Nonsmoking employees of waterpipe tobacco venues were exposed to high levels of SHS including measurable levels of carcinogenic biomarkers (tobacco-specific nitrosamines and PAHs).