Effects of shisha smoking on carbon monoxide and PM2.5 concentrations in the indoor and outdoor microenvironment of shisha premises.

There has been significant rise in shisha premises in the United Kingdom with an unsubstantiated belief that shisha smoking is harmless and relatively safe. This study aimed to assess the public health situation by evaluating the extent of shisha environmental tobacco smoke (ETS) exposure among those that work in, and are customers of shisha businesses. Concentrations of several ETS pollutants such as carbon monoxide (CO) and particulate matter with a diameter of less than 2.5μm (PM2.5) in shisha premises were measured using real-time sensors inside and outside twelve shisha premises and at 5 pubs/restaurants where smoking is prohibited. Mean concentration of CO (7.3±2.4mg/m(3)) and PM2.5 (287±233μg/m(3)) inside active shisha premises was higher than concentrations measured within the vicinity of the shisha premises (CO: 0.9±0.7mg/m(3) and PM2.5: 34±14μg/m(3)) and strongly correlated (PM2.5 R=0.957). Concentrations were higher than indoor concentrations in pubs and restaurants where smoking is not permitted under UK law. The number of shisha pipes was a strong predictor of the PM2.5 concentrations. The study also assessed the risk perception within patrons and managers, with only 25% being aware of the risks associated to shisha smoking. The study identifies owners, employees and consumers within active shisha premises being exposed to concentrations of CO and PM2.5 at levels considered hazardous to human health. The results and outcome of this research serve as a basis to influence a discussion around the need of developing specific policies to protect consumers and employees of such premises.