Secondhand Smoke Exposure in Water Pipe Venues in Turkey, Russia, and Egypt

Despite the successes of smoke-free legislation, tobacco control policies largely exempt water pipe venues. Compared to cigarettes, experimental studies suggest that water pipe secondhand smoke contains higher levels of nicotine, carbon monoxide (CO), and polycyclic aromatic hydrocarbons (PAHs). Our objective was to characterize airborne concentrations of secondhand smoke contaminants in water pipe venues and biomarkers of exposure in employees. In 2012-2013, we conducted cross-sectional surveys of water pipe venues and employees in Istanbul, Turkey and Moscow, Russia. Data from Cairo, Egypt is expected in March 2014. We enrolled 9 venues (71 employees) in Turkey and 17 venues (104 employees) in Russia. We collected air samples of nicotine, particulate matter (PM2.5), nicotine-derived nitrosamine ketone (NNK), CO, and particle-bound PAHs. Employee exposure was assessed via biomarkers in urine (cotinine, NNAL [a NNK metabolite], 1-hydroxypyrene glucuronide [1-OHPG; a PAH metabolite]), hair (nicotine), sali...