Ali Al-Bakri, Mohammed Jawad, Mustafa al’Absi, Pascal Salameh, Saba Kassim, Opportunistic insights into occupational health hazards associated with the waterpipe tobacco industry in the United Kingdom

Introduction  Waterpipe tobacco smoking (WP) is getting popular in Europe with negative health effects and occupational health hazards (1)  200% increase in WP premises between 2007 and 2012 in the UK (over 400 in London) (2,3)  WP under Smoke free laws in the UK but poor compliance (3)  No study in occupational health hazard of employees in WP premises !

Methodology  Primary study about investigating WP dependency in customers in 7 WP premises (6)  During data collection, researcher (AA) observed and interacted culturally with premises staff  Another researcher (MJ) interviewed the data collector (AA) to explore the participant observation experience (4-5).  Exhaled Carbon Monoxide (CO) taken from 9 staff members  Study approved by QMUL ethics committee

WP premisesEmployee types CO (ppm)COHb (%) 1Serving WP Serving food Serving WP Serving food Serving WP Serving food 41.2 CO: carbon monoxide, ppm: part per million, COHb (%): percentage of Carboxyhemoglobin

 Arabic culture embodiment in WP premises  Smoke free laws were perceived as an attack to the Middle Eastern Culture  Occupational health hazards noticed (i.e. igniting and cleaning WP, walking and moving holder)  Self reported deteriorating physical health since working in WP premises  Self reported mental health problems of staff (i.e. stress, long working hours, lack of educational and professional development)

“Dr, if you want to do research, please do research on us [WP premise employees]. We have lots of difficulties, mainly financial ones because our payment is not good, and we always work with smoke. I sometimes feel scared when I think about my future in 20 years and how this smoke will affect my health”.

Discussion  First study to investigate occupational health hazards in WP premises in the UK.  Previous Studies measured CO in WP premises (7-9)  Comparable results in studies measuring exhaled CO in patrons of WP premises (10)  Igniting WP and greatest increase in COHb in first 5 mins of smoking (11)  First 5 minutes of WP session produce different size of particles (12)

Future research  Investigating occupational health hazards of WP premises in a larger scale  Investigating the exhaled CO of the staff during different time in their shifts

Conclusion  High level of CO identified in WP-serving staff  Occupational, physical and mental problems associated with working in WP premises  Future research to investigate the occupational risks including second-hand smoking in WP premises.

References 1- MAZIAK, W The global epidemic of waterpipe smoking. Addict Behav, 36, British Heart Foundation (BHF). (2012). Rise in ‘shisha bars’ prompts warning on dangers of waterpipe smoking [online]. Available at: [Date of access 29 June 2013]. from Jawad, M. (2014). Legislation Enforcement of the Waterpipe Tobacco Industry: A Qualitative Analysis of the London Experience. Nicotine & Tobacco Research. doi: /ntr/ntu Kawulich, Barbara B. (2005). Participant Observation as a Data Collection Method [81 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 6(2), Art. 43, 5- Pearson Educaton ( ). Participant Observation [online]. Available at Date of access 25 May Kassim, S., Al-Bakri, A., al’Absi, M., & Croucher, R. (2014). Waterpipe Tobacco Dependence in U.K. Male Adult Residents: A Cross-Sectional Study. Nicotine & Tobacco Research, 16(3), doi: /ntr/ntt Cobb, C. O. ;Vansickel, A. R. ;Blank, M. D. ;Jentink, K. ;Travers, M. J. ;Eissenberg, T. Indoor air quality in Virginia waterpipe cafes Tob Control. 2013; 22: Zhang, B. ;Haji, F. ;Kaufman, P. ;Muir, S. ;Ferrence, R. 'Enter at your own risk': a multimethod study of air quality and biological measures in Canadian waterpipe cafes Tob Control 9- Torrey, C. M. ;Moon, K. A. ;Williams, D. A. ;Green, T. ;Cohen, J. E. ;Navas-Acien, A. ;Breysse, P. N. Waterpipe cafes in Baltimore, Maryland: Carbon monoxide, particulate matter, and nicotine exposure J Expo Sci Environ Epidemiol 10- Barnett TE, Curbow BA, Soule EK, et al. Carbon monoxide levels among patrons of hookah cafes. Am J Prev Med. 2011;40: Monn C, Kindler P, Meile A, et al. Ultrafine particle emissions from waterpipes. Tob Control. 2007;16: Chaouachi K. Hookah (shisha, narghile, "water pipe") indoor air contamination in German unrealistic experiment. Serious methodological biases and ethical concern. Food Chem Toxicol. 2010;48:992-5; author reply 6-7.

 Special thanks for Peninsula Dental School for funding my participation  The contribution of the owners and staff of the WP premises in the study is appreciated

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