Air pollutants associated with smoking in indoor/outdoor of waterpipe cafes in Tehran, Iran: Concentrations, affecting factors and health risk assessment

Despite increasingly growth in waterpipe smoking in Tehran, so far no study has been conducted on the air quality of the waterpipe and cigarette cafes. Thirty-six cafes were selected and the concentration of three pollutants including formaldehyde, carbon monoxide and nicotine were measured in both indoor and outdoor air of cafes two times (week-day and weekend's session). Air sampling was performed for 180 min for each pollutant. It was observed that the concentration of pollutants inside the cafes was higher during weekend session (with a higher number of "active waterpipe heads") compared with findings during the week-day sessions. Furthermore, the concentration of pollutants in the indoor air of the cafes was significantly higher than that of the outdoors (p < 0.05). According to path analysis, the number of "active waterpipe heads" had the maximum impact on generation of pollutants inside the cafes, followed by the type of tobacco as the second influential factor. The average of lifetime cancer risk (LTCR) resulted by formaldehyde exposure through inhalation in waterpipe (WS), cigarette (CS), waterpipe and cigarette (WCS) and none-smoking (NS) cafes in week-day and weekend sessions were estimated to be 111 x 10(-5) and 61.2 x 10(-5), 33.7 x 10(-5) and 39.4 x 10(-5), 271 x 10(-5) and 322 x 10(-5), and 4.80 x 10(-5) and 5.90 x 10(-5), respectively, which exceed the limit value by the U.S.EPA and WHO. The concentration of pollutants in the indoor air of smoking cafes in Tehran is significantly high, such that it can pose serious risks for the health of both personnel and customers. Therefore, decision makers are expected to enact applicable and strict policies so as to abate this public health risk.