Opportunistic Insights into Occupational Health Hazards Associated with Waterpipe Tobacco Smoking Premises in the United Kingdom

Background: Smokefree laws aim to protect employees and the public from the dangers of secondhandsmoke. Waterpipe premises have significantly increased in number in the last decade, with anecdotal reports ofpoor compliance with the smokefree law. The literature is bereft of information pertaining to waterpipe premiseemployees. This study aimed to opportunistically gather knowledge about the occupational health hazardsassociated with working in waterpipe premises in London, England. Materials and
Methods: Employees fromseven convenience-sampled, smokefree-compliant waterpipe premises in London were observed for occupationalactivities. Opportunistic carbon monoxide (CO) measurements were made among those with whom a rapport haddeveloped. Observations were thematically coded and analysed.
Results: Occupational hazards mainly includedenvironmental smoke exposure. Waterpipe-serving employees were required to draw several puffs soon afterigniting the coals, thereby providing quality assurance of the product. Median CO levels were 27.5ppm (range21-55ppm) among these employees. Self-reported employee health was poor, with some suggestion that workingpatterns and smoke exposure was a contributory factor.
Conclusions: The smokefree law in England does notappear to protect waterpipe premise employees from high levels of CO. Continued concerns surrounding chronicsmoke exposure may contribute to poor self-reported physical and mental wellbeing.