Association between breath alcohol concentration and waterpipe lounge patrons' carbon monoxide exposure: A field investigation

•Increased alcohol use was associated with greater smoke exposure among waterpipe (WP) smokers.•The relation was explained by time spent in the lounge.•Findings illustrate a need for research on the impact of alcohol use on WP smoking.

Background and aimsConcurrent alcohol use and waterpipe (WP) smoking is common among young adults. WP smokers are more than twice as likely to use alcohol as non-users and frequently consume alcohol immediately before and during a WP smoking session. It is unclear what impact alcohol has on WP smoking patterns and resultant exposure to tobacco-related toxicants. The current research aimed to understand the association between alcohol consumption and WP smoke exposure among WP lounge patrons.MethodsSeventy-one lounge patrons (66.2% male; Mage = 27.03, SD = 5.32) completed pre- and post-WP session self-report measures and biomarkers of smoking (expired carbon monoxide; eCO) and alcohol consumption (breath alcohol concentration; BrAC) upon entering and exiting the WP lounge.ResultsAfter controlling for number of bowls and charcoals smoked, greater consumption of alcohol was associated with greater smoke exposure among WP lounge patrons (p < 0.05), such that a 0.1 unit increase in BrAC was associated with an eCO increase of 19.44 ppm. This relationship was mediated by time spent in the WP lounge.ConclusionsConcurrent alcohol use resulted in greater eCO, likley due to participants spending a greater amount of time in the WP lounge and experiencing longer sustained exposure to secondhand smoke. These findings illustrate a need for further research on the impact of alcohol consumption on WP smoking to assess the potential need for regulation of these products in WP lounges.