Elevated carbon monoxide levels among hookah and alcohol concurrent users

Despite evidence confirming the harmfulness of hookah tobacco smoking, this behavior remains popular among young adults. Additionally, young adults often combine hookah smoking with alcohol use. No known study has examined if the combination of these two behaviors results in increased negative effects. Therefore, the purpose of this pilot study was to examine the relationship between hookah and alcohol use among young adults. Between midnight and 4:00AM on a Friday night, researchers recruited patrons exiting hookah smoking establishments to complete a brief survey and submit carbon monoxide (CO) and breath alcohol concentration (BrAC) readings. A total of 66 hookah bar patrons (Mean Age=21.42, 22.7% female) participated in the study. Among the total sample, 39.4% reported consuming alcohol including 43.3% of those under the age of 21. When comparing CO levels of those who reported both hookah and alcohol use (Mean CO=44.08 ppm, SD=23.37) with those who reported only smoking hookah (Mean CO=30.24 ppm, SD=24.37), combined users had significantly higher CO levels (t(64)=-2.34, p=0.022). After removing 0.00 BrAC readings from the sample, CO and BrAC were not correlated (r=.155, p=0.460, n=25), however, this may be due to small sample size. The link between alcohol use and increased CO among hookah smokers warrants concern. Additionally, this connection between hookah and alcohol is not limited to young adults who are of legal drinking age, but also underage individuals. Understanding the extent of the effects of hookah and alcohol concurrent use may aid in decreasing the negative health impacts caused by these two behaviors.