Hookah, a water pipe used to smoke flavored tobacco, is a popular alternative to e-cigarettes and other tobacco products. Smoking hookah is a social event, often done in a group with friends. Because of its popularity, there are now hookah bars all across the United States. In New York City, there are over 140.

At the hookah bars, there are regular customers who may come in a few hours a week with friends to get their fix. But the employees at the hookah bars are exposed to the smoke forty or more hours a week. This constant smoke inhalation is bound to have adverse health effects.

A recent study published in Tobacco Control and led by researchers from New York University’s College of Global Public Health and Langone, tested exactly what these effects are. They ran tests on ten employees of hookah bars after they were done one shift. They found that the employees had high levels of toxins, similar to cigarette smokers. Twenty percent of the participants had 90 parts per million of carbon monoxide, which is significantly high. There were also higher levels of inflammation detected.

Although tobacco smoke is banned in public venues in New York City, Hookah use is sometimes exempt from air laws.