Objective The prevalence of waterpipe tobacco smoking has risen in recent decades. Controlled studies suggest that waterpipe secondhand smoke (SHS) contains similar or greater quantities of toxicants than cigarette SHS, which causes significant morbidity and mortality. Few studies have examined SHS from waterpipe tobacco in real-world settings. The purpose of this study was to quantify SHS exposure levels and describe the characteristics of waterpipe tobacco venues. Methods In 2012-2014, we conducted cross-sectional surveys of 46 waterpipe tobacco venues (9 in Istanbul, 17 in Moscow, and 20 in Cairo). We administered venue questionnaires, conducted venue observations, and sampled indoor air particulate matter (PM2.5) (N=35), carbon monoxide (CO) (N=23), particle-bound polycyclic aromatic hydrocarbons (p-PAHs) (N=31), 4-methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) (N=43), and air nicotine (N=46). Results Venue characteristics and SHS concentrations were highly variable within and between cities. Overall, we observed a mean (standard deviation (SD)) of 5 (5) waterpipe smokers and 5 (3) cigarette smokers per venue. The overall median (25th percentile, 75th percentile) of venue mean air concentrations was 136 (82, 213) μg/m3 for PM2.5, 3.9 (1.7, 22) ppm for CO, 68 (33, 121) ng/m3 for p-PAHs, 1.0 (0.5, 1.9) ng/m3 for NNK, and 5.3 (0.7, 14) μg/m3 for nicotine. PM2.5, CO, and p-PAHs concentrations were generally higher in venues with more waterpipe smokers and cigarette smokers, although associations were not statistically significant. Conclusion High concentrations of SHS constituents known to cause health effects indicate that indoor air quality in waterpipe tobacco venues may adversely affect the health of employees and customers.

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Smoke-free regulation should be extended to waterpipe venues to protect nonsmoking employees and patrons from the adverse health effects of SHS.

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INTRODUCTION Smoking prevalence in Russia is one of the highest in the world. It leads to significant damage to the National Health Service. The purpose of the present research was to assess the effectiveness of a qualified smoking-cessation (SC) center in Moscow, and to identify the main determinants of smoking cessation. METHODS The subjects of this study were a cohort of smokers (n=524) who had attended the SC service in Moscow between 2012-2015. They were followed, for at least 6 months after receiving the professional counselling in smoking cessation, to assess the results of the assistance and to identify determinants of successful smoking cessation. RESULTS Of the smokers, 19% succeeded in reducing by more than half the number of smoked cigarettes, more than 46% of patients completely stopped smoking for different terms: 38% for more than a month and 24% for more than half a year. Odds ratios (ORs) indicated that the probability of successful smoking cessation significantly increased if there was a previous success in smoking cessation: OR 3.71 (95% CI 1.70-8.12); and if there was a high level of motivation to stop smoking OR 4.3 (95% CI 1.92-5.61). The probability of successful smoking cessation decreased with intensity of smoking > 10 cigarettes a day: OR 0.57 (95% CI 0.31-1.02); and an elevated (>7 points) Fagerström-test score OR 0.64 (95% CI 0.37-1.07). CONCLUSIONS Degree of motivation and willingness to quit smoking were the principal determinants of the effectiveness in the attempt to quit smoking within our study cohort.