Risk assessment of exposure to heavy metals from hookah consumption in Turkiye

Hookah, also known as a water pipe, is a popular form of tobacco smoking and one of the most widely used nicotine-containing products in Asia and Africa today, particularly in Turkiye. As hookah use among adolescents is increasing globally, health problems associated with exposure to high concentrations of heavy metals are also becoming more significant. Therefore, the amount of heavy metals in the fresh and waste tobacco flavours (cola, dominic, gum, two apples and cranberry melon) and in the wastewater of hookahs, which are most commonly used in hookah cafes in Turkiye, were analysed using inductively coupled plasma mass spectrometry (ICP-MS). Based on the heavy metal results obtained, a risk assessment was conducted using best-case and worst-case scenarios to evaluate the health risks that may arise from exposure through inhalation and oral exposure. A risk assessment has revealed that, in the worst-case scenario, the levels of non-carcinogenic metals such as cobalt, antimony, copper and lead found in tobacco flavours pose a risk, while, in the best-case scenario, lead and copper pose a risk. The presence of risk is a consequence of aluminium in both scenarios.