Secondhand Water-pipe Smoking

Secondhand Water-pipe Smoking and its Correlation with Systemic Inflammation among Cafés Employees in Karachi, Pakistan



The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Water pipe (WP) with Neutrophils to Lymphocytes ratio and Platelets to Lymphocytes ratio.


A cross sectional survey was conducted among employees at cafés and restaurants of Karachi, where WP smoking facility is offered to consumers. A total of 200 participants were selected through convenience sampling, out of which 181 consented to participate. Participants were divided into exposed (to SHS) and unexposed groups.  Data were collected by using structured questionnaire, and blood samples were drawn to measure systemic inflammatory markers (Neutrophil to Lymphocyte ratio NLR, Platelet to Lymphocyte ratio PLR). Data was analyzed by using SPSS software.


Among the included 181 participants, 48.1% (n=87) were unexposed to SHS, 31.5% (n=57) were exposed to SHS of WP and 20.4% (n=37) were exposed to SHS of cigarette & WP. Mean NLR (P = 0.779) and mean PLR (P = 0.205) did not vary significantly according to exposure to SHS among participants. After adjusting for socio-demographic covariates, associated of NLR and PLR with exposure to SHS was also not found to have a statistical significance.


The study found no correlation between exposure to SHS of WP and systemic inflammation using different markers. However, the cross-sectional nature of data and uncontrolled confounding and relatively lower level of exposure in the study sites may potentially explain the overall findings of the study.

Key words:

Secondhand smoking, waterpipe smoking, cigarette, systemic inflammation, Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio

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