Bamboo tobacco water pipe smoking, environmental exposures on lung function and respiratory health in rural Laos PDR

Respiratory health is closely linked to air quality. Globally, poor indoor and outdoor air quality create immense public health burden of disease and disability that is most evident in rural regions of low and middle income nations. To date, Southeast Asia (SEA) boasts a number of emerging economies; however, rapid economic growth comes at a cost, and environmental pollution, especially air pollution, and tobacco use remain obvious threats to health. In rural SEA, a paucity of health data adds to the present problem that includes community level risk factors that include indoor cooking fire smoke, domestic dust-dirt exposure, and agricultural animal handling. Individual risk factors for respiratory disease such as an unstudied form of tobacco use known as "bamboo water pipe smoking" is prevalent in rural SEA and considered socially acceptable (Centers for Disease Control & World Health Organization, 2010); however, the exposure to carbon monoxide and health risks from its use remains unknown. This form of water-filtered tobacco use may produce byproducts of combustion that might affect respiratory health and lung function, and if it does, is without evidence. Prior studies of water-filtered smoking include the Eastern Mediterranean tobacco water pipe (i.e. hookah) and indicate that high levels of carbon monoxide inhaled by the smoker. Notably, myths or beliefs attributed to the safety of a tobacco water-bath filtered smoke have been unsupported.;In the presented dissertation, I continue the assessment of water-filtered tobacco smoke and present two studies that include the first in-field investigation of bamboo water- pipe use, carbon monoxide exposure, and lung function using a sample of rural adult males from Laos PDR. In my first study, I examine carbon monoxide exposure in bamboo water pipe smokers in assessing water-filtered tobacco smoke. In my second study, I report findings from the first lung function (spirometry) assessment of bamboo water pipe smokers of rural Laos PDR. Findings of both my studies indicate that 1) water-filtered bamboo water pipe smoking does not remove carbon monoxide prior to inhalation; 2) bamboo water pipe use produces compatible carbon monoxide to cigarette use; 3) bamboo water pipe use may harm lung function; and 4) community level risk factors in rural areas of Southeast Asia (i.e. cooking fire smoke) may be harmful to health. Further studies are warranted to evaluate the health effects from bamboo water pipe use and community level risk factors in rural areas of Southeast Asia.