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Hookah Habit Not So Cool, New Research


Hookah use is up among young people while cigarette smoking is down. What should you know about hookah use and its health impact?


(Updated November 17, 2013) A new report from the Centers for Disease Control and Prevention (CDC) notes that while cigarette smoking is down among young people, hookah and electronic cigarette smoking is up. The CDC evaluated data from the 2012 National Youth Tobacco Survey and reported that hookah use (at least once a month) among high school students was 5.4 percent, an increase from 4.1 percent in 2011.

If you smoke tobacco using a water pipe known as a hookah, the habit may look cool, but looks are deceiving. Researchers found that young adults who engage in the hookah habit are exposing themselves to an array of dangerous toxins.

What a hookah has that cigarettes don’t

A hookah is a water pipe that uses charcoal to heat and burn specially treated and flavored tobacco. The hookah habit is especially popular among the college aged crowd, as a previous study noted that 17.4 percent of surveyed students said they actively used hookahs.

A hookah consists of a chamber for smoke, a bowl that holds tobacco, a pipe, and a hose. Tobaccos burned in hookah are soaked in flavorings, such as mint or chocolate. When you inhale the flavored smoke through the mouthpiece and hose, the smoke is cooled by water, which makes it less irritating than cigarette smoke.

But less irritating does not mean less dangerous. In a new study conducted at the University of California San Francisco (UCSF), investigators measured the amount of chemicals in the urine and blood of 8 male and 5 female hookah smokers who also had experience smoking cigarettes.

The volunteers participated in a number of comparative tests consisting of either an average of three hookah sessions or smoking 11 cigarettes per day, but on different days. Here’s what the investigators found when they evaluated the urine and blood samples.

  • Hookah use exposed smokers to higher levels of carbon monoxide than did cigarettes. Carbon monoxide is especially dangerous for anyone who has a respiratory or heart condition
  • Levels of carbon monoxide over 24 hours in the breath of the volunteers was 2.5 times higher after they used the hookah compared with after smoking cigarettes
  • Hookah use exposed smokers to higher levels of benzene, a volatile organic compound (VOC) that is a risk factor for leukemia
  • Hookah smokers are exposed to less nicotine than are cigarette smokers
  • Hookah users are exposed to different chemicals because they are smoking more than just tobacco. According to Jacob, among hookah smokers “the heat causes chemical reactions in the mixture which produce toxic volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs).” PAHs are cancer-causing substances linked to lung cancer.

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Among the other VOCs in hookah smoke are acrylamide, which causes nervous system damage; and acrolein, which irritates the throat, eyes, and nose. One of the PAHs in hookah smoke is naphthalene, which damages red blood cells.

According to UCSF tobacco researcher Neal Benowitz, MD, one of the study’s authors, compared to non-smokers, “If you are smoking from a hookah daily, you are likely to be at increased risk for cancer.”

Also Read:
What Is the Hoopla about Hookah?
Hookah Use Raises Carbon Monoxide Levels, Cardiac Risk

In a previous study conducted at the University of Florida College of Public Health, investigators tested the carbon monoxide levels from 173 hookah café patrons and 198 patrons of traditional bars where smoking was allowed. They found that hookah patrons had an average carbon monoxide level of 30.8 parts per million (ppm; some higher than 90 ppm) compared with an average of 8.9 ppm from traditional bar patrons.

Using a hookah is a popular habit among college aged and young adults, but users should beware. Although the water pipe may cool the smoke, the hookah habit itself is not cool and poses significant health risks.

Barnett TE et al. Carbon monoxide levels among patrons of hookah cafes. American Journal of Preventive Medicine 2011 Mar; 40(3): 324-28
Centers for Disease Control and Prevention news release
Jacob P et al. Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking. Cancer Epidemiology, Biomarkers and Prevention 2013 April 15
University of California San Francisco news release

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