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What is the Hoopla about Hookah?


A growing number of young adults are turning to hookah smoking, a waterpipe that uses charcoal to heat specially treated tobacco and which produces smoke that is less irritating than cigarette smoke. Although this habit may sound less harmful than smoking cigarettes, some experts warn that hoopla about hookah is warranted.

Smoke from a hookah is flavored

Researchers at Wake Forest Baptist Medical Center studied the growing trend of hookah use and hookah bars by conducting a web-based survey involving 3,770 students from eight North Carolina colleges and universities. The young adults were questioned about their smoking and drug habits and their knowledge about these activities.

Among the students surveyed, 46.6 percent said they had ever smoked cigarettes, and 40.3 percent said they had ever smoked tobacco from a hookah. Current cigarette smokers made up 25 percent of the survey group, and 17.4 percent said they actively used hookahs. Males and freshmen were the groups more likely to use the waterpipes.

The researchers observed a relationship between individuals who smoked tobacco from a hookah and those who also smoked cigarettes and/or marijuana, had a history of using other illegal drugs, and had consumed alcohol within 30 days of the survey. Generally, hookah users also tended to believe that using a hookah was less harmful to their health than smoking cigarettes.

In fact, “many young adults are misinformed about the safety of hookah smoking and some mistakenly believe it to be safer than cigarette smoking,” noted Erin L. Sutfin, PhD, assistant professor in the Department of Social Sciences and Health Policy and the study’s lead author.

A hookah consists of a smoke chamber, a bowl that holds the tobacco, a pipe, and a hose. The tobaccos used in a hookah have been soaked in flavorings, such as honey, molasses, mint, or even chocolate. To smoke a hookah, you inhale the flavored smoke from a mouthpiece that is attached to the rubber hose. The smoke is less irritating than cigarette smoke because it is cooled by water before it travels through the hose.

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Sutfin noted that 22 percent of the survey’s participants who said they used a hookah had never smoked a cigarette, which suggests hookahs may be their first experience with tobacco. She warned that hookah users “may inhale more deeply over a longer period of time” because of the pleasant taste and aroma of the smoke.

This habit can leave hookah smokers inhaling more tobacco smoke than they would if smoking cigarettes, thus increasing their health risks. As with cigarette smoking, hookah use increases the risk of lung cancer, respiratory disorders, periodontal disease, and low birth weight among women who use hookah while pregnant.

Thus far, studies show that hookah smoke contains high levels of tar, carbon monoxide, heavy metals, and cancer-causing substances. Individuals who use a hookah are exposed to more carbon monoxide and smoke than are cigarette smokers, but both groups of smokers are exposed to about the same amount of nicotine.

The Wake Forest study also found that students who go to college within 10 miles of a hookah café or other venue are more likely to use the waterpipe. Although this study was conducted before North Carolina’s ban on tobacco smoking in restaurants and bars went into effect, Sutfin explained that hookah establishments can circumvent the ban; for example, by not serving alcohol or food.

The study’s authors point out that their study is important because it highlights the increasing use of hookahs and the need for college administrators and states to include hookahs in their smoke-free and tobacco-free policies.

Is the hoopla about hookahs warranted? Sutfin noted that “Hookah cafes create the perception that this is a safe activity. It is not.” In addition to the smoke-related health issues, use of hookah pipes in public places may expose users to improperly cleaned pipes, which increases the chances of spreading infectious diseases.

Sutfin EL et al. Drug and Alcohol Dependence 2011;
doi: 10.1016/j.drugalcdep.2011.01.018