The popularity of hookah in the United States has increased over the past two decades. It is a social experience, which may have additional appeal to teens and young adults who are looking to have “grown-up” experiences with their peers. Among hookah users, there are many misconceptions about hookah, chief among them that it is less harmful than cigarette smoking.1 In 2013, 42.1 percent of high school students in Florida said that, compared to cigarette smoking, water pipe/hookah smoking is less harmful.2Indeed it’s invention centuries ago was born out of the desire to find a less harmful way of smoking tobacco.3 We’ve learned a lot about tobacco smoke since those days, and we now know that hookah smoking is damaging to health.4 Of particular concern is the length of a session. While a cigarette usually takes 5-7 minutes to smoke, hookah sessions last much longer. During a one hour long session, it is estimated that a hookah user can inhale the equivalent of 100 or more cigarettes.5 Parents, talk to your kids about the dangers of hookah. Studies have shown that parental attitudes, opinions, and feelings about their kids’ tobacco use greatly influence whether or not their kids will use tobacco. More facts about hookah are listed below.
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What is a hookah?
- A hookah is a water pipe that is used to smoke tobacco, mostly containing flavors such as apple, mint, and peach. The hookah has been in use for more than four centuries, and originated in Africa and Asia. A hookah resembles a water-filled vase.
- Tobacco is placed in a small bowl at the top with charcoal placed above it, usually separated by aluminum foil. A small flexible pipe extends from the side of the vase.
- As a hookah user inhales through that pipe, a vacuum pulls the heat from the charcoal through the tobacco, which is ignited, and creates smoke that then travels through a tube into the water, and back through the pipe into the smoker’s body.
Is hookah a safe alternative to smoking?
- It is a troubling and common misconception that hookah is less harmful than cigarette smoking.6 A 2009 study found the majority of hookah users (58.3 percent) believe hookah is less harmful than cigarette smoking.7
- The unique way hookah is used, actually makes it more harmful in some ways. The heating element, typically wood cinders or charcoal, produce their own toxic chemicals in addition to those in the tobacco.8,9
- The concentration of cancer causing additive substances may be equivalent to that in cigarettes, but hookah smokers are additionally exposed to the carcinogenic (cancer-causing) effect of hydrocarbons and heavy metals in the charcoal.10
- The pipe used to inhale the smoke is also often passed around the group, exposing users to serious risk of transmission of communicable diseases like hepatitis and tuberculosis. 11
What are some health concerns related to hookah?
- Hookah users and non-smokers inhaling the secondhand smoke are exposed to high levels of carbon monoxide, heavy metals and cancer causing chemicals.12,13
- Levels of exhaled carbon monoxide (a toxin) from hookah users were twice as high as cigarette smokers. 14
- The tobacco used in hookah contains numerous toxic compounds known to cause lung cancer, heart disease and other diseases. 15
- There is some evidence that hookah smoking causes chromosomal damage. 16
- Gum disease has been reported to be five times more common in hookah smokers than in cigarette smokers. 17
- Additionally, secondhand smoke from hookah is a mixture of tobacco smoke and smoke from the heating elements, typically wood chips or charcoal, and poses a risk for non-smokers. 18
Is hookah use addictive?
- The tobacco used in hookah contains nicotine, which is highly addictive, perhaps leading to greater receptivity to other tobacco products including cigarettes.
- In fact, hookah smoke contains 36 times the amount of nicotine compared with cigarettes.19,20
What are the concerns regarding hookah use among youth?
- Hookah remains a concern in Florida as there has not been any significant decrease in the use of hookah among Florida’s high school students in recent years.
- In 2013, 8.2 percent of Florida high school students reported current hookah use, which is the same as 2010. 21
- In 2013, 16.7 percent of high school students had ever tried smoking hookah, compared to 16.6 percent in 2010.22
- Flavored tobacco, and the nature of the water-diffused mechanism, may make the smoking sensation less harsh than cigarettes, offering an appealing gateway to other cigarette product use.23
What are the concerns regarding hookah use among young adults?
- There is currently greater availability of hookah near college campuses than ever before.24,25
- In one study, which sampled college students from eight universities in one U.S. state; 40.3 percent of the sample reported ever using hookah and 17.4 percent of the students reported current (past 30 day) hookah use.26 Many hookah smokers also reported cigarette use. 27
- A 2013 University of Florida survey found seven hookah venues in the community surrounding the college campus. Among the students, hookah smoking was more prevalent than cigarette smoking for ever use (46.4 percent vs. 42.1 percent) and past year use (28.4 percent vs. 19.6 percent).28 According to this study, in Gainesville, the availability of hookah is high enough to provide the first known study in which ever use and past year use of hookah surpassed that of cigarette smoking in a U.S. university student population.
1Aljarrah K, Ababneh Z, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacco Induced Diseases, 2009, 5:16
2Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2013
3Chattopadhyay A. Emperor Akbar as a healer and his eminent physicians. Bulletin of the Indian Institute of the History of Medicine, 2000, 30:151-158.
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5 Shihadeh A et al. Towards a topographical model of narghile water-pipe café smoking: a pilot study in a high socioeconomic status neighborhood of Beirut, Lebanon. Biochemistry, Pharmacology, and Behavior, 2004, 79(1):75-82
6 Aljarrah K, Ababneh Z, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacco Induced Diseases, 2009, 5:16
7Aljarrah K, Ababneh Z, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacco Induced Diseases, 2009, 5:16
8Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food and Chemical Toxicology, 2003, 41:143-152.
9Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, tar, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food and Chemical Toxicology, 2005, 43(5):655-661.
10Gatrad R, Gatrad A, Sheikh A. Hookah smoking. BMJ British Medical Journal, 2007, 335(7609): 20.
11Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 2005, 116(1):e113-e119
12 Maziak W et al. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control, 2004, 13:327-333
13Sajid KM, Akhter M. Malik GQ. Carbon monoxide fractions in cigarette and hookah (hubble bubble) smoke. Journal of the Pakistan Medical Association, 1993, 43(9):179-182.
14Jackson D, Aveyard P. Waterpipe smoking in students: prevalence, risk factors, symptoms of addiction, and smoke intake. Evidence from one British university. BMC Public Health, 2008, 8:174.
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16Yadev JS, Thakur S. Genetic risk assessment in hookah smokers. Cytobios 2000;101:101-3. [PubMed]
17Natto S, Balijoon M, Bergström J. Tobacco smoking and periodontal health in a Saudi Arabian population. J Periodontol 2005;76:1919-26.
18Maziak W et al. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control, 2004, 13:327-333
19Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food and Chemical Toxicology, 2003, 41(I): 143-152
20Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, tar, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food and Chemical Toxicology, 2005, 43(5):655-661.
21Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2013
22Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2013
23Rastam S et al. Estimating the beginning of the waterpipe epidemic in Syria. BMC PublicHealth, 2004, 4:32
24Eissenberg, T., Ward, K. D., Smith-Simone, S., & Maziak, W. (2008). Waterpipe tobacco smoking on a U.S. College campus: Prevalence and correlates. Journal of Adolescent Health, 42(5), 526-529.
25Primack, B. A., Walsh, M., Bryce, C., & Eissenberg, T. (2009). Water-pipe tobacco smoking among middle and high school students in Arizona. Pediatrics, 123(2), e282-288.
26Sutfin E, McCoy T, Reboussin B, Wagoner K, Spangler J, Wolfson M: Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina. Drug Alcohol Depen 2011, 115:131-136.
27Barnett TE, Curbow BA, Soule EK, Tomar SL, Thombs DL: Carbon monoxide levels among patrons of hookah cafes. Am J Prev Med 2011, 40:324-328.
28Barnett T, et al. Evidence of emerging hookah use among university students: a cross-sectional comparison between hookah and cigarette use. BMC Public Health, 2013, 13:302