Hookah Smoking is at Least as Bad as Cigarettes

By Staff Writer

Hookahs, also known as waterpipes, are devices that have been used in various regions of the world for the past four centuries to smoke specially made tobacco. The tobacco, which comes in a variety of flavors, is heated into smoke by charcoal embers, drawn through the body of the hookah through liquid at the bottom (usually water, but sometimes other substances), and out through a tube to a mouthpiece that is passed around by the participants.

Recently, hookahs have begun to grow in popularity in the U.S., and concerns have been raised about their health effects.

A common misconception is that because hookah tobacco, also known as shisha, is not directly burned and is drawn through water, it is not as dangerous as other forms of tobacco. However, although much research remains to be done, most experts agree that shisha is as dangerous as cigarette smoke, and may even pose some unique additional risks.

History

The hookah was originally invented in the late 1500s in the court of the Indian emperor Akbar as a way to smoke tobacco, which was then new to India, in a “pure” manner. The device quickly became popular among the Indian nobility and soon spread through Pakistan, Iran, and the Arab world, where it remains popular as a social centerpiece in coffee shops or at parties.

In the U.S., hookah lounges -- sometimes referred to as hookah bars or shisha bars -- have become hip in recent years, particularly in large cities, college towns, and multicultural areas. Many cities around the country have begun to impose indoor smoking bans, and because hookah bars can often obtain exceptions, they’ve become a way for people to socialize while smoking inside.

In the past, these bars catered mainly to immigrants from areas where hookahs are traditionally smoked, but the bars have more recently become popular among fashionable young people. In major cosmopolitan cities such as New York, Chicago, San Francisco, and Los Angeles, the same bars often serve alcohol or food from the Middle East or India. In most cases, the bars are run by people from the Muslim world, and they feature a heavily Arabic and Islamic decor.

Along with hookah bars, a parallel growth has occurred in home-based hookah smoking. Smoke shops and specialty stores are seeing a huge growth in hookah sales, and both hookahs and shisha are available to order through many websites.

Operation

A typical hookah has several main components: the head, the body, the water bowl (or jar), and the hose:

• The bowl, which is at the top, holds the tobacco to be smoked during the session.
• Atop the bowl is placed a thin screen, which holds the charcoal used to heat the tobacco to a temperature at which it will evaporate into smoke.
•  A central tube moves down from the bowl on top through the body to the jar below.
• In the jar, the central tube is submerged in water, which cools the smoke as it passes through.
• The smoke then rises into the pocket of air above the water, where the hoses are attached for the users to draw the cooled smoke through a mouthpiece.

Health Risks Compared to Cigarettes

In a typical hookah-smoking session, the user may inhale as much as 100-200 times more smoke than is inhaled from a single cigarette. Because the shisha smoke is cooled by the water, smokers may get the false impression that the smoke is safe, but in fact the cooling element does almost nothing to reduce the negative effects of tobacco smoke. It’s also untrue that the water removes harmful chemicals.

Hookahs have also been associated with the following health risks and concerns:

• According to the American Lung Association, hookah users exhibit high levels of nicotine in the blood after a single session of hookah smoking. Nicotine, a mild stimulant, is the main chemical responsible for tobacco addiction, which means that hookahs are just as addictive, if not more so, than cigarettes or cigars.
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• Because hookah smoking sessions tend to last a long time—up to 45 minutes or an hour—and involve deep inhalations and frequent puffing, a single smoking session can expose the hookah user to large amounts of highly concentrated toxins and carcinogenic substances over the course of a single session.
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• Again, the fact that hookah smoke is cooled leads many uninformed users to believe that the smoke is not as carcinogenic as smoke from cigars or cigarettes. This is simply not true. The cancer risk from tobacco is caused primarily from chemicals in the smoke, rather than the heat or the burning. Thus, hookah smoke is just as likely as cigarette smoke to contribute to lung cancer, oral cancer, or esophageal cancer. Meanwhile, there are the other risks that typically go along with tobacco smoke, including pulmonary disease, cardiovascular disease, oral problems, increased risk of tuberculosis, and reduced immune system functioning.

For women who are pregnant, hookah smoke can be just as harmful as cigarette smoke. Second-hand smoke from hookahs should also be avoided.

Risks Unique to Hookahs

Hookah smoking is unique in that it uses lit charcoal embers to evaporate the tobacco into smoke. Burning charcoal comes with its own set of health risks, including carbon monoxide, metals mixed in with the smoke, as well as abundant carcinogenic chemicals. Passing the smoke through water does not significantly reduce these things.

Shisha is made using a variety of techniques, and many people buy it online from all over the world. However, tobacco bought from overseas, particularly flavored varieties, may contain additives and chemicals that are not listed on the packaging, and which may bring added health risks into the mix.

Because the mouthpiece is often shared between several people, hookah smoking comes with an increased risk of transmitting illnesses such as tuberculosis, herpes, hepatitis, as well common colds and flus. In hookah bars, the mouthpieces may not be cleaned properly between uses, which means that germs can linger for hours after use.