NEW YORK (Reuters Health) — Smoking
hookah can be addictive and harmful, though many dabblers may not
realize the dangers, according to a new review.
"The cooled and sweetened flavor of hookah tobacco
makes it more enticing to kids and they falsely believe it's less
harmful," Tracey E. Barnett from the University of Florida in
Gainesville told Reuters Health.
Barnett has studied the recent rise in teen hookah smoking. She was
not involved in the new review, published in Respiratory Medicine.
"One-time use can lead to carbon monoxide poisoning or other
diseases, including but not limited to tuberculosis, herpes,
respiratory illnesses including the flu, and long-term use can lead
to heart disease and many cancers," Barnett said.
Smoking with a hookah, or "shisha," device has become increasingly
common in Europe and the Western Hemisphere in recent years. The
practice rose to prominence on the Indian subcontinent among Hindus
in the 15th century and subsequently spread through the Ottoman
Empire. According to one estimate, about 100 million people
worldwide smoke hookah each day.
Though the water-pipe device with its series of tubes and
mouthpieces looks nothing like a cigarette, it is almost always used
to smoke tobacco, and as such carries many of the dangers inherent
in cigarette smoking.
"While water is a filter, it does not filter out any of the toxins,"
The new review brings together the results of several studies on
addiction, lung damage and health dangers associated with hookah
According to the World Health Organization, one hookah session
typically lasts 20 to 80 minutes and a hookah user may inhale as
much smoke during one session as a cigarette smoker would from
smoking 100 or more cigarettes.
The review authors, led by Dr. Ruben Blachman-Braun of Universidad
Anahuac in Huixquilucan, Mexico, cite another study which found
nicotine levels in the urine of daily hookah smokers were equivalent
to levels in people smoking 10 cigarettes per day, more than enough
to spark addiction.
In the existing scientific literature, hookah has been linked with
health problems including chronic bronchitis, lung cancer, oral
cancer, prostate cancer, heart disease and pregnancy complications
similar to those seen with cigarette smoking. It has also been tied
to the hepatitis C virus and herpes from sharing mouthpieces.
In one 2013 study in Nicotine & Tobacco Research, researchers
treated cells from the lining of human lungs with tobacco and
non-tobacco smoke from a water pipe smoking machine. They found that
smoke from a hookah pipe slows down and stunts lung production
regardless of whether the smoke came from a tobacco or tobacco-free
People don't generally seem to understand just how
dangerous hookah smoking can be, said Adrienne J. Heinz. She studies
alcohol and drug use patterns at the Stanford University School of
Medicine in California and was not involved in the new review.
"In casual conversations with friends and patients — folks often
appreciate that smoking anything comes with risks," Heinz said.
"However, hookah is certainly viewed as more benign, and when you
share general facts about toxin exposure in one hookah session, it
often shocks and surprises them."
Results of an online survey of more than 5,000 college students,
also published in Nicotine & Tobacco Research in 2013, indicated
that more than 10 percent of college students had recently smoked
hookah, which was the most widely used of non-cigarette tobacco
A similar study using online questionnaires of college
students found 13 percent of them tried hookah for the first time in
one seven-month period, and those who had less apprehension about
the dangers were more likely to try it.
It's easy to see why people might be surprised at the dangers of
hookah, since there haven't been public health campaigns to raise
awareness of hookah risks the way there have been campaigns about
cigarette smoking, Heinz said.
"There is also the misconception that because hookah sessions tend
to be less frequent than smoking a cigarette, and because hookah is
smoked through a water chamber, that the practice is safer," she
Hookah is deemed more socially acceptable than other forms of
smoking, Barnett said. But people should not think of hookah as a
safe alternative to smoking cigarettes, she said.