The hook in hookahs

Just last month my 15-year-old son, Daniel, mentioned that some of his friends were smoking hookahs (also known as shisha, narghile, goza, and hubble bubble). Daniel ticked off its advantages: It’s not addictive (like alcohol), not illegal (like pot), and safe from the health hazards of cigarettes. His friends’ parents think that it’s cool, he said, and someone he knew even had her Sweet 16 party at a hookah bar (before they became illegal in New York City).

Daniel and his friends were parroting the myths that are being perpetuated by many other teens and young adults in the U.S. As our reporting of the recent research reveals, 15 percent of freshmen surveyed at my alma mater, Johns Hopkins, admit to smoking water pipes. Although many Hopkins students are future doctors, they’re ignoring the facts. Last year  the American Lung Association reported evidence that hookah smoking carries many of the same health hazards as cigarette smoking—heart disease, clogged arteries, and lung cancer. And because the mouthpieces are shared with others, users are also at risk for infectious diseases, such as TB, hepatitis, and herpes. 

Furthermore, evidence suggests that an average 45-minute hookah session raises levels of nicotine in the blood up to 250 percent. It also delivers the equivalent of 100 times the smoke of a cigarette (with its related toxic agents such as carbon monoxide), contributing to a growing concern in the medical community that the practice may lead to regular cravings and addiction to cigarettes. 

As the February 2008 journal Nicotine & Tobacco Research illustrates, it seems that hookah users don’t have a clue! Data analyzed from 201 hookah smokers revealed that 79 percent felt that cigarettes were more addictive than water pipes, 67 percent felt cigarettes were more harmful, and more than 65 percent believed that cigarettes have more nicotine. 

So far, the part about germs has been enough to deter Daniel. But the battle is far from over. When I told him that I was writing this, he insisted, “They wouldn’t make something legal if it were so unsafe.” —Orly Avitzur, M.D., medical adviser to Consumers Union

Comments

[hookahkings59]

Huge and very useful information posted over here regarding the hookah & tobacco.Every one can easily understand viewing this article.

[deeptrip]

Sorry I wrote it wrong.

10 grams 0.5% is 0.05 gram and this is 50 mg. About 50 times more nicotine then one cigarette with an avarge level of 1mg nicotine.

Another fact that nicotine is water soluble and the long airway of the hose will filter some nicotine also.

Another experience is that people who smoke cigs will have the urge to light up after a hookah session.

In my opinion the real problem with hookah is the high CARBON MONOXID (CO) in the smoke. This is because the coal doesn't really burn the sisha, but heats it up. Because of this improper burning/heating process more CO will be produced, then with a proper burning.

Further studies are needed, but NO KIND OF SMOKING IS SAFE. Only vaporizing is safe but that's not smoke, that's vapor you inhale.

[deeptrip]

You say sisha contain's 0.5% nicotine. Well actually you put about 10 gramms of tobacco in a hookah, so 10 grams 0.5% is 0.5gram and that is 500mg of nicotine. A cigarette contains about 1 mg of nicotine. Please don't be such fools.

Oh yes and there is no such thing like 0.0% nicotine sisha tobacoo. If you want nicotine free tobacco you have to buy special nicotine free tobacco. But you can't find nicotine free sisha tobaco which goes in water pipes!

Nicotine is addictive and without nicotine you wouldn't feel the "calming" and "relaxing" effects, not even the buzz.

Despite this I am too still waiting for some objective study on hookah vs cigarettes, because there is no real study on this subject till now.

[Andrew]

I'm a hookah smoker myself, and while I don't try to tell myself that it's any less dangerous, I still believe it is less addictive. It may just be that I don't get addicted to things easily in general, but I stopped all of my "habbits" (alcohol, tobacco, and caffeine) cold turkey for a full month, and had virtually no craving for tobacco, the mild alcohol cravings were gone after a week, and the only one that carried on was a mild craving for my usual Grande double Cappuccino (but my taste for all of these things was slightly changed. I don't take my coffee or my liquor as strong since my month off)

Anyone who thinks there is no risk is kidding themselves, but I think that in moderation it's acceptable, and if you don't have the control to do something only in moderation, you shouldn't do it at all.

[Justin]

Daniel shouldn't be smoking yet, because he's not 18.

When he turns 18, hookah is fun and it's nobody elses business what he does...soooo this topic is BOGUS.

[Ana]

Thank you for writing this. My girlfriend quit smoking 4 months ago, and for new years some friends brought a hooka that everyone, including me, was smoking from it. They insisted that is harmless, and I was going to get my girlfriend one, but after this article, there is no way im getting her one. I do not like contributing to unhealthy choices or economically support bad habbits. - Ana

[Caleb]

So they Keep talking about the nicotine in them but if you look on the side of a pack of shisha almost all not all but almost have 0% nicotine most are just tobacco and flavoring

[Ben]

People who smoke cigarettes can do so any time, anywhere. It is something many people do several times every day. Hookah is a more casual, social smoking. I smoke hookah only on the weekends, usually Friday night - and not every single Friday either. Usually one to three times per month, give or take. So given the frequency (or lack thereof) hookah in theory should not be as bad as cigarettes. Plus, as several people have mentioned, the hookah is shared (unlike cigarettes) so the exposure per experience is cut down.

[Mike]

You know the particular study this person is referencing has been proven completely wrong right? No Hookahs are not healthy but there is no mention about the growing community of people who smoke the herbal shisha, not to mention the people who stopped smoking completely (and that includes the hookah) by way of mixing shisha tobacco with shisha herbal. While fundamentaly true, the facts are very skewed on this subject. All you have to do is FULLY research it. Regardless, no hookahs arent safe and as always USE COMMON SENCE.

[Hookah bar in L.A.]

On a more political note the hookah studies and research being done by the u.s lung and cancer association and the world health organization when examined closely are using generic brand tobaccos used in ciggerettes but are putting them in the hookahs and then displaying these insane results. The fact is that real hookah tobacco in which the so called experts are over looking have 2-3 ingredients which are tobacco, glycerin, and sugar. relative to the ciggerette tobacco of 400 ingredients. and if researched properly will prove the point that hookah smoking is not as bad as ciggerettes however smoking of any kind is not good for you ethier.

[Snuffer]

I have never heard of hookah before reading this article. But I can definitely see where hookah would be less dangerous than cigarettes, given that it is not done as often and the product is purer,(assuming you've got clean water in the bong). Being a nasal snuff user myself,and an ex smoker, I can tell you that nasal snuff, if done everyday can be addictive,but not nearly to the extent of, or with the ease of, cigarettes. I did it everyday-all day for over a month and then just stopped. I really feel that the addiction is stronger from the other chemicals that are used in cigarette tobacco processing, than from the tobacco itself. (Someone really needs to do a study about that.)
Snorting powder fine tobacco is easy to do & doesn't make you reak like smoke. There is no second hand smoke or "offensiveness" to anyone around you. And costs nearly nothing to do. A $3.00 tin lasts about 3 weeks to a month.(The only problem is if you are doing it while driving, someone may think you are snorting an illegal substance--that can be an issue.)
My point is that when you ban things like tobacco, people will find other ways to do it. Remember prohibition? And opening a hookah bar can bring a profit, so hookah is not going to be a "fad" as someone mentioned, but quite the opposite. People can't smoke in public because it is harmful and offensive to others. That leaves us no choice but to find other ways to serve our vice. I think we will see more creative & even profitable ways to get our tobacco fix. Including hookas and nasal snuff. Everyone in the bar I hang out in does nasal snuff, and by the way, its a bar where cigarettes are allowed.

[wes]

You're all morons. The hookah tobacco that is smoked has 0.5% or 0.0% nicotine. I would highly suggest getting the right information before making senseless accusations about the chemical levels in the tobacco. The only thing that can cause any harm at all, is if you inhale while the coal is being lit like an idiot.. Being a hookah smoker, and cigarettes as well, the difference between the two is that hookah tobacco is cured in molasses with no other chemicals, and cigarettes are doused in many chemicals. After smoking cigarettes and smoking a hookah, I get way more buzzed smoking a few cigarettes than I do smoking a hookah with friends. There is virtually no harm in smoking a hookah and has less hazards than smoking cigarettes. Plus, not to mention that the smoke coming from the tobacco in a hookah is cooled and filtered through water. The smoke coming from cigarettes is filtered, but recent studies have shown that the filter actually lets more of the harmful substances in it than unfiltered cigarettes. I think I've covered everything; now to go fire up the hookah with a few buds.

[Angela Lasek]

If someone does not know what they are smoking, then they have no right smoking it. Whem someone smokes a cigarette, they know it's harmful to them, though they do it anyways. Hookah, as well as cigarettes and other substances all have reprocussions, and this is something that needs to be known before using. It's knowing what you put into your body and knowing that there may be consequences. This is a new fad among the younger generation, this I know because I am apart of it. It won't last long, and the new generation will soon find something else to cling onto.

[Josh]

Even though hookah statistically can be much stronger of a hit in one blow, it is not something you do as often as cigs. You can't really take a hookah to work and take a 15 minutes 'smoke' break. You're not going to smoke it in your car, it is something that may be occasional such as once every couple of nights or a week. In comparrison, a cigarette is nearly always available to you and on hand any time you have an urge.

In my own -opinion- i'd say it could be as dangerous as a cigarette, but most of the time is probably not.

I am not trying to promote hookah, just trying to bring an opposite perspective to the readers.

[J]

The water alone in the pipe is a vessel for all kinds of bacteria to be sucked directly into the upper airways and lungs of all the users not to mention all the dirty mouths, Nasty!

[Rich]

I don't smoke in any form and find the practice disgusting. (Ever seen what smoker's lungs look like? Ugh.) But I have to agree with the comment that the way that the statistics are presented seems "spun."

I am disappointed that Consumer Reports chose to run this piece as is, because it does harm to their reputation for objectivity. Also, this sort of tone is bad for dialogue; the people who need to be persuaded to rethink their hookah use are not going to listen to someone who obviously does not respect them.

[Marjorie]

I have neveer been a smoker but married one who quit in 1955 and then lived until 93,and didn't get lung cancer but did have heart trouble after 85 years of age.
He also had a drinking problem for several years before he realized that life was better before that, and quit that too.
Excessive eating can also be bad for ones health and each individual has to control that by themselves, so it just goes to show that each person has to use good judgment or face the consequences.

[M. D.]

In my opinion it all boils down to personal choice. I was an alcholic for most of my life, and upon realizing I didn't need my crutch, began to see that life had so much more to offer. All these people can say it is safer to use a hookah than a convenional smoke delivery system, but it is still smoking. Question is, with everything going on around us, and being bombarded with chemicals, why would anyone want to injest more? Ask anyone who has leaned on a habit, and I guarantee they will find a way to justify their actions. No one wants to be wrong. It's human nature. But,I would venture to say ,that the thrill of doing something that they feel is allright, but is not healthy for them, will eventually rob them of time they could use to be more productive in their lives. I am basing this on my experience, but life is pretty constant,and people are people.

[Hookah Smoker]

Well the fact is that if you smoke a hookah by yourself you are damaging yourself more than cigarettes. However, If you share a hookah with 4 or 5 other people the smoke that you are inhaling is either equal or slightly less/more of a cigarette. True - hookah smoke does cause all of the things you mentioned, ie: heart disease, clogged arteries, and lung cancer. However, it is much less likely to cause that than cigarettes. I have smoked a hookah for a number of years as well as my room mates, and none of us crave cigarettes or hookah. None of us have a problem going days without smoking. Don't get me wrong any kind of smoke entering your lungs is bad, but saying hookah is as bad as cigarettes is just false.

[Colleen]

My 17 year old college freshman son discovered hookah as soon as he went away. The hookah bar he went to never checked ID on anyone. Hookah is touted as the 'safe, cool way to relax'. He insists it helps him chill out. Even campus police (real police, not security guards) say it's legal and don't check IDs for age. I'm sure it's not healthy, just by common sense ruling-but I think it's probably not nearly as bad for him as some of the other things college freshman are doing these days.....

[Tom Trottier]

It all depends on what you smoke in the hookah. Tobacco is obviously harmful, pot is obviously illegal.

[Samuel Tune]

I have seen young people smoking hookah's in a bar in my city, and wondered why this use of tobacco isn't being regulated just like the use of and sale of tobacco to minors in any other form? With new anti-smoking laws regarding public places, I hope this fad goes away quickly.

[Anne]

In most Hookah bars (which are not illegal in New York City), they actually follow the law of not selling tobacco to minors and enforce I.D. checks. I.E. Children, such as your 15 year old son and the other 16 year old birthday party, would not have been served a hookah.

"All 50 states and the District of Columbia prohibit the sale of tobacco products to minors. Most states define minors as persons under 18 years of age; however, enforcement varies widely. Three states – Alabama, Alaska, New Jersey, and Utah – define minors as persons under 19 years of age." - http://www.cancer.org/docroot/PED/content/PED_10_12_State_Legislated_Actions_on_Tobacco_Issues.asp?sitearea=PED

The amount of smoke inhaled while smoking hookah is completely different based on how many people there are per hookah (more people = less smoking during 45 minutes), how many "hits" a person takes (some people take breaks during the time, others smoke more rapidly), and the duration of each "hit." Ergo, the "100 times the smoke of a ciagarette" claim seems like it's more intent on scaring people away from smoking hookah than actual science.

Additionally, you appear to have no conclusive evidence on the health effects to the "occaisional" smoker, other than the "fear of germs/infectious diseases" and the possibility that they may become addicted to cigarettes (which, quite frankly, seems a little far-fetched and doesn't take into account the complexities of what causes addictions). Most hookah bars provide plastic covers, so the spread of germs would come from your friend sitting next to you and not some random stranger - so if you share their beverage you're just as likely to get those same infectious diseases anyway.

The fact that most of 201 hookah smokers "didn't have a clue" about the obvious risks of smoking nicotene infused tobacco seems a little bit odd. The fact that on instinct they respond that cigarettes are much more "dangerous" than hookah probably stems from the fact that they've had it drilled into their head that if they smoke "even one cigarette" they might become a pack-a-day chain-smoker. In which case, a pack-a-day chain-smoker probably does have more health risks than the occasional (once every 2 weeks) hookah smoker.

"79 percent felt that cigarettes were more addictive than water pipes:

67 percent felt cigarettes were more harmful,

and more than 65 percent believed that cigarettes have more nicotine."

**Note here that the term of comparison is "cigarettes" and not "1 cigarette," which appears to be the comparison you are making.
**Also, "water pipes" are not addictive whatsoever. Apparently those 79% of people were more correct than the authors of the study. The nicotine inhaled through them is - so perhaps if they asked "Is the nicotine in 1 cigarette more addictive than the nicotine inhaled through a water pipe during a 45 minute hookah session where you take a number of extended hits?" the study may have found hookah smokers are not quite so dumb as you'd have the readers of your article to believe.

I'd be interested on a more well-researched article on the subject, rather than this obviously uninformed spun story set out to frighten people (including my mother, who sent it to me).

Thanks,
22 year old (legal) hookah smoker.

[Mom in IL]

THANK YOU VERY MUCH for exposing the very scary underbelly of this popular "trend." My daughter totally defended her actions, much like your son's "reasons," and disregarded my concerns, despite the fact that she and her friends all reeked from the smell of having been in a hookah bar.
It reminds me of how some would claim that chewing tobacco was "safe," because one didn't inhale any smoke, (and hey, major league athletes chewed it and it was "cool..."). Also, back in the early 1960's, my husband's grandmother had a lung related medical problem and was told by her doctor to smoke menthol cigarettes in a closed room to help her condition.... uh huh, sure......she died in her early 60's ....
Get the word spread out to all high schools and colleges, please!!! I'm passing on your article... thanks, again!

[Dale N Scott]

It's interesting to note that the teenager in the story seems to have the perception that the Government 'made' hookah smoking legal as though there was some action on the part of the system to legalize the practice rather than just not taking any action to make it illegal. It makes it sound like an endorsement (which it is not). The Government doesn't 'make' things legal. They are (legal) until a law is passed to make them illegal. It's potentially dangerous thinking to assume that what is not against the law has the blessing of the government and thus supersedes common sense.

[Michael]

Good article. The idea that “They wouldn’t make something legal if it were so unsafe" is a valuable topic to discuss on its own because of its applicability to this as well as many other situations. The weakness of this argument may be apparent to an adult with life experience, but to a child trying to make sense of the world, some thought-provoking discussion and some pointed counter-examples is probably required.

[Yolimar]

As a reponse to Daniel, cigarettes are not ilegal, yet all of us know they are harmful ;-)

[Patrick]

Daniel's last comment is pretty funny! So, then, why are alcohol and cigarettes legal? Ah, the ignorance of youth!