Waterpipe tobacco, or hookah smoking, has been around for centuries as an integral part of many cultures in Africa and Asia. In recent years, the popularity has grown to encompass North America, spreading particularly to the young adults demographic under the impression of a “safer” option than cigarettes with labels of “0.5% nicotine and 0% tar” on waterpipe tobacco. However, contrary to popular belief, the smoke that emerges from a hookah contains many of the same toxins known to cause lung cancer, heart disease, and other diseases. Furthermore, hookah smoke delivers nicotine, the exact same addictive drug found in cigarettes, in higher amounts, despite the fact that water absorbs some of this nicotine. How is this possible?
A recent study by WHO, or the World Health Organization, found that the average hookah smoking session exposes the smoker to more smoke over a longer period of time than a cigarette smoker. A cigarette smoker typically takes 8-12, 40-75 ml puffs over a time frame of about 5-7 minutes. This leads to an inhalation of 0.5-0.6 litres of smoke. In contrast, a hookah session, on average, lasts about 20-80 minutes, during which the smoker takes anywhere between 50-200 puffs, delivering 0.15-1 litre of smoke per puff. In short, the hookah smoker consumes as much smoke in one session as a cigarette smoker does by smoking 100 or more cigarettes.
While the long-term effects of hookah smoking have not been studied as extensively as cigarette smoking, the preliminary research is very alarming. Several take home points are to be noted, the most important being the equivalence of a one-hour smoking session to 100+ cigarettes. This poses many health risks to the smoker, a pregnant woman and her fetus, as well as non-smokers via second hand smoke. Using a hookah or waterpipe is not a safer alternative to cigarettes, even after being passed through water, and there is no proof of any device or accessory to make it safer. The tobacco in hookah is heated with charcoal, leading to dangerously high levels of carbon monoxide. Lastly, sharing of the mouthpiece puts users at risk for many diseases such as hepatitis and tuberculosis.
Extensive research and worldwide efforts in the upcoming years are needed to study and fully understand the consequences of hookah smoking. Furthermore, it will become increasingly vital to develop both prevention and cessation strategies before waterpipe tobacco becomes as serious of a health risk as cigarettes have in the last 50+ years. “Teens and young adults are initiating tobacco use through these hookahs with the mistaken perception that the products are somehow safer or less harmful than cigarettes,” said Paul G. Billings, a vice president of the American Lung Association. “Clearly that’s not the case.”