Inhaled Toxicants from Hookah vs. Cigarette Smoking

Although smoking cigarettes may be declining among the US college population, it seems that smoking one of its counterparts, the hookah, is on the rise.  The hookah contains communal pipes that allow users to draw tobacco smoke through water.  This specially made tobacco comes in many unique flavors.  There seems to be the misconception that smoking from a water pipe (hookah) is less harmful, however, many of the health risks are the same as smoking cigarettes.  In fact, since users often believe this misconception, one hookah smoking session can often become more dangerous.

In a recent systematic review and meta-analysis of inhaled toxicants from water pipe and cigarette smoking, it was discovered that, compared with a single cigarette, one hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine and 10 times the carbon monoxide.  This study clearly shows that a hookah smoking session exposes users to higher amounts of smoke volume and toxicants.  Led by lead author Dr. Brian A. Primack,M.D., Ph.D., a University of Pittsburgh School of Medicine professor, he states that the results show that smoking hookah tobacco poses real health concerns and should be monitored more closely than it currently is.  The methods to this study include searching through biomedical bibliographic databases for relevant articles and conducting meta-analysis to calculate the parameters of smoke volume, nicotine, tar, and carbon monoxide between a single cigarette and a single hookah smoking session.  Out of 542 potentially relevant studies, only 17 were qualified for meta-analysis.

A caveat is that due to the various ways of usage of cigarette and hookah smoking, it is difficult to accurately analyze the effects of both counterparts and develop a perfect comparison.  Thus, the researchers cannot say which is “worse,” however, it can be noted that hookah users are probably being exposed to a lot more toxicants than they realize.

I feel that this is an important issue that needs to be brought up more often in healthcare, with a focus on the college aged population.  More education and media coverage on the dangers of this activity should also be exposed.  It has been studied that about one-third of U.S. college students have used a hookah, and many of those individuals had not used other forms of tobacco previously.

Public Health Rep. 2016;131(1):76-85.

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