Hookah Should not be Used as Alternative to Smoking: Less Safe than Previously Thought

A recent study conducted by researchers from the University of California debunks the myth that smoking hookah is safer for you than cigarettes.

Researchers found that young adults who frequented hookah bars carried elevated levels of nicotine, cotinine, tobacco-related cancer-causing agents and other dangerous compounds found in their urine--all of which may increase the risk of cancer and other chronic illnesses.

"This study reports systemic intake of tobacco-specific nitrosamines and VOCs after a typical water pipe-smoking session in a hookah bar setting, thus making the findings generalizable to most water pipe users in the United States," said Gideon St.Helen, Ph.D., postdoctoral fellow in the Division of Clinical Pharmacology and the Center for Tobacco Control Research and Education at the University of California, San Francisco, via a press release.

For the study, researchers examined 55 healthy participants who had also experienced water pipe smoking. All participants were between the ages of 18 and 48, and were instructed to refrain from smoking for a week.

At the end of this period, they provided a "before" urine sample. Next they smoked water pipes at a hookah bar in San Francisco Bay area. Lastly, participants were asked to provide an "after" urine sample following the smoking session, as well as document how much time was spent smoking, the number of bowls smoked and the number of users per hookah.

Study participants smoked for an average of 74 minutes at around 0.6 bowls per person.

Results showed that just one night of water pipe smoking increased the risk of nicotine found in urine by a 73-fold; fourfold increase in cotinine; twofold increase in NNAL; and a 14 to 91 percent increase in benzene and acrolein.

The researchers also noted that levels of cotinine, nicotine and NNAL stayed elevated in urine samples that were taken the next day, with the average nicotine increase comparable to smoking at least one cigarette.

"I have seen entire families, including young children, smoking water pipes. I have even been offered a smoke by my friend who thought water pipe smoking was 'totally safe,'" St.Helen added, via the release. "Our study provides evidence that water pipe smoking leads to significant intake of tobacco-related addictive and harmful substances, and is therefore not without risk, particularly among children and youths."

Yet a 2013 study by researchers from the University of Cincinnati suggested that hookah is safer because of the tobacco used. Also known as shisha, this moist material is made up of honey, molasses and other flavoring agents. Lead study author Joseph Caruso of the university said he believes that because of lower metal levels found in tobacco used for water pipe smoking, it may be a safer option than smoking cigarettes. 

However, he cautioned against the dangers that come with any type of tobacco use:  "Any form of smoking is dangerous, and our studies on toxic metals in hookah smoke are taking the first steps toward the necessary animal and human studies that will establish a clearer picture of the relative dangers of hookah and cigarette smoking."

More information regarding the findings can be seen via Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.