Hookahs: Where there's smoke, there are toxins

Hookah bars, where people go to smoke flavored tobacco from a hookah, or waterpipe, are becoming increasingly popular in North America. On average, there are five new hookah bars opened every month, and in 2008, 470 were already open, according to HookahBars.com.

After a hookah bar opened in his community, Tom Eissenberg, a professor of psychology at Virginia Commonwealth University’s Institute for Drug and Alcohol Studies, began studying the effects of waterpipe tobacco smoking. The results bust the myth that waterpipe-smoking is less toxic than puffing away on a cigarette—in fact, it’s worse.

Who uses waterpipes?

It’s largely the 18 to 25-year-old crowd. If you go into a waterpipe bar in Richmond and ask people to fill out a survey, which I did, you’ll find many of them 18 to 22. There’s a reason for that--because they’re not old enough to drink, and alcohol’s not served there. They have big-screen TVs, show movies, serve food.

And you found in your surveys that users don’t think this type of tobacco smoking is bad for them?

The biggest thing is that they use the “f” word—the water filters the smoke. This has been studied, and there’s no reason to believe that the water acts as a filter. There are folks who are purists about the experience and don’t like the idea of cigarettes. They’ll say—as smoke is coming out of their mouth-- “Oh, I’m not a smoker.” They’re very aware of risks of cigarette smoking. And they’ll say, “If it was dangerous I would have heard of it by now.” They see cigarette smoking as completely different.

Explain how this study worked.

We invited waterpipe users who also used cigarettes. In one session they smoked a cigarette and sat around while we took breath samples and blood samples and measured their heart rate. In another session they did the same with a waterpipe. A single cigarette takes about five minutes to smoke, and waterpipes are used for an average of 45 minutes, but we took measurements at the same intervals. (A second study is underway with people who only smoke waterpipes.)

How much tobacco is used in a waterpipe versus a cigarette?

We put 15 grams of tobacco in the waterpipe head, but the tobacco you put in is wet—it’s been soaked in honey or something else sweet and maybe chunks of fruit added, so it’s really 15 grams of shisha, versus one gram of tobacco in the cigarette. The other thing about the pipe is that because the tobacco is so wet, you can’t just hold a lighter to it. So it’s topped with charcoal, which is important because you’re not just inhaling tobacco smoke but also charcoal.

What did you find in your research?

We found waterpipe users are exposed to three times the carbon monoxide (in 45 minutes) as the user of a single cigarette (in five minutes). But even after five minutes of smoking, there’s significantly more exposure from waterpipe. A study has shown the charcoal used in the waterpipe is responsible for that increase. As far as nicotine, we also saw a greater exposure with the waterpipe than the cigarette.

We also measured how people smoke—how many puffs, how big the puff is. With a waterpipe, the water cools the smoke, so you can take a much bigger inhalation. We found waterpipe users have 48 times the smoke inhalation (based on puffs and volume) as cigarette users.

So how risky is this kind of tobacco use?

I cannot answer that right now, because that data doesn’t exist. But we can look at what’s in the smoke and compare that to the cigarette—and what causes cancer and cardiovascular disease. We know carbon monoxide is what causes cardiovascular disease in smokers. The fact that studies don’t exist [for waterpipes] does not mean it’s safe, just that the research hasn’t been done.

Are waterpipe smokers surprised by your findings?

Surprised is probably not the right word. Disbelieving, yes.

Do you think this will help debunk the myth that smoking tobacco from waterpipes is OK?

It’s surprising how strong the myth is. We want to get the word out that this is not a benign activity. We haven’t done the epidemiology yet, so we don’t know all the dangers, but we know the toxin exposure. If you’re smoking a waterpipe because you think you’re avoiding dangers of cigarette use, you’re wrong. We know there’s carbon monoxide in the smoke, and we know there’s nicotine in the smoke, so there’s a likelihood that people will become dependent on the waterpipes. The bottom line is that there are the same poisons in waterpipe smoke as there are in cigarette smoke, which we know people are dying from. It’s remarkable how successful we’ve been making sure people know cigarettes are dangerous. I want to duplicate that with waterpipes.

This post was originally published on Smartplanet.com