Hookahs are trendy, but are they safe?

Hookah smoking is no safer than cigarette smoking. If you read no further, that is the take-home message for this blog -- no matter what you may have heard or read, the scientific evidence is clear that hookah smoking is not a safe alternative to smoking cigarettes.

Countering the widely-held, although mistaken, belief that hookah smoking is safer than cigarette smoking is important, so let's take a step back and consider what hookah is, learn about its history and current popularity, and then look at the facts about the scientific evidence regarding its effects on health.

An ancient practice

Hookah is a bowl-shaped device with a tubular pipe. It also may be called waterpipe, shisha or hubble-bubble. Charcoal-heated air is passed through a tobacco mixture and then through a water-filled chamber and, ultimately, through the pipe for the user to inhale. Though it sounds complicated, a hookah is an ingenious and relatively simple way of delivering tobacco smoke. (see photo, on left)

The practice of hookah smoking goes back nearly 500 years. It most likely began in India after Columbus brought back the first tobacco plants and seeds from the Americas, where tobacco had been in use for centuries.

Of course, they didn't have the modern additives that make tobacco smoke smoother today, so Indian tobacco users experimented with passing the smoke through heated water bowls to make the smoke easier to inhale. The practice moved westward quite quickly, and within another century, the modern version of the hookah was in use throughout the Middle East, where it was often used in groups and became a social activity.

An exception to clean air rules

Currently, hookah is used in many countries around the world, and people seem to be accepting and embracing it quickly. In the U.S., data indicate that it's usually used among young adults, with several studies indicating that about 10%-25% of them used hookah in the past month. Unfortunately, teens also have begun to take up the practice.

Hookah bars have also popped up, many of them in college towns (such as Palo Alto, California, in photo on right), in order to take advantage of the built-in young adult population. Since there has been a lot of confusion about the health effects of hookah, some municipalities -- even those that have strict regulations regarding cigarette smoking - have made an exception for hookah bars. This is because the bar owners have successfully argued that hookah smoking is substantially different than cigarette smoking, both in how it's inhaled and how much secondhand smoke there is.

However, hookah smoking is very little different than cigarette smoking. The fruit, honey, and other flavorings that are used in hookah tobacco, as well its moistness due to being passed through water, and its function as a relaxing social activity, all go to mask the fact that what hookah users and those around them are inhaling is tobacco smoke -- with all of the health dangers that accompany it.

Proven health risks of hookah

As hookah smoking has taken off across the world, there's been more research into its health effects.

Hookah smoke, like cigarette smoke:

•contains significant amounts of cancer-causing ingredients, such as arsenic, cobalt, chromium, and lead;

•generates heart-disease-causing carbon monoxide in amounts equal to, or greater than, cigarette smoke; and

•has the same addictive properties, which can lead a hookah user to begin using cigarettes, or becoming a dual user of hookah and cigarettes.

Additionally, hookah use has several uniquely unhealthy qualities:

• Hookah users may inhale more smoke than cigarette smokers, because hookah sessions often last an hour or more, during which hookah users will inhale not only the smoke from the hookah itself but also that of the others with whom they are smoking;

• Unlike cigarettes, hookah smoke may also contain charcoal or wood cinder combustion products, which can increase cancer- and heart disease-causing agents in the smoke; and

• Sharing the hookah's waterpipe can increase the risk of contracting a communicable disease, such as tuberculosis, hepatitis, or meningitis.

So, the bottom line is that, appearances and popular beliefs to the contrary, hookah smoking offers no refuge from the dangers of cigarette smoking. Despite the relaxing social atmosphere in which hookah is used, its pleasant flavorings, and its smoother taste, it is a devil in disguise and should not only be avoided, but subject to the same laws and regulations as cigarette smoking.

For more information about hookah smoking, click here.

Dr. Glynn is director of cancer science and trends for the American Cancer Society.