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Nicotine
Hookah pipes — More or less harmful than cigarettes?
Originally Published: July 25, 2003 ~ Last Updated / Reviewed on: June 20, 2008
 

Hi Alice,

My friends and I occasionally (once a week or so) like to smoke the "Hookah" or sometimes referred to in Arabic as an "argeelay." The tobacco that it comes with smells really good and comes in all kinds of flavors, such as apple, mango, mixed fruit, etc. Anyway, I consider myself to be pretty healthy in that I have never experimented with drugs, never smoked cigarettes, and rarely drink alcohol. My question is about the health effects of smoking a hookah. The rewards are mostly relaxation after a long day of studying for law school. The hookah provides this through smell, flavor, and sound of the water that filters the tobacco when you puff on it. However, I don't know what the health risks are. How does it compare to cigarettes? People say that it's much safer than cigarettes... and according to the packaging that comes with the tobacco, there are far fewer harmful ingredients... in fact, it's mostly tobacco & molasses. It's a very popular trend these days. It's time we get a good source of information. So what's the verdict?

— Moose & Co.

 

Dear Moose & Co.,

You and your friends are part of a trend that has ebbed and flowed in terms of popularity in America over the years. Hookah pipes (also known as water pipes, sheesha, nargile, and argileh) originated in what is today Turkey and are now popular throughout the Middle East as a leisurely, social after-meal activity. Across the United States, bars and cafes that offer hookah pipes are popping up. In a hookah pipe, the tobacco (often fruit flavored) is heated by coals, and the resulting smoke passes through tubes and water so that it cools down by the time the person inhales. The tobacco mixture used in the pipes is usually 30 percent tobacco and 70 percent fruit flavorings, molasses, and/or honey — though the amounts can vary by manufacturer.

Some people feel that smoking a hookah is safer than other methods of tobacco smoking since they believe that the water filters out the harmful compounds before the smoke is inhaled. But, compared to cigarettes, little research exists on the health risks of hookah smoking.  To date, there have been no studies looking specifically at the consequences of smoking the non-tobacco substances that are used for flavoring. The little research that does exist, though, shows preliminary evidence that suggest hookahs are not any safer than cigarettes, and as with cigarettes, effects may include a higher chance of developing heart disease and/or lung cancer. Some studies have also shown that a person inhales 100-200 times more smoke (by volume) during a typical one hour hookah smoking session than when smoking one cigarette – because the hookah smoke is cooled by water, it can be inhaled more deeply and held for a longer length of time. On the other hand, because hookah smoking is usually a social activity, those who use hookah pipes might not be smoking as often or as much as cigarette, cigar, and pipe smokers.

To risk stating the obvious, the tobacco used in a hookah is still tobacco, so its smokers are still exposed to:

  • Nicotine: The addictive chemical in tobacco products. While the pipe's water absorbs some nicotine, research suggests that hookah smoke delivers enough of the drug to potentially lead to addiction.
  • Tar: Hookah tobacco does not contain tar... until you light it, that is. Tar is produced when hookah tobacco is burned, so hookah smokers' lungs will still be exposed to the brown, sticky material that leads to cancer, emphysema, and other health problems in smokers, as well as causes stains on teeth and fingers.
  • Carbon monoxide: A colorless, odorless gas that is toxic to humans. The amount produced by a hookah pipe depends on several factors, including the kind of tobacco, the type of charcoal, and the size of the pipe being used. In general, using commercial (quick-lighting) charcoal makes for higher levels of carbon monoxide. Also, smaller hookah pipes appear to deliver the most carbon monoxide, followed by cigarettes, with larger hookahs producing relatively less.

Just like people who use other tobacco products, hookah users can develop an addiction, and there are resources available to help them quit. Those in New York State can call the NYS Smokers' Quitline for help forming a quit plan; some other states offer a similar service. New York City residents may also call 311 to receive information about the city's free tobacco cessation services. If you are a Columbia student, Primary Care Medical Services sponsors a free Tobacco Cessation Program that provides education and counseling around various quitting tools, including nicotine replacement therapy and support groups.

As for relaxing after a rigorous day of law school studying, you might want to investigate some other techniques for de-stressing - maybe yoga or meditation can do the trick. If you're a Columbia student, you can also get a free Stressbusters mini-backrub or take part in a stress management workshop. Check the Health Services at Columbia for more information and a current schedule.

Best of luck de-stressing after class in a healthy way,

Alice

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