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Do You (Or Your Kids) Hookah?

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A hookah—also known as hubbly bubbly, shisha, or narghile—is an elaborate glass based waterpipe used for smoking tobacco. You have probably seen it in movies based in Arab countries, but may not be aware that its use has become very widespread among college students in the US and other western countries. Special tobacco (usually moist with added sweeteners and flavors) is placed in the bowl at the top of the apparatus and heated with burning charcoal. During inhalation the smoke from the charcoal is pulled through the tobacco down the pipe and towards the water. After bubbling through the water, the cooled smoke surfaces and is drawn through the hose and inhaled.

The smoke delivered by a waterpipe contains similar concentrations of carbon-monoxide to the smoke inhaled from a cigarette. It also contains the usual other toxins (nicotine, tar heavy metals etc) delivered by cigarette smoke. There may be some differences resulting from the different types of tobacco and additives used with waterpipe smoking, and from the different temperature to which the tobacco is heated (about half the temperature that cigarette tobacco reaches).

However, overall we have no good data supporting the commonly held belief that waterpipe smoking is less harmful than cigarette smoking. This belief appears to be partly based on the idea that the passing of the smoke through the water somehow “cleans” the smoke. This is false. This process simply cools the smoke, making it easier to inhale, but basically the same smoke with all its toxic constituents comes out the other end via the mouthpiece and is inhaled.

Even in countries where waterpipe use is very common (some Arabic, eastern Mediteranean, and Asian countries), many users also smoke cigarettes, making it difficult to clearly identify the health risks specific to waterpipe use.

In Syria, where waterpipe use is widespread, many men acknowledge that they are addicted to the hookah. Until more is known about waterpipe use and its effects, it would be reasonable to assume that waterpipe use is about as addictive and harmful as cigarette smoking.

Over recent years, waterpipe use has increased in frequency in the United States – primarily in connection with the increased numbers of “hookah bars” which have been developed. Hookah bars are commonly found on or near college campuses, and the increase in use appears to be primarily in this age-group (16-28). These bars provide the waterpipes and tobacco for a fee, and are perceived as a novel and pleasant social experience by young people. When a group of young people find they are enjoying waterpipe smoking but perhaps spending more money or time at the hookah bar than they would like, then some start to purchase their own waterpipe and materials and smoke at their apartment. As many as 20-33% of students on some campuses have at least tried a waterpipe. In one survey, 37% of college freshmen believed that waterpipe use was less harmful than cigarette smoking. It is therefore important to make clear to young people that waterpipe smoke is just as harmful and addictive as cigarette smoke.

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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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