Dear Dr. Peg,
Some friends introduced me to hookah smoking a few months ago, and we've been getting together to smoke a couple times a week. It's fun to hang out, and the smoke smells nice. I know cigarette smoking is dangerous, so I've never done it, but hookah smoking is safe, right? Doesn't the water filter out all the bad stuff from the smoke? And isn't hookah tobacco healthier than the tobacco in cigarettes?
Dear Hooked on Hookah,
I'm sorry to disappoint you, but you are wrong on all counts. As usual, I'll start with the basics.
What is a hookah? A hookah is a water pipe. It is a device for smoking a flavored tobacco mixture. The mixture is placed in a small bowl at the top of the device. From the bowl, a hollow pipe leads straight down into a chamber called the base, which is partly filled with water. The pipe extends below the surface of the water. From the side of the base, above water line, a hose leads to a mouthpiece. To smoke a hookah, you place a lit piece of charcoal on top of the tobacco mixture and suck out the mouthpiece. The smoke goes down the pipe, bubbles up through the water into the air at the top of the base chamber, up the hose and into your lungs.
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In the U.S., the hookah has become popular in recent years, especially with young people of both sexes. Hookah smoking is promoted as an aesthetic social activity, touting the sweet smell of the tobacco and the bubbling sound of the water as pleasant, relaxing influences. A typical hookah session can last two or three hours and involves several friends smoking from the same pipe. Commercial hookah bars have sprung up all over the country. There are at least five here in Albuquerque, where you can go just to smoke.
What does one smoke in a hookah? Typically, the mixture is one-third tobacco and two-thirds flavorings. The flavorings may include molasses, dried fruit, honey and other ingredients. The resulting aroma was likened to a baking apple pie by one hookah-selling Web site.
Sounds pretty benign, doesn't it? It isn't. Like many fads, it has been hyped with false claims in order to increase its popularity and profits.
What are the dangers of hookah? Tobacco is tobacco, no matter how you get it, and tobacco smoke is hazardous. In fact, hookah smokers get more smoke than cigarette smokers, and here's why. Cigarette smoke is uncomfortably hot if you inhale it deeply. Hookah smoke has been cooled by its passage through the water. In addition, you have to inhale hard to pull the smoke through the hookah. The result is cooler smoke going farther into your lungs. Add that to the duration of a typical hookah session, and the result is huge volumes of smoke being deposited into your lungs. A study done by the World Health Organization showed that one hookah session of a mere few hours can deliver as much smoke into your lungs as 100 cigarettes - that's five packs. It's a rare cigarette smoker who gets that much in one day.
Tobacco smoke contains nicotine, a highly addictive substance that is not filtered out by the water in a hookah. In addition to nicotine, you are pulling other dangerous substances through that hose. Tar is not water-soluble, so it comes on through the pipe, the same amount in one session as in a whole pack of cigarettes. Tar causes cancer. Other carcinogens - cancer-causing agents - also make it through, like heavy metals and carbon monoxide. In fact, because of the charcoal that is burned on top of the tobacco mixture, hookah smoke has a higher level of heavy metals and carbon monoxide than cigarette smoke. Hookah smokers risk cancer of the lung, lip, tongue and bladder.
As you probably know by now, tobacco smoke affects the cardiovascular system, increasing blood pressure, heart rate and the risk of heart attack and stroke. Smoke of any kind is also a lung irritant, which can trigger asthma and allergies. And, of course, there are all the secondhand smoke issues to consider.
In addition to the tobacco, there are the smoked flavorings to consider. Unfortunately, nobody has yet studied the effects of inhaling dried apricots, but I would bet they aren't all good.
Finally, think about sharing the mouthpiece. It's like kissing everyone in the group. Hookah pipes can spread herpes, flu, strep throat, a cold and even tuberculosis. And wiping it on your sleeve doesn't sterilize it.
I'm a big believer in social gatherings and relaxation time. By all means, gather away, and relax like crazy. But if you are concerned with the health of your young lungs, think about gathering around a cup of tea or relaxing with exercise and a bath instead of a water pipe. And if you are already addicted to any form of tobacco, I strongly urge you to quit. The Student Health Center has people and programs to help you. Call 277-3136.
Peggy Spencer has been a UNM Student Health physician for 16 years. E-mail your questions to her directly at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.
