Hookah: An Underratedly Dangerous Tobacco Product

New generations of young people have brought different different ways of using tobacco into popular culture. Currently, hookah is a very popular use of tobacco that has quite ludicrously taken ahold of a large portion of young party goers. Hookah bars typically also serve alcohol, so they have become an alternative to traditional bars. While many people feel that hookah is a harmlessly fun activity, many studies show that just like other forms of tobacco, it poses health risks.

The biggest issue with hookah’s popularity in young people is due to lack of information and skewed perception. A study published in Tobacco Induced Diseases journal collected data from both hookah users and non-users. As stated in the figure below, more than half of hookah users in the study felt that hookah is less harmful than cigarettes (Aljarrah et al., 2009).

Hookah users’ harm perceptions in comparison to cigarettes

Furthermore, a study published in Tobacco Control collected all hookah products in Lebanon and samples from Dubai (United Arab Emirates), Palestine, Syria, Jordan, Bahrain, Canada, Germany and South Africa. The study found that “the majority had textual health warning labels covering on average only 3.5% of total surface area of the package. Misleading descriptors were commonplace on waterpipe tobacco packages and related accessories” (Nakkash et al., 2010). Therefore, it is clear that hookah companies are not regulated enough to provide adequate information to users about how harmful they can be.

Hookah can also be dangerous because of their link to other substance use. For example, a study published in Drug and Alcohol Dependence found that “Hookah users were more likely to use other substances, including cigarettes, cannabis, alcohol, cocaine, and amphetamines. The strongest associations emerged between hookah use and alcohol and cigarette use” (Goodwin et al., 2014).

Even when hookah is being used on its own, it can still pose serious health concerns. For example, a study published in the Journal of Pakistan Medical Association tested carbon monoxide (CO) levels emitted by the smoke of different sizes of hookah and traditional tobacco cigarettes. The study found that “Mean carbon monoxide fractions (% by volume) of hookah smoke, using domestic charcoal were 0.38±0.07 (large hookah; unfiltered); 1.40±0.43 (small hookah; unfiltered)…and 0.41±0.08 (cigarette smoke)” (Sajid et al., 1993). Therefore, CO levels of hookah smoking can be much higher than those of traditional cigarettes.

Furthermore, a study published in Europe PMD tested the genotoxicity of hookah smoke, and found that “The mitotic index (MI), chromosomal aberrations (CA), sister chromatid exchanges (SCE) and satellite associations (SA) were analyzed. All the parameters showed a significant increase (p < 0.01) in the smokers compared with control individuals, viz MI, 3.88-5.41; CA, 0.94-2.22; SCE, 3.59-5.66; and SA, 5.2-8.65. A distinct time and dose effect relationship was observed. Hookah smoke is thus, both clastogenic and genotoxic for human beings” (Yadav et al., 2000).

Hookah is a trend that has found its way into trendy bars and party-going millennials very easily. Its easy accessibility, diversity of flavors and types, and fairly affordable prices have led to its proliferation across the global market. While hookah seems like a harmless pastime and social activity, it is clear that it poses health risks that are as real as those of traditional cigarettes.

Works Cited

Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacoo Induced Diseases. Vol 5, p 1-7. 2009.

Goodwin RD, Grinberg A, Shapiro J, et al. Hookah use among college students: Prevalence, drug use, and mental health. Drug and Alcohol Dependence. Vol 141, p 16-20. 2014.

Nakkash R, Khalil J. Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories. Tobacco Control. The British Medical Journal. Vol 19, p 235-239. 2010.

Sajid KM, Akhter M, Malik GQ. Carbon monoxide fractions in cigarette and hookah (hubble bubble) smoke. Pakistan Medical Association. p 179-182. 1993.

Yadav JS, Thakur S. Genetic risk assessment in hookah smokers. Europe PMC. Vol 101, p 101-113. 2000.