Hookah Smoking as Toxic as Cigarettes
Written by Jessica Benson, in Section Clinical Perspective
A new study has found that, contrary to widespread beliefs among users, hookahs filter out only a tiny proportion of the toxic metals found in tobacco smoke. The popularity of hookahs is driven by myths about their safety, such as the effect of the “filtering” provided by the water in the base of the pipes, but in reality, the risks of hookahs appear to be equivalent to those of tobacco. Finding out more about the latest study and some of the myths associated with hookahs provides a good reason to think twice before inhaling smoke through a water-pipe.
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Does the Water in Hookahs Reduce Users’ Exposure to Metals?
The study was fairly straightforward in design: the researchers looked at the number of specific metals (including iron, lead, copper, nickel, and uranium) that were found in the tobacco and compared it to the amount detected in the various components of the pipe after the resulting smoke was filtered through the water.
The researchers found that only about 3 percent of the metals present in the tobacco were filtered out by the water, with 57 percent remaining in the smoke and the rest being contained in the tobacco ash. This strongly suggests that the water filtration is far from being adequate to reduce risk from metal exposure, and the authors conclude that “this small fraction would not protect the user against exposure to the majority of the potentially toxic metals.”
In particular, uranium was the most available metal in the smoke, which is a known carcinogen, and other metals such as nickel were found, which is known as a carcinogen, immunotoxin, and neurotoxin. Long-term exposure to heavy metals such as these has been known to increase the chances of head and neck cancer.
The authors do point out that some factors may influence the level of exposure to metals, such as where the tobacco was grown since the number of metals in the tobacco depends on geographic factors-and how the hookah is used (e.g., using liquids other than water for filtration). However, the core message-that water-based filtration has a minimal impact-is unaffected by these variables.
How Many People Use Hookahs?
Much of the concern about hookah use is among youth, and the Monitoring the Future survey provides information about their use among 12th graders. In 2010, when questions about hookah use were first included, 17.1 percent of 12th graders said they’d used a hookah in the past 12 months, but in 2013, this rate had increased to 21.4 percent. However, only 9 percent had used hookahs more than five times in the past year, so most are experimenting or just occasionally using the devices.
Much of the other research into hookah use has been in college students and young adults, but some adult findings are available. The 2009-2010 National Adult Tobacco Survey found that around 1.5 percent of U.S. adults had used a hookah in the past month, but in a 2011 survey of young adults (aged 18 to 34), 8 percent had used one in the past month, and 17 percent had done so at some point in their lives. For college students, past-month use is typically at around one in 10.
Myths About Hookah Use
The new study addresses one key myth about hookah use: that the water in the pipe helps filter out toxins. The belief appears to come from the fact that hookah smoke feels “smoother” on the throat, but this is more related to moisture content than toxic chemicals. Hookah smoke is known to contain carbon monoxide, tobacco-specific nitrosamines (carcinogens found in tobacco), aldehydes (like formaldehyde) and volatile organic compounds, among many other harmful chemicals present in cigarette smoke.
There is also a perception that hookah users consume less nicotine than smokers, but studies show that the nicotine exposure from using a hookah is about equal to — or even greater than — that from smoking cigarettes. A typical hookah session lasts much longer than the time taken to smoke a cigarette, and for this reason, users may be exposed to more nicotine as well as more toxic chemicals compared to smokers.
Finally, the assumed “safer” nature of hookahs doesn’t stand up to scrutiny: hookah use is associated with lung cancer, heart disease, respiratory illnesses, oral cancer and other smoking-related health conditions.