Despite the hype, hookah is not a safe alternative, expert says

In a recent study published in Cancer, Epidemiology, Biomarkers and Prevention, Gideon St. Helen, PhD, and colleagues revealed that smoking water pipes, also known as hookahs, is not necessarily an innocuous social diversion.

St. Helen, from the Division of Clinical Pharmacology and the Center for Tobacco Control Research and Education at the University of California, San Francisco, reported that after a single evening of water pipe smoking in a hookah bar, young adults had increased urinary levels of nicotine, cotinine, tobacco-related carcinogens and volatile organic compounds.

Hookah smoking continues to gain popularity among young people, despite increased efforts to crack down on cigarette smoking. According to a 2010 CDC survey of high school seniors, one in five boys and one in six girls reported smoking a hookah in the past year.

In an interview with HemOnc Today, St. Helen discussed his findings, their implications and the pervasive social misconceptions about hookah smoking.

HemOnc Today: What do these findings suggest about the long-term effects of hookah smoking?

St. Helen: That’s a really good question, because one of the things we said in the discussion is that you’d expect people who smoke water pipes chronically, like over several years, to have an increased risk of disease. But to put a number on the risk, we’d need epidemiologic studies. Our study is a first step in providing epidemiologists with data on the type of exposure levels hookah smokers or water pipe smokers have. Because that’s what’s missing when it comes to doing quality epidemiologic studies; there are really no good studies that have looked at what levels of these carcinogens hookah smokers are exposed to.

HemOnc Today: Why do you think the general public perceives hookah smoking as being a safe alternative to cigarette smoking?

St. Helen: I think there are probably a number of reasons. The first is that with the water pipes, there is a bowl or a jar with the water in it. And the idea is that when you breathe the smoke, it bubbles in the water. And people think the water sort of “scrubs” the smoke of a lot of its pollutants. So that’s the general idea; I think people assume that because of the water, the smoke they are inhaling is free of a lot of the toxins that are present in the the smoke. And that’s why they might think, “Oh, I’m not inhaling toxic compounds.” And what we’ve shown is that this isn’t necessarily true; you are still taking in very dangerous compounds.

Another reason for this perception, I think, is when people use hookahs in a social setting, they share it with multiple users. And the probably think that because they’re sharing it, they don’t take in as many toxic compounds as when they’re smoking by themselves.

HemOnc Today: One shocking comment that you made was about having witnessed whole families smoking water pipes together, including young children.

St. Helen: Yes, that was in 2006. I had just started doing my PhD at the University of Georgia, and I was studying secondhand smoke. I went to a party, a birthday party, held at a Middle Eastern restaurant in Atlanta. And when you walk in, you see the tables with people smoking Hookahs, and I saw little kids – about six, seven, eight years old – smoking them with their families. And I was surprised by that. So, that was my first exposure to hookahs.

HemOnc Today: Is letting a child smoke a hookah equivalent to secondhand smoke exposure? Or is it worse?

St. Helen:  Well, the thing about hookah smoke is, it’s different than cigarette smoke. There are similarities between hookah smoke and secondhand cigarette smoke, but also distinct differences. One of my colleagues, Peyton Jacob III, PhD, wrote a paper last year in which he compared cigarette smoke with hookah smoke, and found a lot of differences. For instance, you will find higher levels of benzene in hookah smoke, and we know that benzene causes leukemia, and that’s a risk for children. But there are other compounds that are higher in tobacco smoke than in hookah smoke. You really can’t compare the two, because there are important differences.

But another important concern is related to the high levels of nicotine that children take in with hookah smoking. We know that children’s developing brains are susceptible to the effects of nicotine addiction. So that’s definitely a concern when it comes to children, the possible effect of nicotine on their developing brains. We know that for persons who are exposed to nicotine at a younger age, the possibility of them becoming addicted is higher.

HemOnc Today: What is the overall risk of addiction with hookah smoking for the average adult?

St. Helen There are studies that need to be done on this. This is definitely one area of interest to us, the likelihood of addiction to hookahs. That’s one area that needs to be studied. Right now, though, we don’t know the answer to that.