Hookahs Safer Than Cigarettes? A Pipe Dream

Toking on Water Pipes Gaining in Popularity, but Full of Health Risks

Medically Reviewed by Laura J. Martin, MD on May 10, 2010
From the WebMD Archives

May 10, 2010 -- Lots of people who quit cigarettes to escape the dangers of nicotine are turning to water pipe smoking, wrongly assuming that toking on “hookahs” is safer, new research indicates.

Researchers used questionnaires and collected information on 871 Canadians aged 18 to 24 and found that 23% had used water pipes, commonly known as hookahs, during the previous year.

Water pipe users were more likely to have used psychoactive substances such as marijuana, the researchers say.

The youths who used water pipes tended to be younger, male, English speakers who didn’t live with parents but whose moms and dads had higher household incomes than other study participants.

Hookahs Healhier? No

A hookah is a single or multi-stemmed, often glass-based device used for smoking tobacco. The smoke is cooled and filtered by passing through water. They are popular in many areas of the world. But the study authors say the notion that hookah is safer than smoking cigarettes is erroneous.

“Little is known about the addictive nature or health risks of water pipe smoking, but it may be at least as harmful as cigarette smoking,” the authors write.

Water pipe smoke contains nicotine, carbon monoxide, and carcinogens and may contain even greater amounts of tar and heavy metals than cigarette smoke, the researchers say. Water pipe smoke has been linked to lung cancer, heart disease, infectious diseases, and pregnancy-related complications.

Researchers say that water pipe smoking has increased recently in North America and Europe.

Among their findings:

  • Hookah use was markedly higher among people who had smoked cigarettes, used tobacco products, drank alcohol, or engaged in binge drinking.
  • Water pipe use also was higher in people who had smoked marijuana or who had used illicit drugs in the past year.
  • Hookah users may constitute an advantaged group of young people who have the leisure time, resources, and opportunity to smoke water pipes.

The authors note that at least one researcher reported that a single session of smoking a water pipe might be equivalent to smoking two cigarettes for a non-daily hookah user, or 10 cigarettes for a daily water pipe smoker.

The World Health Organization has said that hookah use is equivalent to smoking 100 cigarettes in a 200-puff session. But outside the Middle East, few studies have been done on the subject.

Hookah Use in U.S.

In the U.S., between 9% and 20% of college students said they had used a water pipe in the past month. A 2006 Canadian study found that 7% of children in grades seven to 12 reported they had used a water pipe, and 3% in the past 30 days.

The researchers attribute use of water pipes, at least in part, to lack of publicity about possible dangers and the perception that smoking through a water pipe is less addictive than cigarette smoking.

That is a danger, they say. People who don’t smoke cigarettes may try smoking with a water pipe because of the notion that it is less harmful. To prevent this, the researchers say, more study is needed to gather evidence that might help people make more informed decisions.

The study is published online in advance of the June print issue of the journal Pediatrics.

Show Sources


News release, American Academy of Pediatrics.

Duglas, E. Pediatrics, June2010; vol 125: pp 1184-1189.

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