For kids hoping to avoid the drugs and alcohol crowd, the next best thing is a fad called a hookah which allows groups of teenagers and young adults to smoke flavored tobacco together, in a community-like environment, through a single, multi-hosed water pipe. What most teenagers do not know however, is that smoking from a hookah waterpipe is no safer than smoking cigarettes and in fact, with the additional of charcoal ignition and prolonged smoking-sessions, may indeed be even more harmful than traditional smoking methods. Furthermore, research is beginning to show that as with other “gateway” habits, the “innocent” hookah smoking habit often eventually leads to cigarette smoking and/or drug use.
Also known as a waterpipe, narghile, argileh, shisha, hubble-bubble, and goza, a hookah is a water pipe (i.e. smoke is passed through a water basin before inhalation ) constructed with a smoke chamber, a bowl, and a multi-stemmed (sometimes single stemmed) pipe, that is used to smoke a flavored tobacco called shisha. Shisha is a specially made tobacco that is available in a variety of flavors (e.g., apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon). The wide available flavors of course, makes smoking from a hookah even more appealing to teenagers and young adults.
In the middle east and Arab world, people smoke from a shared waterpipe as part of their culture and traditions. Social smoking, groups of people smoking together in a communal-type setting, is done with a single or double hose hookah, and sometimes even triple or quadruple hose hookahs for parties or small get-togethers. When the smoker is finished, either the hose is placed back on the table signifying that it is available, or it is handed from one user to the next, or folded back on itself so that the mouthpiece is not pointing at the recipient.
The practice of hookah smoking began its spread to the United States in the early 2000’s. From 2000 to 2004, over 200 new hookah cafés opened for business, most of them targeted at young adults. According to a 2011 survey, nearly half of college and high-school students had smoked tobacco from a hookah.
Hookah construction and components
A typical modern hookah waterpipe consists of a head (with holes in the bottom), a metal body, a water bowl (and cover), and a flexible hose with a mouthpiece.
Also known as the head of the hookah, the bowl is a container, typically made of Pyrex, stainless steel, porcelain, ceramic, clay or marble. The bowl holds the charcoal and tobacco during the smoking session. The bowl is loaded with tobacco and then covered with a small piece of perforated aluminum foil or a hookah cover screen that is typically made from glass or metal. Lit coals are then placed on top of the aluminum foil, which allows the tobacco to heat to the proper temperature and evaporate the tobacco contents into the chambers located below. A snap-on ashtray sits below the bowl to catch any tobacco or ashes falling from the bowl.
The bowl of the hookah is attached to the top of the hookah body. The body of the hookah sits on top of the water jar, typically a glass or acrylic base filled partially with water. A downstem hangs down below the level of the water in the jar. Smoke passes from the hookah bowl, through the hookah body, and out the downstem where it bubbles through the water into the empty air space above the water line. Passing the smoke through water cools and humidifies the smoke. Liquids such as fruit juice are sometimes added to the water. Pieces of fruit, mint leaves, and crushed ice may be sprinkled into the water.
One or more flexible tube hoses allow smoke to be drawn from the water jar, cooling down the smoke before inhalation. The end of the hose is fitted with a metal, wooden, or plastic mouthpiece.
The various hookah components are attached (or detached) via rubber grommets which allow tight, sealed connections. Many hookahs also contain a purge valve connected to the airspace in the water jar. The purge valve allows smokers to purge stale smoke which has been sitting unused in the jar too long.
The tobacco used in a hookah is a syrupy mix that uses molasses and vegetable glycerol as moisturizer and has specific flavors added to the tobacco mix. Typical flavors include apple, grape, guava, lemon, mint, as well as many other fruit based mixes. Charcoal is the source of energy to produce heat that will be transferred to the tobacco inside the bowl.
The jar at the bottom of the hookah is filled with water sufficient to submerge a few centimeters of the body tube, which is sealed tightly to it through rubber or plastic grommets. Often the bowl is covered with perforated tin foil or a metal screen and coal placed on top of the screen. The foil or screen separates the coal and the tobacco, which minimizes (but does not eliminate) the inhalation of charcoal ash with the smoke and reduces the temperature the tobacco is exposed to, in order to prevent burning the tobacco directly.
When one inhales through the hose, air is pulled through the charcoal and into the bowl holding the tobacco. The hot air, heated by the charcoal vaporizes (but does not burn) the tobacco, thus producing smoke, which is passed down through the body tube that extends into the water in the jar. The smoke bubbles up through the water, losing heat, and fills the top part of the jar, to which the hose is attached. When a smoker inhales from the hose, smoke passes into the lungs, and the change in pressure in the jar pulls more air through the charcoal, continuing the process.
If the hookah has been lit and smoked but has not been inhaled for an extended period, the smoke inside the water jar may be regarded as “stale” and undesirable. Stale smoke may be eliminated through the purge valve, if present. This one-way valve is opened by the positive pressure created from gently blowing into the hose.
Health effects and the dangers of hookah smoking
Many teenagers and young adults are drawn to hookah smoking as an alternative to drugs or cigarette smoking. Unfortunately, although the toxins in hookah smoke may be different from that of cigarette smoke, that doesn’t make smoking from a hookah any less harmful, especially considering that hookah smoking sessions usually last for an hour or longer of almost near-continuous smoking. A 2005 WHO report states that smoking using a waterpipe poses a serious potential health hazard and is not a safe alternative to cigarette smoking. The average hookah session typically lasts more than 40 minutes, and consists of 50 to 200 inhalations that each range from 0.15 to 0.50 liters of smoke. In an hour-long smoking session of hookah, users consume about 100 to 200 times the volume of smoke of a cigarette. The chemical compositions of cigarette smoke and hookah smoke are different, however, as the workings of the charcoal in the modern hookah causes the tobacco mixture to be heated to a lower temperature, as opposed to the higher temperature in a cigarette where the tobacco is directly burnt.
The charcoal used to heat tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, toxic compounds, heavy metals, and other cancer-causing chemicals (even after the smoke has passed through the water). Hookah tobacco and smoke contain numerous toxic substances known to cause lung, bladder, and oral cancers. Irritation from exposure to tobacco juices increases the risk of developing oral cancers. The irritation by tobacco juice products is likely to be greater among hookah smokers than among pipe or cigar smokers because hookah smoking is typically practiced (with or without inhalation) more often and for longer periods of time.
Contrary to what many hookah users believe, the water in the hookah does not filter out the toxic ingredients in the tobacco smoke. Researchers at the University of California analyzed toxins in hookah smoke and found that the participants inhaled acrylamide (linked with damage to the nervous system), acrolein (which can irritate the eye, throat and nose), benzene, carbon monoxide and naphthalene (which can damage red blood cells) when they smoked hookah. Levels of benzene byproduct were doubled and breath levels of carbon monoxide were more than doubled after the participants smoked hookah, compared with smoking cigarettes.
Furthermore, researchers at the Mayo clinic noted:
- Hookah smoke contains high levels of toxic compounds, including tar, carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). In fact, hookah smokers are exposed to more carbon monoxide and smoke than are cigarette smokers.
- As with cigarette smoking, hookah smoking is linked to lung and oral cancers, heart disease, and other serious illnesses.
- Hookah smoking delivers about the same amount of nicotine as cigarette smoking, possibly leading to tobacco dependence.
- Hookah smoke poses dangers associated with secondhand smoke.
- Hookah smoking by pregnant women can result in low birth weight babies.
- Hookah pipes used in hookah bars and cafes may not be cleaned properly, risking the spread of infectious diseases.