Hooked on Hookah: Study Raises Questions About Water Pipe Smoking

A new study, "Water Pipe Smoking Among North American Youths," published in the June print issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics, describes the demographic characteristics of water pipe users. And what they found could blow supporters of this leisure activity out of the water.

Using data collected from questionnaires sent to 1,208 people ages 18 to 24 in Montreal, Canada, researchers found that 23 percent had used a water pipe during the previous year.

Also known as hookah, shisha, goza, narghile, and hubble bubble, water pipe smoking is a centuries-old tradition in Arabic societies that involves smoking tobacco by using an upright device with a small platform where tobacco is burned, a metal body, a base half-filled with water, and a hose with a mouthpiece for inhaling. But what researchers found was water pipes were more popular among people who were younger, male, speaking English, not living with their parents and who had a higher household income.

In a technical report accompanying last year’s American Academy of Pediatrics tobacco policy statement, the use of tobacco, in any form, can lead to addiction, significant morbidity, and premature death. Their statement also cites tobacco that is smoked through a hookah or water pipe. Tobacco smoke contains thousands of toxic chemicals, including many known carcinogens.

However, water pipe smoke contains nicotine, carbon monoxide and carcinogens, and may contain greater amounts of tar and heavy metals than cigarette smoke. The organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists says there is no safe method, level, frequency, or duration of tobacco use or exposure.

Hookah study project coordinator Erika Dugas has been following participants for a decade, since the age of 12. Now into their ‘20s, the participants were asked for the first time about their hookah use and the results surprised researchers.

In an interview with Coalitions Online, Dugas said water pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, and had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year, the study reported.

As the prevalence of cigarette smoking declines in Montreal, the United States and all over North America, smoking water pipes is becoming more popular. The study authors suggest that the growing popularity of water pipes may be due in part to perceptions that they are safer than cigarettes.

“There’s a misconception of the harmfulness for sure,” Dugas said. “It’s under the radar.”

Dugas and her team of researchers at the Nicotine Dependent In Teen study at the University of Montreal’s research center, hope this evidence of harmfulness will put the subject matter on health advocates’ and clinicians’ radars soon.

“People don’t really understand what it is. We have to make people realize what they are putting into their lungs,” Dugas said.

What’s worse, researchers say, is that hookah tobacco is not regulated by the Canadian Food Inspection Agency or the US Food and Drug Administration. Dugas and her team hope this research prompts policy makers in both countries to take an interest in it and regulate the product.

In a hookah water pipe, smoldering coals are used to slowly burn a mixture of tobacco, molasses, fruit, and flavoring. Children in both countries are taught that fruit is healthy, but hookah fruit flavors are especially appealing to youth and are sending the wrong message, Dugas said.

Researchers plan to survey their control group again in the Fall. Their work was supported by the Canadian Cancer Society.