Commentary: Hookah Use is on the Rise and Surrounded by Myths and Misperceptions

I am writing this post having recently returned from the First International Conference on Waterpipe Tobacco Research, which was held in Abu Dhabi in October. Sponsored by the NYU Abu Dhabi Institute, International Development Research Centre, Syrian Center for Tobacco Studies, NYUAbu DhabiPublicHealthResearchCenter, and the AmericanUniversity of Beirut, conference participants met to exchange expertise regarding waterpipe tobacco smoking – a rapidly growing epidemic. While many waterpipe tobacco smokers often think that this method of tobacco use is safe, all available scientific data demonstrate that it is in fact dangerous and addictive.

In recent years, there has been an increase in hookah use around the world, most notably among youth and university students. The United States is not immune. The Monitoring the Future survey for 12th grade students found that in 2012, 18.3% of high school seniors in the United States had used hookahs in the past year, up from 17.1% in 2010. Other studies of young adults indicate that hookah smoking is more prevalent among university students in the United States, with past-year use ranging from 22 percent to 40 percent.

Even this past week, in their latest Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) reported that while cigarette use among our nation’s youth decreased between 2011 and 2012, consumption of non-conventional tobacco products, like electronic cigarettes and hookah, increased in that time period. The Food and Drug Administration (FDA) currently does not regulate non-conventional products like hookah, and I am alarmed by the research that shows, in study after study, that these products are increasingly getting into the hands of America’s young people.

While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks. One reason is that smokers inhale charcoal combustion products when they smoke hookah. Another reason involves the way hookah is smoked, including frequent, high-volume puffs and long smoking sessions. In fact, multiple studies from several countries, including the United States, show that, in a single hookah session, hookah smokers are exposed to much greater amounts of toxicants than a cigarette smoker after a single cigarette. A typical 1-hour-long hookah smoking session involves approximately 100 puffs, while an average cigarette is 10 puffs. A typical puff from a hookah can be 10 times the volume of a puff from a cigarette. Overall, a typical hookah smoking session involves inhaling 100 times the volume of smoke inhaled from a single cigarette. The smoke from a hookah contains many of the toxicants that are in cigarette smoke, including polycyclic aromatic hydrocarbons that cause cancer, volatile aldehydes that cause lung disease, nicotine that causes dependence, and carbon monoxide that is associated with cardiovascular disease.

We have come too far to allow this new strain in the tobacco pandemic to take hold across the globe. I urge you to watch this video, which was produced with Legacy®, and shares research on the harms of hookah. Additionally, please share this declaration with policymakers and other public health advocates. It was agreed upon by more than 100 scientists, policy makers, academics, and public health advocates from 18 countries across five continents and recommends actions that can be taken now to reduce the public health threat posed by growing popularity of waterpipe tobacco smoking.

Thomas Eissenberg, PhD