A recent study looked at hookah use in California, and the results were concerning. From 2005-2008, hookah use among adults in the state increased by 40%, with young men, ages 18-24, reporting hookah use twice as often as all adult men.  Use was more common among people with some college education, non-Hispanic whites, young adults, and current and former cigarette smokers.

The dangerous contaminants, including tar, carbon monoxide, heavy metals and carcinogens remain in the smoke, despite passing through the water.

While public indoor smoking is banned in California, hookah use is allowed in hookah lounges that are classified as retail tobacco shops.  The researchers note that the American Lung Association suggests that the public cigarette ban may actually be helping to increase the popularity of the lounges because they provide a legal alternative for smoking socially with peers.  It may also give the impression that hookah smoking is safe.

Contrary to popular belief, however, hookah use is not safer than cigarette smoking, and there are some ways that it poses even greater medical risks to users.

A hookah is a water pipe that has a smoke chamber through which the smoke from specially formulated tobacco is passed.  It is then drawn into a rubber hose and into a mouthpiece from which it is inhaled. The dangerous contaminants, including tar, carbon monoxide, heavy metals and carcinogens remain in the smoke, despite passing through the water.

Hookah sessions often last as long as an hour and smokers inhale more deeply from the pipe than from cigarettes, so hookah smokers may in fact inhale 100-200 times the volume of smoke inhaled from a single cigarette in a typical hookah session. They receive the same amount of nicotine as from cigarettes and are at equal risk of addiction.

Hookah smokers are exposed to higher levels of carbon monoxide than cigarette smokers because charcoal is used to heat the tobacco in the pipe.  The health risks associated with hookah smoke include lung, bladder and oral cancers, cardiovascular disease, and low birth weight babies. Additionally, because pipes are often shared, hookah smoking increases the risk of transmission of infections, including tuberculosis, viruses such as herpes and hepatitis, and others.

The secondhand smoke from a hookah is as dangerous to nonsmokers as from cigarettes and has the additional toxicity of a higher carbon monoxide level.

The study was published in the American Journal of Public Health, online, ahead of print.