Early studies: Hookah may be harmful

WASHINGTON, March 23 (UPI) -- Preliminary research suggests smoking water-pipe tobacco -- or hookah, a trend increasingly popular among college students -- could be as harmful as cigarettes, according to a new report.

The American Lung Association report claims the filtering and flavoring of hookah do not make it less dangerous.

"There are a lot of misperceptions about hookah tobacco use. There's very little information in the public realm," said Thomas Carr, national policy manager for the ALA.

Many believe using a water pipe is safe since the smoke is filtered through water and a hose, removing harmful agents. Not so, according to the ALA's report: Links have been found between water-pipe usage and oral, lung and bladder cancer, in addition to heart disease and clogged arteries.

Though limited, research has also shown nicotine in the body increased by 250 percent after just one 40- to 45-minute session of hookah smoking. Since people spend a longer period of time smoking hookah, they may inhale more carcinogens -- possibly up to the equivalent of 100 cigarettes.

Another risk in smoking water pipes is inhaling harmful chemicals from the charcoal or wood fragments used for heating the tobacco, such as carbon monoxide or metals. A 1993 study in the Journal of the Pakistan Medical Association found smoke from water pipes could contain carbon monoxide levels up to 1.4 percent, while cigarette smoke usually contains levels of 0.4 percent. Water-pipe smokers may also need to worry about infectious diseases, since hookah smoking is often a social activity in which mouthpieces are shared. The heat and moisture create an opportunity for bacteria and viruses to be easily spread.

The tobacco, which is usually a combination of tobacco and honey, molasses or dried fruit, is heated up by either charcoal or burning embers. The smoke is then filtered through a bowl of water or another liquid, such as wine, and inhaled through a hose with a mouthpiece. The tobacco used in water pipes often comes in a variety of flavors, such as berry, vanilla, apple and mint.

However, very few studies have been conducted on the use of water-pipe tobacco. Because many water-pipe smokers are also cigarette smokers, it's hard to isolate the water pipe's effects from cigarettes.

Thomas Eissenberg, a professor in the Department of Psychology and Institute for Drug and Alcohol Studies at Virginia Commonwealth University, said it's important to inform people of the risks of using water pipes to reduce this potentially harmful behavior.

Packages of tobacco used for water pipes are misleading because some are marked 0 percent tar. This is technically true but deceptive because tar is a component of the smoke, not the actual, physical tobacco.

"There's an unproven statement that water-pipe tobacco smoking is less risky than using cigarettes -- there's no evidence that this is true," Eissenberg said.

However, "there's no doubt there are limitations to the research we have now. There's one study of the nicotine levels of 14 Jordanian men. People are going to be reluctant to believe that," he said.

Hookah bars and cafes have gained popularity in the United States in recent years, often springing up in large cities and near colleges. The sweetened, flavored tobacco makes smoking hookah less irritating than smoking cigarettes. The novelty, mystique and social camaraderie surrounding this ancient practice, which originated in Persia and India, is as another reason for its spread, Eissenberg said.

Water-pipe smoking is sometimes not banned under state laws that prohibit smoking in public. Laws either exempt hookah bars and cafes or neglect the issue altogether.

Mostly 18- to 24-year-olds have taken up the habit, Carr said, but he worries it could become a gateway to cigarettes in teens.

"It appears teens are more likely to smoke cigarettes if they use hookah," Carr said. "Tobacco companies use flavors to graduate beginning smokers into addicted smokers."