Hookah Health: Some Unfortunate Research

[thevoiceofzeke]

I know that this topic is covered all the time, but i thought I'd post an article I just wrote for my campus newspaper regarding hookah health and whatnot. I found some very reliable sources on the subject =). If anyone would like to read:

Unfortunate Research

The Truth (mostly) About Smoking from a Hookah




I've never referred to myself as a “smoker.” I've been a passenger on the anti-smoking (in public places) bandwagon in the past. I've been disgusted by the smell of cigarettes and friends of mine whose addictions I've watched develop. All this, and I've never been a smoker. I have, however, been smoking hookah for about four years.

I won't presume that most Flip Side readers need a tutorial on the “hookah,” so I'll keep this brief. It's a water pipe consisting of a ceramic bowl, an aluminum—stainless steel if it's quality—stem that extends into a glass bowl, and two paper- or rubber-based hoses. The base is filled partway with water, and the bowl with flavored “shisha” tobacco, which is tobacco soaked in fruit flavors, glycerin, and molasses, and then a screen is used to separate the tobacco from a hot coal that burns it.

Due to recent inquiries into my genetic health predispositions, I've been taking a deeper look into my own well-being, and this has inevitably led to some questions that have long been on my mind: Is hookah dangerous? Is it safer than cigarettes? Is it addictive? The answers, after a month of extensive research, are as follows: yes, no, and yes (contrary to personal experience).

A number of studies done by a number of scholars and members of the health community all point towards similar conclusions. According to a “hookah health” study done by Thomas Eissenburg, a psychology professor at Virginia Commonwealth University, “every risk of cigarette smoking is also associated with water pipes.” He goes on to say that “a hookah, which is smoked for about 45 minutes, delivers 36 times more tar than a cigarette, 15 times more carbon monoxide and 70% more nicotine.”

A further look into several other sources more or less confirm this, although the numbers vary pretty drastically from place to place). Another study sponsored by the CDC drew the following conclusions:

• A typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette.
• Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility.
• Hookah smoking is NOT a safe alternative to smoking cigarettes.
• Even after it has passed through water, the smoke produced by a hookah contains high levels of toxic compounds, including carbon monoxide, heavy metals, and cancer-causing chemicals.

Again, the numbers presented vary, but this is quite a sobering piece of information for any hookah smoker. I think I subconsciously avoided researching this subject, but it's clear to me now that, according to the scientific community, this isn't even a debate.

I feel compelled to present some arguments that run contrary to the aforementioned studies. The first is that there are several variables not taken into consideration in these studies. There are different kinds of shisha tobacco, different kinds of coals, different methods of smoking, and different materials to smoke from, all of which I'll elaborate on.

The choices in coals, and their speculative health effects, have not been studied to great length yet. There are “quick-light” coals that use chemicals to ignite faster and “natural” coals that are condensed wood or coconut (must be stove-lit). This choice likely changes your intake of “toxins.” Furthermore, there are different methods of smoking. Do you inhale or puff? Do you smoke through aluminum foil or a stainless screen? Logic would certainly suggest that puffing would be less detrimental to your throat and lungs, and studies on the effects of smoking through an aluminum screen have been inconclusive—it depends on how hot the coal is, whether the foil is touching the shisha, how many holes for ventilation are poked, and a few other less significant factors.

My second argument consists of my own personal experiences with hookah. I had to visit a chiropractor over the past Summer where I had multiple upper-body x-rays taken of me. I took a moment when looking them over to discuss the effects of my “smoking” habits with her, and took copies of them to a routine check-up with my family doctor a few days after that. The results: my lungs are in great conditions, as are my gums, throat, esophagus, stomach, etc. I have no signs smoking-related health problems. I'll say again that I've been smoking hookah for four years, granted it was a couple times a month in the beginning and has increased since I bought my own hookah. Still, I would think I'd be showing something. That, and I have absolutely zero signs of addiction. I've never had a nicotine withdrawal or an urge to smoke, and I've quit for months at a time without difficulty. I personally believe the “addiction” issue to be largely dependent on willpower anyway.

Lastly I'd like to bring up a couple more tidbits of information. Scientifically, the average length of a hookah smoking session is between 45 minutes and an hour. This is controllable and can also vary greatly, not to mention the fact that most hookah bowls are split between two or more people.

Smoking hookah is dangerous. Period. Now...I'm one who believes more or less that everything is killing me, and there's been a long-running argument between my cautious and reckless consciousnesses as to whether or not it's worth it to fear disease/death. None of this information has stopped me, or will stop me, from smoking hookah. It's an indulgence I partake in a few times a week, if not more, and I thoroughly enjoy it every time. It's up to you to take whatever you will from everything I've just written, but I highly suggest you experience it for yourself at least once.



Sources:

http://www.mayoclinic.com/health/hookah/AN01265

http://www.usatoday.com/news/nation/2005-1...kah-trend_x.htm

http://www.health.harvard.edu/press_releas...-hookah-smoking

http://www.cdc.gov/tobacco/data_statistics...okahs/index.htm

[FiveSpeedF150]

Well written.

[Stuie]

I will cop to the more CO, but tar and nicotine... not buying.

Did the Anti-Smoker Leagues fund these studies... bet so.

How do they know the amounts and how much is absorbed by the body... they find people to smoke then kill them and do a full autopsy? (not a medical person, seriously no idea, not being sarcastic)



Fertility.... if you have kids and smoked for years before they were conceived.



That's one.

[mattarios2]

i agree with stuie.

[indian_villager]

I'll provide the simplest counterpoint, evaporation vs. combustion. By the end of our session the tobacco is still there.

[thevoiceofzeke]

I will cop to the more CO, but tar and nicotine... not buying.

Did the Anti-Smoker Leagues fund these studies... bet so.

How do they know the amounts and how much is absorbed by the body... they find people to smoke then kill them and do a full autopsy? (not a medical person, seriously no idea, not being sarcastic)

Check the sources of my sources.

No, these studies were not funded by "anti-smoker leagues." I know what you meant by that term, but do some researching of your own please before you discredit mine. The sources are sound, the studies are sound. I've read two of them.

They know by checking the levels of nicotine and other chemicals in the bloodstream before and after smoking. The information about tar and nicotine levels is infallible. It's quite simple. One of the reasons there haven't been more studies about this is because hookah smoking hasn't become a full blown trend in America...yet. More attentions will be paid to it when it has.


I know people who smoke hookah don't want to hear any of this, but for the most part it's truthful (if not exact). If you want to draw a simple generalization based in fact, here's one:

Smoking a hookah bowl by yourself is worse that smoking a cigarette.

I'll provide the simplest counterpoint, evaporation vs. combustion. By the end of our session the tobacco is still there.

That's a null point. You're still inhaling the chemicals in the tobacco. Heat is still applied to the source to a point where the chemicals can be released into the air that you're inhaling.

Seriously people check my sources before you make some ill-conceived nonsensical argument, haha.

i agree with stuie.

That's unfortunate. Edited October 15, 2009 by thevoiceofzeke

[Hookie The Hookah]

There are a number of studies that suggest the opposite of what's being claimed here. Additionally, the methods used to obtain the data typical of these "sky is falling" type posts have proven to be dubious (ie the actual combustion of hookah tobacco which is not what happens when someone smokes a hookah). It is not reasonable to assume that vaporizing molasses and/or whatever else is in the tobacco would produce similar harmful chemicals as actually burning tobacco. The people who are interested in doing these kinds of studies are also doing so with a very large anti-tobacco bias, this can and will taint results. Everyone knows that tobacco is bad for you right? This is the assumption implicit in studying hookahs in America. If shisha had been historically made with something other than tobacco the research would be taking on a significantly different tone imo.

http://www.harmreductionjournal.com/content/5/1/19

This study is great, because it challenges the conventional wisdom of modern hookah research and unlike the sources you listed indicates that it was done independent of corporate funding.

I'm a student at VCU in Richmond VA. Richmond VA houses the HQ of Phillip Morris. VCU has partnered with PM to do studies on many different aspects of tobacco smoking. The problem with this "partnership" is that PM funds the studies entirely and then has FULL CONTROL over what information is released to the public. In the last few years VCU has published a number of questionable findings even more dramatic than what is suggested here. This is more or less the equivalent of PM simply saying "don't smoke hookah it's worse than cigarettes hehe," which is subscientific to say the least. Edited October 15, 2009 by Hookie The Hookah

[thevoiceofzeke]

There are a number of studies that suggest the opposite of what's being claimed here. Additionally, the methods used to obtain the data typical of these "sky is falling" type posts have proven to be dubious (ie the actual combustion of hookah tobacco which is not what happens when someone smokes a hookah). It is not reasonable to assume that vaporizing molasses and/or whatever else is in the tobacco would produce similar harmful chemicals as actually burning tobacco. The people who are interested in doing these kinds of studies are also doing so with a very large anti-tobacco bias, this can and will taint results. Everyone knows that tobacco is bad for you right? This is the assumption implicit in studying hookahs in America. If shisha had been historically made with something other than tobacco the research would be taking on a significantly different tone imo.

http://www.harmreductionjournal.com/content/5/1/19

This study is great, because it challenges the conventional wisdom of modern hookah research and unlike the sources you listed indicates that it was done independent of corporate funding.

I'm a student at VCU in Richmond VA. Richmond VA houses the HQ of Phillip Morris. VCU has partnered with PM to do studies on many different aspects of tobacco smoking. The problem with this "partnership" is that PM funds the studies entirely and then has FULL CONTROL over what information is released to the public. In the last few years VCU has published a number of questionable findings even more dramatic than what is suggested here. This is more or less the equivalent of PM simply saying "don't smoke hookah it's worse than cigarettes hehe," which is scientific to say the least.

I acknowledged in my article that the science doesn't always agree definitively, and this certainly isn't a "sky is falling" post. You have to take into consideration that the only conclusions drawn by the CDC-sponsored study suggested that shisha tobacco still contains chemicals that can cause various types of cancer and other illness, but they don't say that the degree of intake is significantly more or less than any other method of smoking.

I do believe the whole "15x more of this, 200x more of that" argument is a little blown out of proportion, and you also have to consider the conditions under which these studies were held. The science isn't entirely reliable, as I've stated in the article, but to deny that you aren't taking in nicotine and a much greater volume of smoke is an affront to common sense.

The combustion thing is kind of silly too. Just because the tobacco is shisha is soaked in molasses and uses indirect heat to burn doesn't mean that it doesn't burn. It's a question of how hot the tobacco gets, not if it turns to ash.

I'll admit that HRJ's take on the subject is certainly valid, but it still doesn't debunk the fact that hookah is bad for you just like cigarettes are. This isn't necessarily about a comparison between the two, I'm just trying to demystify some people who for some reason believe that because your smoke travels through water first, it's "safe."


It's an ever-changing argument as there have been no long-term studies. Comparing hookah health detriments to those of cigarettes is also somewhat silly because the nature of smoking hookah is drastically different. Hookah is still bad for you. That's the bottom line.


edit: I should add that I haven't had time to read the entire HRJ study yet, but I read the methods and conclusions. Edited October 15, 2009 by thevoiceofzeke

[UGAHookah]

Excellent article. One thing I'd consider is that cigarettes have tar added to them and Hookah tobacco does not. The tar in hookah naturally comes from the burning of organic material. I'm not exactly sure how much "tar" the water filters but I would imagine that some is filtered. I wouldn't say smoking Hookah is worse than smoking cigarettes, one thing to take into account is that while the average hookah smoker may inhale much more smoke from one hookah session than if they were to smoke a single cigarette, your average cigarette smoker does not just smoke one cigarette a day. The average cigarette contains added tar and much more nicotine than shisha. I would imagine that smoking a pack a day is worse then a hookah session every other day or maybe even everyday. I could be wrong but hey I'm just speculating...

[thevoiceofzeke]

No I'd agree with you there. I intentionally left out the habits of cigarette smokers vs. those of hookah smokers because I had a 1000 word limit in the article and I figured most people would understand that. The HRJ study posted by Hookie made a point of touching on that subject and it is important. It was simply irrelevant to my article.

[Stuie]

Although many believe that the water in the hookah filters out all the "bad stuff" in the tobacco smoke, this isn't true. According to a World Health Organization advisory, a typical one-hour session of hookah smoking exposes the user to 100 to 200 times the volume of smoke inhaled from a single cigarette. Even after passing through water, tobacco smoke still contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). Hookah smoking also delivers significant levels of nicotine — the addictive substance in tobacco.

In the Mayo Article you posted he says this.

Where's the proof.

"President Obama said he would bring peace to the middle east"

Both are statements with out one lick of proof.

Where does WHO say this... Who at WHO said this? Where's his facts, where's his proof. Good Speech but no facts really stated.

[Hookie The Hookah]

The combustion thing is kind of silly too. Just because the tobacco is shisha is soaked in molasses and uses indirect heat to burn doesn't mean that it doesn't burn. It's a question of how hot the tobacco gets, not if it turns to ash.

It absolutely is not silly. It does not burn. Literally there is nothing about smoking hookah, save overheating a bowl, that results in combustion. Vaporizing and combustion are two different cats entirely. There are studies done on the difference between combustion and vaporizing that support this notion and while I am not an expert on this subject everything I've read is in direct conflict with the arguments made by these studies.

I've said this before in similar threads and I'll say it again: we will not know the long-term effects of hookah smoking until there are enough western long-term hookah smokers to form a decent study. Furthermore, as you suggested, the comparison of Hookah smoking to cigarette smoking is both stupid and pointless. Studies that use this format for researching the health effects of hookah are undermining their own credibility by making links that both are unneeded and problematic.

[thevoiceofzeke]

Although many believe that the water in the hookah filters out all the "bad stuff" in the tobacco smoke, this isn't true. According to a World Health Organization advisory, a typical one-hour session of hookah smoking exposes the user to 100 to 200 times the volume of smoke inhaled from a single cigarette. Even after passing through water, tobacco smoke still contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). Hookah smoking also delivers significant levels of nicotine — the addictive substance in tobacco.

In the Mayo Article you posted he says this.

Where's the proof.

Where does WHO say this... Who at WHO said this? Where's his facts, where's his proof. Good Speech but no facts really stated.

Well first of all the CDC and Eissenburg's studies echoes those facts. Not to mention you'd have to be a fool to deny that you inhale a ridiculously large volume of smoke from a hookah in comparison to ONE cigarette, and it should also be common sense that ALL BURNED TOBACCO contains carcinogens and chemicals detrimental to your health. The Mayo article says nothing of whether or not you get more or less of these chemicals with a hookah.


Please don't try to derail my thread with political philosophy. That's not what this is about.

[thevoiceofzeke]

It absolutely is not silly. It does not burn. Literally there is nothing about smoking hookah, save overheating a bowl, that results in combustion. Vaporizing and combustion are two different cats entirely. There are studies done on the difference between combustion and vaporizing that support this notion and while I am not an expert on this subject everything I've read is in direct conflict with the arguments made by these studies.

Okay, I'll give you this. It's my fault for misusing the term "burn." Regardless, it doesn't change the fact that you're inhaling chemical vapor released by a heat source. You're still getting the nicotine, right? What makes you think all the other chemicals are magically ignored in this process?

Hookie, I'm using the word "you" generally here. I don't disagree with much of what you're saying.

[indian_villager]

I'll provide the simplest counterpoint, evaporation vs. combustion. By the end of our session the tobacco is still there.

That's a null point. You're still inhaling the chemicals in the tobacco. Heat is still applied to the source to a point where the chemicals can be released into the air that you're inhaling.

Seriously people check my sources before you make some ill-conceived nonsensical argument, haha.

Ohh the buzz word of the anti-smoking league, "chemicals" until you put the smoke directly from a hookah into a gas cromatograph and the smoke that is exhaled to show the contents that are in the streams as well as the concentrations i am considering your argument null. With cigarette smoke, what is inhaled is combustion products of tobacco that is dried using fertilizer causing the existance of nitrousammines (sp?) which leading research shows is what causes cancer, also there is the myriad of other crap that is added to the tobacco post/pre drying (look up the list there is actually a list of FDA allowable chemicals which will still maim you). And I would not even begin to call the sources you put up as scholarly. I know of the paper that those articles are based off of. I just cant find it. Ask mushrat for help if you want it. If you closely read the article you will notice that the shisha was subjected to excessive tempratures to the point of pyrolisis. Now who among us has lifted their foil only to find nothing but ash? Exactly.

When I am done smoking I am usually left with moist tobacco. Almost an insignificant amount is pyrolized (inevitable) and the majority of what you are inhaling is glycerin vapor. I concede to the fact that smoking anything will not be detrimental to your health in any way, but I think this shit is exaggerated to the point of absurdity.

There is one paper that is a solid counter argument, but unfortuantely i can't dig it up right now which compares the blood of hookah smokers to cigarette smokers. The study showed that the blood of the hookah smoker was "cleaner" by a very high margin compared to that of a cigarette smoker.

Now I don't know what your background is as far as technical knowlege, but be sure that your sources put up credible arguments backed by proper data. I am a 4th year chemical engineering student. So before you walk around calling the arguments of the members "ill-concieved" and chuckling to yourself make sure you either put up better credentials or data.

[Hookie The Hookah]

It absolutely is not silly. It does not burn. Literally there is nothing about smoking hookah, save overheating a bowl, that results in combustion. Vaporizing and combustion are two different cats entirely. There are studies done on the difference between combustion and vaporizing that support this notion and while I am not an expert on this subject everything I've read is in direct conflict with the arguments made by these studies.

Okay, I'll give you this. It's my fault for misusing the term "burn." Regardless, it doesn't change the fact that you're inhaling chemical vapor released by a heat source. You're still getting the nicotine, right? What makes you think all the other chemicals are magically ignored in this process?

Hookie, I'm using the word "you" generally here. I don't disagree with much of what you're saying.

Yeah, I gotcha. I'm not trying to suggest that "chemicals" are absent from the process of smoking hookah, but rather that the studies I've read are informed by questionable practices (burning of tobacco and using machine "smokers" to test the burnt material for their chemical makeup). The fact is that you get wildly different chemical results from burning something as opposed to vaporizing it.

Nicotine is always going to be present as it is a chemical that builds up on the leaves of tobacco and thus will turn to vapor if vaporized or smoke if combusted; it won't be magically ignored, right. But this fact highlights another major deficiency in hookah research. That is distinguishing between washed and unwashed tobacco. Instead they just throw around that it's addictive without suggesting that you can get next to no nicotine from smoking tobacco that has had its nicotine almost completely removed. Edited October 15, 2009 by Hookie The Hookah

[Zinite]

http://en.wikipedia.org/wiki/Tar_%28tobacco_residue%29

Tar is the common name for the resinous partially combusted particulate matter produced by the burning of tobacco

There is this misconception that they add actual tar to cigarettes or shisha. Tar is any particle that comes from the combustion of tobacco. You're saying they did a blood test to determine the amount of tar:

They know by checking the levels of nicotine and other chemicals in the bloodstream before and after smoking. The information about tar and nicotine levels is infallible.

That is what it looks like you're saying. If you stand by that statement, anything else you're saying is discredited. There is no combustion taking place when you use a hookah properly. Period.

[Hippo_Master]

yeah, where's the tar? i never see it. And the nicotine, can't feel that either when it comes to the washed stuff. So it all comes down to monoxide - we all know this one. Big Surprise.

When they come do a study involving me - the way I smoke, the tobacco I use, the coals I use, the way I pack my bowl, the way I keep the tobacco from getting harsh - I'll give a shit.

I'm also perfectly healthy, if not beyond healthy, after many years of hookah smoking.

[Zinite]

These 'scientific' studies can be published all day long, but it doesn't mean anything until they bring in an experienced hookah smoker and study the chemistry of the smoke on both the inhale and the exhale. You should then be able to compare how much is being absorbed by the body. Do this with 50 different hookah smokers, with different types of tobaccos and coals, and you have yourself a legitimate study.

[Chreees]

I think nobody can prove shit about harmful effects of hookah smoking. Not enough proper research.

[Zinite]

I think nobody can prove shit about harmful effects of hookah smoking. Not enough proper research.

I don't think there's an argument about whether or not it's harmful. Of course it's harmful. Introducing anything like this into your body - especially in the quantities that us hookah smokers do - is going to be harmful. It's when 'studies' start saying that hookah is 500 times more harmful than a pack of cigarettes based merely on the volume of smoke, that we can bitch about it. But absolutely, proper research needs to be done.

[indian_villager]

Hell there has to be a gas cromatograph on campus they are willing to let me use. I'll look into it.

[Stuie]

Although many believe that the water in the hookah filters out all the "bad stuff" in the tobacco smoke, this isn't true. According to a World Health Organization advisory, a typical one-hour session of hookah smoking exposes the user to 100 to 200 times the volume of smoke inhaled from a single cigarette. Even after passing through water, tobacco smoke still contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). Hookah smoking also delivers significant levels of nicotine — the addictive substance in tobacco.

In the Mayo Article you posted he says this.

Where's the proof.

Where does WHO say this... Who at WHO said this? Where's his facts, where's his proof. Good Speech but no facts really stated.

Well first of all the CDC and Eissenburg's studies echoes those facts. Not to mention you'd have to be a fool to deny that you inhale a ridiculously large volume of smoke from a hookah in comparison to ONE cigarette, and it should also be common sense that ALL BURNED TOBACCO contains carcinogens and chemicals detrimental to your health. The Mayo article says nothing of whether or not you get more or less of these chemicals with a hookah.


Please don't try to derail my thread with political philosophy. That's not what this is about.

First off don't quote me and yell at me for saying something political then edit that out of the quote. That's a fast way to land on the Ban-Wagon, just ask mushrat.

Second I just pulled a ridiculous statement out of the air like the one in the Mayo article. I die hard conservative, not to be confused with Republican.

Third, my issue is that I am denying the volume thing, They just seemed to pull numbers out of the air.

Fourth, Are you going to say stop derailing anytime says the articles you posted might be skewed or not accepted as fact.

Fifth, As much as I would like to read all 3 articles, I really don't have time to point out some of your research's short falls.

Sixth, .. aww what the hell have fun here. I can't prove anything either way cause lack of research done by independent researchers

[indian_villager]

One more thing. Don't think you are some hero of health. This kind of thread comes up at least 3 times a year pushing the same data from the same source. We all know what we are getting into. If you have so much against it why are you smoking. People will do as they do. If you don't like what is happening you are free to leave.

[mitchard]

Smoking isn't good for you. I would like to think all of on here realize that.