Hookah Health: Some Unfortunate Research

[ilikemyusername]

"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 typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette.

Personally, I know its not exactly good for me, but when I smoke shisha I don't feel like I've just smoked a carton of camel lights, if anything I actually feel BETTER. Remember that glycerine is a humectant, I'm actually moisturizing my lungs by smoking... and I like it that way.

[mitchard]

Personally, I know its not exactly good for me, but when I smoke shisha I don't feel like I've just smoked a carton of camel lights, if anything I actually feel BETTER. Remember that glycerine is a humectant, I'm actually moisturizing my lungs by smoking... and I like it that way.

True. I feel like shit after smoking one cigarette. I can smoke hookah for an hour and not feel anything like that.

But then again, I don't think we have seen a study related to the effects of evaporated glycerin within our lungs.

[ilikemyusername]

Personally, I know its not exactly good for me, but when I smoke shisha I don't feel like I've just smoked a carton of camel lights, if anything I actually feel BETTER. Remember that glycerine is a humectant, I'm actually moisturizing my lungs by smoking... and I like it that way.

True. I feel like shit after smoking one cigarette. I can smoke hookah for an hour and not feel anything like that.

But then again, I don't think we have seen a study related to the effects of evaporated glycerin within our lungs.

ever see an oil of olay commercial? same shit...

[arzan87]

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.

I'm not sure but do you mean this one? Posted by Eric in this link
http://www.hookahforum.com/?showtopic=32698&st=40

Here's a fun study that says its not that dangerous. This study involves people who smoke 50% tobacco/50% molasses mixtures and not cigarettes....

Hookah Tobacco Study

It has real things like statistics, data, hypotheses and all the stuff that makes science actually something worth reading...

And this is the one that apparently discredits the WHO study.

Unsure if this was posted before, but just in case, the material here by Chaouachi is relevant and directly refutes many of the assumptions and liberties published by World Health Organization as well as references by the BBC. Amongst other things, the report describes a large discrepancy that can be found due to particulars such as coal type, lack of coal movement, burning of shisha, frequency of tokes, etc.

http://www.jnrbm.com/content/5/1/17

The intro is as follows:

A critique of the WHO TobReg's "Advisory Note" report entitled: "Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators"
Kamal Chaouachi

Background and aim
The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved.

Results
We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field.

Conclusion
The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report.

I agree with Indian Villager here, its just the CO that can be proved to be harmful, everything else is, literally, up for debate

[SeanBeccaccio]

After the research that claimed NHT killed brain cells was proven to be complete bullshit I don't really trust any non-independent party's research.

I apologize if this post does break the rules, I thought it pertained to the subject. I'll serve my time if it does. =P

[thevoiceofzeke]

It seems like my argument has been taken for an "anti-smoking" rant, haha. I'm certainly not suggesting that people need to quit and I'm certainly not suggesting I'm a "champion" of health. This is getting borderline ridiculous. I'm simply presenting some data that's out there that was the centerpiece for my article and comes from credible (though not PERFECT) sources. I've admitted to the holes in my argument and that the sources are questionable....shit I even wrote that in my article 0_0. It's not ME arguing; it's just a presentation. Please keep the personal presumptions out of it.

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

Actually I think something similar was done in the HRJ study that Hookie posted. It's a very long and tedious read but it's very thorough and the conclusions, I'd say, are reliable. It's definitely more credible than my sources have been, too. Still, it'd be really interesting if you actually could do this and conduct a sort of study on your own...I'd be interested in your results.



I think this thread has run it's course. Perhaps it's the way I wrote my article, but too many misconceptions have been made to have a valid discussion in my opinion.

P.S. I'll be editing and resubmitting my article after reviewing the HRJ study; if for no other reason than to present it as a credible counter-source. Thanks, Hookie, for pointing me in that direction.

I think Zeke deserves a little slack here -- he was just writing a fluff piece (sorry, but it's a fluff piece), not a dissertation.

Thank you for acknowledging this. I had a 1000 word limit, haha. It was meant, as I said in another post, to demystify. It's also really only relevant to people that go to UW - Eau Claire. Everyone I encounter here often claims that smoking hookah is "healthy." Edited October 16, 2009 by thevoiceofzeke

[thevoiceofzeke]

Here is my revised article if anyone's interested:

Sort-of-Unfortunate Research

The Truth (mostly) About Smoking 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 disputable.

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.
• 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.

These studies—many of which have been corporately funded—have been met with counter-arguments from independent sources. There's the debate of combustion vs. vaporization, and one independent and extremely thorough (not speculative, like the Mayo and CDC studies) study by the Harm Reduction Journal has drawn quite different conclusions. Since I'm limited to one thousand words here, I urge you to read my sources, particularly the HRJ study.

A few reasons that the clinical corporate studies may be unreliable are as follows: the method of smoking was not elaborated on in any of them (ex. coal on foil or on the shisha; quick-light or natural coal; paper- or rubber-based hose; inhale or puff; etc.); the VCU study was funded by Phillip Morris which then had full control over what information is released publicly; these studies claim a normal session is “45 minutes to an hour,” which is a huge variable, not to mention the fact that a single hookah bowl is split often between 2 or more people.

I can add to HRJ's findings my own personal reinforcement. I have been smoking for a long time and yet, on a full body x-ray, I showed no signs of smoke-related health problems. I have a healthy heart, throat, stomach, and healthy lungs. I can also fully debunk any claims of addictiveness. I don't know and I've never heard of anyone addicted to smoking hookah.

Accept the fact that until more studies have been done on Western long-time smokers, we won't have flat out conclusive generalizations. It seems the only consensus that has been met among all of my sources is that the volume of smoke and the carbon monoxide intake is increased (duh) when compared to cigarettes (which is an irrelevant comparison to be making anyway). You should be intelligent enough to know that smoking hookah is dangerous. Period. You know that it's going to hurt your health, just like cigarettes, drinking, and other mind-altering substances often do. 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. Smoking, like anything else, should be done in moderation. 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 before making any decisions.



P.S. If you are interested in trying and you don't know anyone who owns a hookah, check out the Mediterranean Deli and Grocery at 628 Water St. It doubles as a reasonably-priced hookah café and the manger, Sam, is a flat out good guy (the food is delicious too).



Sources:

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

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

[Tyler]

Try this. Take a full drag of a ciggerette, then blow through a coffee filter, then do the same with a hookah. Compare.

[Nutshell]

http://www.youtube.com/watch?v=-DbFBu_I_lA
Here's the video where they filter 400 cigarettes through water.

[NUBBS]

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

I agree. I think most of the studies are done with original tobacco(tombac).

Also I wanna add, in the original post/article, the shisha is cooked not burned. Cigarettes burn, and if hookah burns you know, cuz its harsh.

[Genie]

I don't trust any of the studies because they don't describe the parameters of the test. Also, smoking ciggs always turned my teeth yellow. Hookah does not. Ciggs gave me "smokers" cough, hookah doesn't. I DO crave hookah. But not like I ever craved ciggs.

I've seen many a smoker excuse themselves after 45 minutes of hookah smoking to go satisfy their cigg urge. This makes no sense. If they're getting multple times the amount of nicotine from hookah than from a cigg, why must they still go smoke a cigg? I simply don't believe they're getting what their addiction needs from hookah. Be that nicotine or cigg additives.

Something in all these clinical hookah tests just doesn't add up.

[thevoiceofzeke]

I don't trust any of the studies because they don't describe the parameters of the test. Also, smoking ciggs always turned my teeth yellow. Hookah does not. Ciggs gave me "smokers" cough, hookah doesn't. I DO crave hookah. But not like I ever craved ciggs.

I've seen many a smoker excuse themselves after 45 minutes of hookah smoking to go satisfy their cigg urge. This makes no sense. If they're getting multple times the amount of nicotine from hookah than from a cigg, why must they still go smoke a cigg? I simply don't believe they're getting what their addiction needs from hookah. Be that nicotine or cigg additives.

Something in all these clinical hookah tests just doesn't add up.

Your logic is so unbelievably flawed.

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

I agree. I think most of the studies are done with original tobacco(tombac).

Also I wanna add, in the original post/article, the shisha is cooked not burned. Cigarettes burn, and if hookah burns you know, cuz its harsh.

All I have to say to you three is read the HRJ study. It perfectly describes the parameters of the test and makes infallible conclusions.


Also it's sheer ignorance to suggest hookah isn't harmful to your health. Of course it is to some degree. You people obviously just didn't read the entire thread. Edited October 16, 2009 by thevoiceofzeke

[ih303]

I don't trust any of the studies because they don't describe the parameters of the test. Also, smoking ciggs always turned my teeth yellow. Hookah does not. Ciggs gave me "smokers" cough, hookah doesn't. I DO crave hookah. But not like I ever craved ciggs.

I've seen many a smoker excuse themselves after 45 minutes of hookah smoking to go satisfy their cigg urge. This makes no sense. If they're getting multple times the amount of nicotine from hookah than from a cigg, why must they still go smoke a cigg? I simply don't believe they're getting what their addiction needs from hookah. Be that nicotine or cigg additives.

Something in all these clinical hookah tests just doesn't add up.

Your logic is so unbelievably flawed.

Genie is simply giving a first person testimonial of personal experience with hookah vs. cigarettes and making an observation that that experience does not jibe with the conclusions of the studies. That sounds like logic to me.

I appreciate your post, man. But don't come on here and belittle forum members. With only 21 posts and 4 years of smoking experience under your belt, you're the one who ends up looking like the fool.

[Genie]

I'd definitely never suggest hookah isn't harmful. I just don't buy the study results and I don't trust the study parameters. And I feel pretty justified not trusting clinical studies. Look how many "perfectly harmless" medications have been put on the market after years of study only to be to be recalled when people start having side effects (sometimes deadly) that never surfaced (or surfaced very rarely) during testing.

And, yes, the comments I made above were based on personal observation. I'm no scientist and I'd never encourage someone to take up smoking in any form. Smoking isn't healthy.

[Arcane]

Smoking hookah is dangerous. Period.

if you're concerned about the health issues of hookah, this is all you need to know.

accept it or quit.

i hate hearing people argue that hookah is safer than cigarettes...i do agree, but like someone roughly said, "its like saying you're gonna die in a car crash or plane crash"...doesn't matter how you get there, the destination is the same...so, enjoy the ride.

[Genie]

• A base, or smoke chamber, which is partially filled with water
• A bowl, which contains tobacco and the heating source
• A pipe that connects the bowl to the base and dips into the water in the base
• A hose, a second tube in the pipe that does not dip into the water but opens into air in the base and allows users to inhale the hookah smoke

This above is from: http://www.mayoclinic.com/health/hookah/AN01265 and it makes no mention of what type of heating source is being used nor does it mention the use of foil. It also doesn't mention what type of tobacco is being used. It states taht the bowl contains the tobacco AND the heating source. Who smokes hookah like that these days?

I was unable to access the second, third, and fourth sources cited: http://www.usatoday.com/news/nation/2005-1...kah-trend_x.htm , http://www.health.harvard.edu/press_releas...-hookah-smoking , and http://www.cdc.gov/tobacco/data_statistics...okahs/index.htm

I'm not one of those foolish enough to believe that the water removes any toxins from the smoke. I also realize that I'm inhaling carbon monoxide and I blame this primarily on the coals themselves. I don't know it to be fact, it's just a hunch. I can't wait for someone to invent the perfect electric coal. I think that would greatly decrease the amount of carbon monoxide we hookah smokers are getting during a session.

I should add that studies don't tend to describe the parameters of the test to my satisfaction. There is a great difference amongst coals and types of shisha. It also matters how much coal is being used. I'd also like to know to what temperature are they heating the shisha. Are they purposefully burning it or allowing it to bake gently like it should for proper hookah smoking.

[Chaz1337]

I don't trust any of the studies because they don't describe the parameters of the test. Also, smoking ciggs always turned my teeth yellow. Hookah does not. Ciggs gave me "smokers" cough, hookah doesn't. I DO crave hookah. But not like I ever craved ciggs.

I've seen many a smoker excuse themselves after 45 minutes of hookah smoking to go satisfy their cigg urge. This makes no sense. If they're getting multple times the amount of nicotine from hookah than from a cigg, why must they still go smoke a cigg? I simply don't believe they're getting what their addiction needs from hookah. Be that nicotine or cigg additives.

Something in all these clinical hookah tests just doesn't add up.

Your logic is so unbelievably flawed.

Genie is simply giving a first person testimonial of personal experience with hookah vs. cigarettes and making an observation that that experience does not jibe with the conclusions of the studies. That sounds like logic to me.

I appreciate your post, man. But don't come on here and belittle forum members. With only 21 posts and 4 years of smoking experience under your belt, you're the one who ends up looking like the fool.

He isn't belittling anyone, He has been a lot more respectful than others have in the past on this forum... Also in his article he blatantly says that he chooses to accept these risks no matter what they are... He isn't just some hookah nay-sayer. He is presenting the research he has done in a professional and unbiased way. People need to be aware of the POTENIAL health risks when beginning to smoke hookah.

[thevoiceofzeke]

Genie is simply giving a first person testimonial of personal experience with hookah vs. cigarettes and making an observation that that experience does not jibe with the conclusions of the studies. That sounds like logic to me.

I appreciate your post, man. But don't come on here and belittle forum members. With only 21 posts and 4 years of smoking experience under your belt, you're the one who ends up looking like the fool.

Firstly, thanks for posting some of your input.

That said, I wasn't arguing against Genie's personal observations, but her post seemed to implicate (at least the way I read it) certain things that can't be generalized just by personal experience.

Also...I'm not trying to belittle anyone. I guess that post was a bit inane and lacking substance, but I'm burnt out trying to clarify my intentions elsewhere. What does it matter how many posts I have on this forum or how long I've been smoking hookah? This isn't about me. I understand that you're coming to the defense of a forum member and that's justified, but please if you're going to criticize me for making personal judgments, don't make any yourself. That's hypocrisy.

I'm sorry that this post has been derailed so dramatically. I'm partly to blame for that. I think it should be locked, since the original argument has run it's course...we're basically talking semantics and making judgments now. It's a waste of time. Edited October 16, 2009 by thevoiceofzeke

[Sonthert]

I have also researched this issue. This is what I have found, contrary to your article, both from research and observation.

Tobacco doesn't burn and lead to pyrolysis products until 740-760F. This is the point at which nasty carcinogens like PAHs and acrolein are formed. I can't find any confirmation that acrolein is a carcinogen. Some sources say it is a suspected carcinogen and some sources say its an irritant only. Nitrosamines are an ever-present threat in many foods you eat on a daily basis and they are present in tobacco that has been mechanically cured, like the American tobacco industry does. It is present in much smaller amounts in tobacco cured naturally, like Australian and Sweedish tobaccos. Nitrosamines are not all carcinogenic, but some found in tobacco smoke are. Studies show that carcinogenic precursors in heavy hookah smokers are increased. That is beyond contest.

In terms of smoke volume, this is an irrelevancy, something "anti-smoking studies" have reveled in. First off, it is a vapor, it is not smoke, there are few to no suspended particles, as would be present in smoke. It is primarily comprised of vaporized glycerine. From a purely functional standpoint, a vapor is the vapor phase of some chemical when its liquid is heated (re: steam from water). It is largely the same chemical composition as the liquid it evolves from. A smoke, on the other hand is a different chemical composition from the material it is evolved from due to thermal chemical reactions. The studies have mentioned repeatedly that smoke volume is higher, but few have connected the amount of smoke to a risk assessment of the materials involved. The ones that have qualitatively explained that the vapor phase from a hookah is far more diffuse in terms of harmful chemicals from a hookah, that is, the smoke is far less harmful from a hookah or a per gram or m^3 basis than cigarette smoke.

Nicotine levels being higher is also a red herring, in my way of thinking. Nicotine is not overwhelmingly demonstrably a carcinogen. The studies I read regarding nicotine's carcinogenic nature seem suspicious. A higher nicotine level would logically add to the addictive nature of the tobacco. The cigarette companies like to cheat though, and add ammonia to cigarettes. Anecdotally, I have heard that the addition of ammonia came from the more powerful punch that tobacco treated with ammonia fertilizers had. The cigarette companies found adding ammonia added to the nicotine absorption in the bloodstream, spiking the nicotine levels in the body more. Ammonia, by itself is not a chemical you want in your body. Mixed with cigarettes, it makes them super-addictive. I have heard of a number of anecdotal studies that brier pipes and cigars have less of an incidence of addiction than do cigarettes. Even though, presumably a person smoking a large cigar or say five brier pipes a day would be burning far more tobacco than would the heaviest cigarette smoker. The cigar and pipe smoker would presumably be getting more nicotine as well...but seemingly nicotine levels aren't the only factor in play here. I have personally seen lots of cigarette smokers who, while smoking a hookah, will light up a cigarette. If they are getting all this nicotine from a hookah, why smoke a cigarette? Some addiction in their body must be going unfulfilled. If we assume that the cigarette companies haven't been cheating a lot and adding other addictive substances to cigarettes (I wouldn't doubt that they do, though), the nicotine amounts from hookah must be in some manner unsatisfactory for their addiction. Perhaps the ammonia makes all the difference? Overall, the point of the matter is, nicotine levels can't be the end all-be all in the conversation. There must be other factors playing into the equation. Its an incredibly complex question where one of the principal players (The cigarette companies) know the answers but aren't sharing them...perhaps thats why they lost an incredibly large lawsuit and the FDA is now charged with regulating whats added to tobacco. The science says, so far, that nicotine is not a carcinogen. That might change. What is reported to be the case (from that old shaky epidemiological evidence) is that nicotine suppresses your normal body's response to carcinogens though. That is, nicotine slows your bodies response to carcinogens from other sources.

The 1964 Surgeon's General Report reported that the mortality rate for cigarette smokers follows exactly what would be expected, the more cigarettes you smoke, the higher your mortality rate. For cigars, the relationship was much weaker. Only when cigar smokers smoked 5 or more cigars a day did they show a small increase in mortality rate. Some cigars are "natural" and some seem to be more processed like cigarettes (usually smaller cigars). Presumably people that smoke 5 or more cigars a day are smoking smaller cigars which if they are indeed more likely to be processed like a cigarette might explain the increase in mortality rate for people smoking 5 or more cigars. The same Surgeon General's Report found that pipe smokers (ostensibly brier pipes) showed no increase in mortality rate at all, no matter how many pipes they smoked a day or for how long they had smoked a pipe. This seems to complicate the issue significantly. Yes, lip and mouth cancers are increased, but these types of cancers are rarely fatal (according to Thomas Eissenberg, one of the people that wrote several studies that others here have quoted) which keeps the mortality rates down for pipe and cigar smokers. Not addressed, to my satisfaction by anyone is the rate of cancer, that is, do lip and mouth cancers in pipe smokers occur at the same rate as lung cancer in cigarette smokers? I can't recall a single "natural" cigar smoker I've ever known (or pipe smoker, although the sample pool is much smaller) getting lip or mouth cancer, but I've known dozens and dozens of people who smoked cigarettes getting cancer. I'm led to believe, purely by empirical observation (not very reliable, I know), that the rate of cancers in pipe and cigar smokers is lower (much lower?) than in cigarette smokers. That certainly doesn't make cigars and pipes safer, however, in the same way hugging a 15' copper rod during a thunder storm is not safer than hugging a 30' copper rod during the same thunder storm. You might have a lower chance of being killed, but its still a very stupid thing to do.

One additional thought. It could be very easily said that "epidemiological" research is less reliable than actual clinical studies. Most of the "smoking is dangerous" studies that are out there are purely epidemiological in nature. They say, chemical X causes Y to happen, which leads to Z which is a carcinogen. First off, there is no universal carcinogen other than radiation. Exposure to large amounts of Z doesn't guarantee cancer. Benzene is a carcinogen, for instance. The studies talk about carcinogens, but don't address how aggressive the carcinogen is, for the most part. A legitimate study would talk about the sampling methodology and how many people could be attributable to a particular cause and how many people got cancer and how many people didn't from exposure to Chemical X. If X only produces a small amount of Y, it might not be appreciably dangerous. If Y, they find doesn't actually go to Z most of the time, X might not be that dangerous. The longer the sequence of events that lack percentages and hard data (20% of X goes to Y and 80% of Y goes to Z as an example) predicated on more "studies show" that also lack hard evidence make the line of reasoning suspicious. It could be entirely correct, on the other hand. Its hard to say. If you looked up Benzene, for instance, one of the carcinogens found in cigarette smoke (but not hookah smoke presumably, benzene being related more to PAHs, but I have no study to support this). You could estimate how dangerous it is. Numerous laboratory studies have demonstrated beyond a reasonable doubt it is a carcingen. Cigarette smoke definitely contains benzene, so it definitely is a carcinogen. But the strength of benzene's carcinogenic nature is important too and its concentration in cigarette smoke doubly so. If benzene, for instance was present at one ppt (Part per Trillion), and it was the only carcinogen in cigarette smoke, we might say cigarette smoke is a carcinogen, but honestly say its not that much of a threat since there is so little there. The US OSHA's standard for Benzene is an 8 hour exposure of 10ppm (parts per million) or a ceiling of 25ppm. One 10,000th of that concentration in cigarette smoke isn't that much. If the concentration of benzene in cigarettes was 10ppm, however, we would be more worried, depending on how carcinogenic benzene is. To me, I doubt anybody who can't back up a claim with clinical numbers. Epidemiological numbers are inferior to clinical studies. A clinical study is proof, an epidemiological study is somebody's opinion. It doesn't take any effort and little research to make an epidemiological claim. I say benzene is a carcinogen and cigarette smoke contains benzene. I could even say that cigarettes smoke contains 100 times the amount of benzene as gasoline vapor does (I just made that up as an example of what these studies do). This would still be decent to say cigarette smoking is more dangerous than breathing in gasoline fumes, based solely on the benzene content. On the other hand if I found that chrysene (a PAH found in cigarette smoke) was 100 times higher in gasoline fumes than in cigarettes, then I would have to address how aggressive each chemical's carcinogenic nature was to "accurately" determine which was more dangerous.

These studies are saying the equivalent of "there's more hookah smoke than cigarette smoke, so its more dangerous". Huh? That's not science. That's why its important to understand that whatever carcinogens are in hookah vapors are far, far more diffuse than they are in cigarette smoke. They are at much lower levels. The amount of smoke is irrelevant. If you've ever drank soft water, it has the characteristic salty flavor people have come to associate with soft water from the NaCl used to remove calcium and carbonate ions. Somebody says "Well, I want to limit my salt intake, so I want to switch back to hard water." Its not an unreasonable line of reasoning, until you find out how diffuse sodium is in soft water. There is approximately the same amount of sodium in a bathtub full of soft water as there is in one slice of white bread. The amount of sodium in a slice of white bread is relatively small, not much of a threat to begin with, when you diffuse it out even more into a bathtub full of soft water it becomes negligible. Such is likely to be true with hookah smoke. The epidemiological approach to medicine might say "Soft water has sodium in it." now, with the same line of reasoning you are using, a tub of full of soft water that has sodium in weighs more than 1000 times as much as a slice of white bread. Since in the tub of soft water and the hookah smoke the component in question is far more diffuse, it is particularly ridiculous. It really should bring into question the motives of the author of the study saying there's more than 100 times the amount of smoke in hookah than in cigarettes. There's certainly more smoke volume in 3 large cigars than there is in 3 packs of cigarettes. One increases your mortality rate by at least 120% (The cigarettes) the other one doesn't increase your mortality rate at all (These are the actual numbers from the US Surgeon General's Report). So, volume of vapor or smoke is irrelevant and should be making you ask yourself "Why are these people lying?". What makes the volume of smoke important? Only if they are comparable, and no honest researcher will tell you that hookah smoke and cigarette smoke are the same. If they try and grab a strand and say they are, you should probably expect they have ulterior motives.

What does your article boil down to? Its well written and quotes sources. The science behind those sources, I would question. Those studies are all assuming (wrongly) that hookah smoke and cigarette smoke are equivalent.

I found some interesting data regarding second hand smoke. The 2006 Surgeon General's report lists increases in heart disease by 25-30% and Lung Cancer by 20-30%. A British study showed a 60% increase in heart disease. A 1992 Journal of Medicine study showed a 23% increase. All these numbers seem to be pointing in the same direction. It gives one a resonable pause to consider these numbers. Diesel exhaust increases lung cancer by 70% on the other hand (If I remember correctly), it has been given a status of not hazardous (although some people rightly question this). Why? The commonly accepted threshold for causation (beyond a correlation) is a 100% increase. This is to separate coincidences from actual causes. Second hand smoke falls well below this. Sure, I know, this seems a little hard to "swallow". The percentage increases for heart disease from a person smoking cigarettes is 800%. The percentage increases for lung cancer are 3500%. Thats a causation, not merely a correlation. The increases in heart disease and lung cancer for cigarette smokers are shockingly bad, really, really high. Its a no-brainer to declare that cigarette smoking causes heart disease and lung cancer. People in the smoking camp have called into question the methodology of arriving at second hand smoke's numbers being that high in the first place, saying that they are exaggerated and overblown. Even if they are accurate, they are really, really small in comparison to smoking a cigarette. In any case, second smoke is a much, much smaller threat than primary smoking, even if the current numbers for second hand smoking are right. Maybe some of you are slightly skeptical still. Here's an example of a false causation from a correlation...I'll just make up numbers, but the basis for it is real:

Press Release: Being married and having children is good for your health!

Researchers in Raleigh-Durham, North Carolina released a study today that showed people who were married lived longer than their unmarried counterparts. People who were married and had children lived even longer still. Experts at the University of North Carolina said "Its clear that having a family is good for your health. Our study found people who were married without children lived an average of 2.3 years longer, people who were married with children lived an average of 5.9 years longer. Women had slightly larger increases than men on average. Unmarried people with children showed almost no increase in life span. People with children who had their children die had a slightly lower average life expectancy."

Married good, children good. Children dying bad, single bad. So what's wrong here? I can't answer to actual studies that have concluded the same thing, this is our little thought experiment. What's the methodology? Its easy. For the sake of rhetoric, I looked at 10,000 people's files at the Hall of Records covering the period 1940-2005. I looked at their marital status, how many children they had and what age they died at. I compiled the numbers and derived an average for the groups "Married With Children", "Married With no Children", "Had children, but then they died", "Single" and "Single, with children". Married with children had the highest average age of death, then "Married with no children", then "Single, with children", "Had children, but the child died" and "Single" had the lowest average age of death.

Its easy to see the pattern here, since I laid it out this way. Children, married good, child died tragically, bad, single bad. So what did I theoretically do? Everything right expect use my powers of reason or honesty. Children and mothers who died during child birth stopped living and died at that age. The baby was "Single". The father who "had a child that died" could be unaffected. The mother who dies during child birth died early and depresses than number, though. Babies, juveniles or infants that died would depress the averages for single, not living long enough to get married. People who were in accidents that killed them and their children would depress the numbers for "had child, but it died" and single, assuming the child wasn't old enough to get married. Some people might get married and die before they've had children. Most of the time, the people having children are older than the people getting married, so deaths that occurred between marriage and having children would drag the married with no children averages down. So why, then could we explain away my BS study's finding that single people with children have lower life expectancies? Because children might in reality shorten your life and being a single parent is a bitch and you work yourself to death trying to provide for them. The "study" glosses over the causes of death. Which are important. Pretty much, if you live to be 20 and no bad luck befalls you, you will live to be 70 or 80. The deaths of infants will kill the average for people who never got married. This study could develop a correlation to show that having children and getting married is good for your health. It would always fail before it got to 100%, though. The increases are always 5-20%. Thats why they are a correlation, not a causation. If I said that babies who die at infancy alive less time than the same people who had them, its obvious. Thats the source of the correlation. How they died, not whether they were single or not. If the tradition was that when a baby was born it was married to somebody immediately, by way of an arranged marriage, the same study would show only an increase in lifespan from having children.

It was also noted that women lived slightly longer. Why do women live longer? Why have women been losing ground to men lately in terms of how long the live? Are men living longer or women living less time? In 1950, if we asked this question, it would be obvious. Men, and only men, went to war and died young. Women didn't and lived a normal life span. Currently, more and more women are joining the military. They can go off and fight and die now, too. This is only one component of the question though, there are undoubtedly a lot of other factors entering into it, but these things affect it. This is why average lifespans in some African Countries are so low. Disease is one factor, being killed in yet another war is the big one, though. In some countries, the women outnumber the men 2:1 or more. Thats not because more women babies are being born, though.

This is the failing with many of these tobacco studies. They dwell on correlations, which are intrinsically based on supposition or opinion attributing death or cancer or whatnot to what they chose to. If they can get to 100% and their methodology is sound they found something.

Thats my three cents. Thanks for reading this.

[Sonthert]

Oh, one more side point, a lot of studies use either raw tobacco or a mixture of 50% tobacco 50% molasses as their test mixture. They don't test the same hookah tobacco we are smoking.

[rhineholt]

I saw your post Sonthert and I was like nah, I'm not gonna read it.
but then I did. and it was amazing!

[Zinite]

Eric wins the thread

[indian_villager]

I don't trust any of the studies because they don't describe the parameters of the test. Also, smoking ciggs always turned my teeth yellow. Hookah does not. Ciggs gave me "smokers" cough, hookah doesn't. I DO crave hookah. But not like I ever craved ciggs.

I've seen many a smoker excuse themselves after 45 minutes of hookah smoking to go satisfy their cigg urge. This makes no sense. If they're getting multple times the amount of nicotine from hookah than from a cigg, why must they still go smoke a cigg? I simply don't believe they're getting what their addiction needs from hookah. Be that nicotine or cigg additives.

Something in all these clinical hookah tests just doesn't add up.

Your logic is so unbelievably flawed.

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

I agree. I think most of the studies are done with original tobacco(tombac).

Also I wanna add, in the original post/article, the shisha is cooked not burned. Cigarettes burn, and if hookah burns you know, cuz its harsh.

All I have to say to you three is read the HRJ study. It perfectly describes the parameters of the test and makes infallible conclusions.


Also it's sheer ignorance to suggest hookah isn't harmful to your health. Of course it is to some degree. You people obviously just didn't read the entire thread.

You come in with some seriously harsh word. Who here is ignorant enough to say that hookah is healthy. Every one in this thread has acknowledged that hookah is by no means healthy. We just feel it is not as detrimental as those studies suggest. I think you need to take it easy and watch your tone.

[redjako]

Well written.

Those are all the same poorly conducted studies with pump devices on a constant pull (never mind you the burning which people dont smoke) and the measurement of volume.

[redjako]

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

Critique of the majority of studies performed upon le hookah.