Hookah Smokers Exposed to More Toxins

As cigarette smoking rates fall, more people are smoking tobacco from hookahs—communal pipes that draw tobacco smoke through water. A new analysis led by the University of Pittsburgh School of Medicine shows that hookah smokers are inhaling a large load of toxicants. 

The findings, published online and in the January/February print issue of the journal Public Health Reports, represent a meta-analysis, or a mathematical summary of previously published data. The research team reviewed 542 scientific articles potentially relevant to cigarette and hookah smoking, and then narrowed the articles down to 17 studies that included sufficient data to extract reliable estimates on toxicants inhaled when smoking cigarettes or hookahs.

Researchers discovered that, compared with a single cigarette, one hookah session delivers about 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide.

“Our results show that hookah tobacco smoking poses real health concerns and that it should be monitored more closely than it is currently,” said lead author Brian A. Primack, an associate professor of medicine, pediatrics, and clinical and translational science. He added that hookah smoking was not included in the federal 2015 Youth Risk Behavior Surveillance Survey System questionnaire, which assesses cigarette smoking, chewing tobacco, electronic cigarettes, and many other forms of substance abuse.

Primack and his co-authors note that it is complex to compare a hookah smoking session to smoking a single cigarette because of the differences in smoking patterns. A frequent cigarette smoker may smoke 20 cigarettes per day, while a frequent hookah smoker may only participate in a few hookah sessions each day.

“It’s not a perfect comparison because people smoke cigarettes and hookahs in very different ways,” said Primack, who also is assistant vice chancellor for research on health and society in Pitt’s schools of the health sciences. “We had to conduct the analysis this way—comparing a single hookah session to a single cigarette—because that’s the way the underlying studies tend to report findings. So, the estimates we found cannot tell us exactly what is ‘worse.’ But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize.” 

Along with the Pitt School of Medicine, the study also included researchers from the Squirrel Hill Health Center, the American University of Beirut, the VA Pittsburgh Healthcare System, and Virginia Commonwealth University.

This research was funded by a National Cancer Institute grant.