Hookah Smoking: A Deadly Recreation
By Mansur Khan, M.D
Hookah smoking has been around for almost 500 years, particularly in South Asia, the Middle East and Africa. Hookahs, or water pipes – also known as narghile, goza and shisha – have gained worldwide popularity over the last several years, including in Europe and the U.S.
Part of its resurgence, particularly in Western countries, is the misperception that it is a healthy alternative to cigarette smoking. Much of this misperception is based on the mechanics of the waterpipe: the smoke passes through a body of water, which smokers mistakenly believe filters the smoke.
Hookah smoking is a social experience, often done in groups. The tobacco, called maassel, comes in packets pre-mixed with honey, molasses and other fruit flavorings, contributing to a pleasant taste and smell. All of these factors contribute to the idea that this is a benign recreational experience.
Numerous studies have demonstrated this casual attitude, especially in adolescents. A recent study of Arab-American teens found that 27 percent had used a water pipe.
Studies in other countries around the world found similarly high rates, especially in youth. Hookah use is often an initial state of later addiction to cigarettes; in fact, teen users had double the rate of becoming cigarette smokers later on.
The data paints a picture dramatically different than what the public believes. Because hookah smoking sessions can last up to an hour, and inhalations are more sustained, hookah smokers may inhale as much smoke as 100 or more regular cigarettes in a single sitting.
Carbon monoxide, which is toxic to the brain, was 4 to 5 times higher after a single hookah session compared to cigarettes. Hookah smoke contains 36 times more tar and up to 250 percent more nicotine than a single cigarette.
Nicotine is the component of smoking that creates addiction. Additionally, there are more toxic heavy metals, such as lead, nickel, chromium and cadmium, compared to cigarette smoke.
What effects does all this have? Hookah smokers have five times the risk of lung cancer as non-smokers. They have four times the risk of throat cancer and 13 times the risk of cancer of the larynx.
Hookah smoking is associated with lip and bladder cancer. Evidence suggests a role in infertility, low birth rates in pregnant mothers and adverse effects on the cardiovascular system.
There is no controversy here: hookah is not a safe alternative to cigarettes.
With such a high prevalence of use among Iranians, it is imperative that the Iranian American community be educated about its realities. Hookah use reflects how certain customs are so firmly entrenched in different cultures, even those that imperil our well-being.
Dr. Mansur Khan is an internal medicine physician practicing in the San Gabriel Valley. He co-founded UMMA Clinic as a student at UCLA and currently serves on its advisory board.
