Girl smoking waterpipeAs fewer teens are smoking cigarettes, other trends in tobacco and nicotine use are starting to rise. One of these is the use of e-cigarettes or e-vapes. E-cigarettes include the use of a nicotine containing cartridges that is vaporized so the use can inhale the product. A second trend is one I hadn’t given much thought to until recently: smoking a hookah. Is this dangerous? How does it compare to smoking a cigarette?

The hookah (aka water pipe) is a pipe where tobacco (or other leaves, like herbs or marijuana) is heated, the smoke passes through water to cool it into a vapor, and this vapor is inhaled through an individual mouth piece. Hookah use originated in Asia and the Middle East, but it’s popularity is growing in urban settings in the US. Unlike cigarette smoking, most states do not have a ban on hookah use inside public settings so hookah bars are starting to pop up. Teens are also finding their way to using the hookah.

A recent study released earlier in July in the journal Pediatrics found that hookah use amongst high school students is on the rise. They also found that males, white students, those from urban settings, and students whose parents had higher education were more likely to have smoked a hookah in the past 12 months. Though the study did not ask specifically what was being smoked, hookahs are often used to smoke various forms of tobacco.

If the tobacco smoke is being filtered through water vapor, does this mean it’s less toxic? No. Smoking a cigarette is usually done on an individual level: a person goes outside, takes a few puffs on the cigarette, and then goes back to their previous activity. Smoking a hookah is typically more social. There are often multiple mouth pieces and people usually gather around and sit for 30-60 minutes taking deep puffs while socializing. This leads to a person actually consuming a significantly higher amount of vapor and tobacco (as much as 100 puffs in a setting) than they would if smoking a cigarette. Due to the vapor being cooled, the user is also likely taking deeper puffs than they would with a cigarette. This draws the vapor deeper into the lungs, potentially increasing exposure. This exposure puts a person at risk for all of the complications of tobacco inhalation (lung, oral, gastric cancer and heart disease).

Teens and parents may have no idea of the risks associated hookah use. Tobacco for the hookah is often flavored, so it can be more pleasant to consume than a cigarette. It is also a very social activity, which can be enticing to teens. As parents and caregivers, we should talk about avoiding all tobacco and nicotine products when we discuss avoiding cigarettes, this includes smokeless tobacco (like snuff), e-cigarettes, and the hookah.