A new study, published in the journal Drug and Alcohol Dependence, sheds light on the increasingly popular use of hookahs by young adults.

“The popularity of hookah smoking among young adults is quite alarming given the potential for negative health effects,” said Erin L. Sutfin, PhD, lead author and assistant professor in the social sciences and health policy department at Wake Forest Baptist Medical Center. “Unfortunately, many young adults are misinformed about the safety of hookah smoking and some mistakenly believe it to be safer than cigarette smoking.”

Using a web-based survey sent to a random sample of students from eight North Carolina colleges and universities asking about smoking patterns, drug habits, and students’ knowledge about these activities, the researchers found that 40.3% reported having ever smoked tobacco from a hookah, while only a slightly higher percentage (46.6%) reported having ever smoked a cigarette. Nearly 25% of students reported being current smokers of cigarettes, and 17.4% said they actively use hookahs.

The survey results showed that freshmen and males were more likely to use hookahs and that there was an association between those individuals who used hookahs and those who smoked cigarettes, smoked marijuana, had a history of other illegal drug use, and had consumed alcohol in the 30 days prior to the survey. According to the researchers, it was also clear from the results that hookah users, in general, shared a mistaken perception that somehow smoking from a hookah was less harmful than smoking a cigarette.

Originally from India, a hookah, or water pipe, is a single or multi-stemmed smoking instrument, often made of glass, consisting of a smoke chamber, a bowl, a pipe, and a hose. The instrument uses charcoal to heat specially made tobacco that has been soaked in molasses or honey and is highly flavored. Most hookah cafes offer a wide variety of flavorings on their menu—everything from chocolate to bubble gum, mango to jasmine. In addition to the sweet smell and taste, the smoke produced by a hookah is “smoother” than cigarette smoke because it is cooled by water before passing through a rubber hose to a mouthpiece, where it is inhaled.

“The smoke produced by hookahs is a very mild smoke that may be appealing to non-cigarette smokers as a starter product,” said Sutfin. Cigarette smoke, by comparison, is a very harsh smoke, which can be irritating, Sutfin explained. She added that 22% of respondents who identified as hookah users had never tried a cigarette, suggesting that hookahs may be their first tobacco product.

While research about hookah smoking is still emerging, evidence shows that it poses many of the same dangers that smoking cigarettes does, including exposure to high levels of toxic compounds such as tar carbon monoxide, heavy metals, and cancer-causing chemicals. In fact, smoking a hookah exposes an individual to more carbon monoxide and smoke than does smoking a cigarette.. Hookah smoking also delivers about the same amount of nicotine as cigarette smoking does, which could lead to tobacco dependence.

Source: Wake Forest Baptist Medical Center