That smelled like a concoction of incense, fruits and cigars wafted to my nose Saturday morning as I entered Hideaway Head Shop, a Dinkytown hookah store. About a dozen eager college-aged customers hungrily stared with anticipation as a salesperson reached behind the counter to reveal an assortment of brightly colored hookah pipes.
The customers seemed to anticipate the moment they’d later puff fruit-flavored tobacco through their new pipes. But what may not have been on their minds is the health risks involved when smoking hookah, as with other tobacco products.
Hookah — a tobacco-smoking device which originated in India 400 years ago — is a hip new trend among college students, popular because of the perception that it’s a safer, less addictive alternative to smoking cigarettes. But emerging research is beginning to disprove this.
Recent studies by the American Lung Association, the World Health Organization and international researchers show that hookah may pose the same — even some unique — health risks as cigarette smoking.
In a typical one-hour session of hookah smoking, the user is exposed to at least 100 times the volume of smoke inhaled from one cigarette, according to a 2007 WHO advisory note. One session produces as much tar as 20 low-tar cigarettes. The smoke is also dangerous because it contains high levels of toxic compounds like carbon monoxide, heavy metals and carcinogens.
Probably the most common misconception is that hookah is safer than cigarettes because of a water filtering system that prevents chemicals from passing through the pipe, an idea suggested by a 16th century physician in India when hookah was invented. WHO asserts this claim is unsubstantiated.
“Using a water pipe to smoke tobacco is not a safe alternative to cigarette smoking. … Contrary to ancient lore and popular belief, the smoke that emerges from a water pipe contains numerous toxicants known to cause lung cancer, heart disease and other diseases,” the report said.
Despite the risks, hookah is an increasingly mainstream leisure activity. Since 2000, an estimated 300 hookah bars have opened in the U.S. and the phenomenon is quickly catching on among college students. Biology, society and environment senior Mohamed Mursal said University of Minnesota students mostly go to the hookah bar on University and Raymond avenues in St. Paul every Friday evening. He used to smoke almost every weekend last year, sometimes in his friend’s dorm room in Frontier Hall. Peer pressure had a lot to do with it.
“[My friends would] have the Xbox set up, a game on the TV. So whenever it’s a social situation there’s always hookah involved,” he said. “They said, ‘Try it, it’s not too bad, it’s filtered through water, and it’s not as bad as people say it is, just try it.’ And it smells nice, it doesn’t smell as harmful as cigarettes, so [I thought] why not?”
His smoking became a ritual: He’d smoke hookah for six hours a day with friends over winter break. The turning point for Mursal came when he couldn’t breathe properly, so he decided to quit. Despite this, he denies he was ever addicted.
Other college students I spoke with also said they see hookah as primarily a social activity with friends or a less stigmatized, legal alternative to cigarettes or alcohol.
“I can’t imagine [hookah] without the social aspect, because I don’t get pleasure out of the buzz,” said sociology and political science sophomore Anthony Streiff, who usually smokes hookah with members of his fraternity, Pi Kappa Alpha. “The only valuable part of it is doing it with other people. I probably wouldn’t do it if it weren’t for the social aspect. I don’t see the point.” He thinks cigarettes and alcohol carry more stigma than hookah.
“It’s really common to smoke hookah, and I think a lot of people believe cigarettes are much worse, but I haven’t seen evidence to back it up,” he said.
Freshman Abi Abu-Bakr also said she smokes hookah with friends during the summer.
“It’s social; it would be weird to smoke hookah alone just because we always smoke hookah when hanging out, so that’s what I associate it with,” she said. “It’s not something I do by myself.”
She said she would never smoke a cigarette, because she understands the health risks. “But in my head, when I started [hookah], I thought it was OK because it’s never been presented as a bad thing,” she said. “And there’s no nicotine in hookah,” she added.
This last claim, of course, isn’t true. A clinical study of hookah smokers found high nicotine levels in smokers’ blood and saliva, debunking the myth that hookah cannot be addictive. And while hookah is perceived to be an occasional leisure activity, it can be a gateway to nicotine addiction and increased tobacco dependency.
For example, a 2006 study examining the emerging trend in tobacco use among teens found that out of 411 college freshmen, those teens who had ever smoked hookah were about eight times more likely to experiment with cigarettes. This is dangerous because tobacco use is the leading preventable cause of premature death in the U.S. and is responsible for 435,000 deaths annually.
It’s precisely the social aspect of hookah that researchers warn against. Yet another study by the University of Memphis and the Syrian Center of Tobacco Studies stresses that the social aspect of hookah exposes users to more smoke over a longer period of time than do cigarettes. And the pleasant smell and taste can mislead users to assume it’s less risky.
It’s true that research about hookah’s risks is still emerging, but that’s all the more reason to remain cautious, even if you’re smoking just for fun.