Is Hookah Bad For You? How Unhealthy Is Hookah?

A friend pulls you to a corner and asks you to wait there, while he turns off the light. At some distance, you see a glowing container that looks like something from the Mogal Era. You wonder what kind of sorcery is it, and as you lift that pipe and let it transcend your mouth; the smoke gradually exudes through your senses, taking you into a world, unattached from the sins of reality.

Hookah, shisha, narghile or water pipe is a way to consume tobacco that originated in the Middle East and certain parts of Asia, but has started to expand to other western nations as well, most notably UK, Australia, Canada and US where teens and adolescents are at a higher risk due to its appeal.

The name comes from the device itself. The hookah as it is commonly referred to as in the Middle East is primarily a large bowl with coals sitting on top of it, in which water and tobacco are mixed. A long tube is attached to it from which the person inhales the smoke.

Hookah Is Not Synonymous To A Cigarette

Normally, the tobacco mixed in hookah is different from the one that is found in cigarettes. Firstly there is more tobacco in hookahs then found in most cigarettes, and secondly, the tobacco in hookahs is mixed with artificial flavors such as strawberry, blueberry, mint, and apple. The tobacco is burnt using coal, wood or charcoal, to create the smoke.

Modern Day Variants

Hookah comes in a variety of shapes, sizes, colors and styles, but they are similar based on functionality. Also, new forms of electronic hookah smoking, including steam stones and hookah pens, have been introduced. These devices are battery operated and function similarly to a real size hookah as the battery is used to power a motor that turns liquid filled with nicotine, flavors, and other chemicals into a vapor, that is then inhaled.

Although there is little information on these electronic hookahs, it is safe to assume that they cause the majority of symptoms and health risks associated with an actual hookah. It is common practice to enjoy a hookah in a large group where each individual shares the hookah using the same pipe.

Is Hookah Becoming New Trending Cool? 

A study was conducted by scientists from the University of North Carolina (UNC) by reviewing 40 other studies having similar topics. They assessed people’s attitude towards non-menthol tobacco flavors such as vanilla, cherry, toffee, and chocolate. The first author of the study Li-Ling Huang, Ph.D., said in a university news release, “We found that flavors for most tobacco products have a universal and rather a strong appeal to youth and young adults and that they were perceived as less harmful to younger people.”

The study pointed out that some of the cigarettes were less appealing to women because of having a taste for different flavors.

But still, flavors remain the common cause why teenagers experiment with cigarettes and then regularly use them.

In addition, teens also believed that flavored e-cigarettes are less harmful than flavored tobacco cigarettes.

According to the researchers, banning non-menthol cigarettes could reduce the use of cigarettes worldwide. Although The US Food and Drug Administration has banned the sale of non-menthol flavored cigarettes, menthol cigarettes are easily available. Also in the market are flavored cigars, cigarillos, hookahs, and e-cigarettes. This shows that similarly to e-cigarettes, the different flavors that hookah incorporates makes it so much more appealing, and tantalizing, because whatever your personal preferences may be you sure to find a flavor that will get you hooked.

Hookah Is Spreading In Frequency And Prevalence – Hookah is Spreading At Large

While policy makers are putting in all the efforts, to sum up, the laws against smoking Hookah at the same time Hookah is increasingly becoming popular amongst the people belonging to different walks of life. Young people are at risk the most because of the ridiculously wrong notion that Hookah is an alternate to smoking a regular cigarette since it is somewhat less of an evil.

Facts And Figures

  • High school students more inclined towards trying Hookah.
  • White students are at a greater risk.
  • Numbers are alarming in the high school students of Canada.
  • Students from financially strong families fall prey to Hookah smoking the most.
  • Flavours attract the Hookah smokers in the first place.

According to a study published in 2014, approximately 18% of high school seniors across the U.S. schools have smoked hookah. The researchers looked at 5540 high schools from 2010 to 2012. Moreover, white high school students were more at risk of trying hookahs compared to black students.

The researchers suggested that adolescent individuals belonging to well-off families appear to be at particularly high risk for hookah use in the United States. Therefore the researchers urged that preventive measures should be put in place that targets this group as hookah use grows in popularity.

Whereas in Canada, the stats are much more alarming as one in four high school seniors (25%) have tried the hookah.  Evidence also suggests that an estimated 40 percent of American college students have tried the hookah.  This could be due to the fact that most Hookah lounges are opening up close to college campuses all over the country.

Due to such a wide range of flavors that are used in hookahs, a person Is more likely to get enticed as these flavors are easily available in most tobacco shops, and a person can buy these flavors and use them in combinations to create their own flavor, causing them to try different flavors and endlessly experiment to make their hookah experience even more enjoyable. In 2013 till 2014, 78.9% of US adolescents aged 12 to 17 who smoked hookah said that they smoked hookah because “they come in flavors I like”

In 2015 more than 1 million high school students and an estimated 220,000 middle school students reported smoking hookah within the past 30 days. Due to the extent of which young individuals get affected by hookah smoke, policies should be adopted focusing on youth.

False Sense Of Safety Perpetuated By Hookah Labels

According to a new research by scientists from University of Buffalo and Roswell Park Cancer Institute, many of the labels on hookah tobacco products are quite misleading. These labels provide information on the ingredients and chemical composition of hookah tobacco and may misinform users.

The study has been published online in the journal Tobacco Regulatory Science. In this latest study scientists examined the nicotine content and pH levels of 140 different packages of 12 brands of foreign-made and U.S.-made hookah tobacco. The hookah tobacco was divided into three groups: herbal, washed or unwashed.

The scientists discovered that the nicotine levels in washed hookah tobacco products were 236 percent higher, overall than what the label claimed. Levels in unwashed products were 71 percent lower than what was mentioned on the labels, whereas herbal products were found to have nicotine levels which were accurate with the product labeling.

The study has stressed upon the dire need of developing standardized testing of all Hookah related products (i.e. Waterpipe Tobacco constituents) for pH levels and nicotine concentrations. It is, in fact, the need of the hour to develop regulations in terms of accurate labeling of the Hookah products.

Loopholes In Indoor Smoking Laws

Clean indoor air legislation is currently in effect in almost 30 states and individual districts in the form of different variations as a result of which there are smoke-free areas, zones and regions in those states and districts which in turn protects the health of the non-smokers in those areas. But there is the presence of loopholes in the indoor smoking laws currently in effect which allows the Hookah bars to take advantage and allow Hookah smoking in their premises more than compared to cigarette products smoking.

There is a need of amending indoor smoking laws and add water pipes and Hookah to the otherwise vague definitions. It should be mentioned clearly that Hookah bars are not exempted from the clean indoor air legislations and hence, they are also bound to adhere to the laws equally.

Because of the difficulty faced by health authorities in properly regulating hookahs in most public places, such as bars and cafes, adolescents and young adults are at a liberty of smoking and taking advantage of lapses in the regulations at these situations. The aforementioned facts and figures, as well as research-based evidence, bring us to the conclusion that now is the prime time to materialize laws and policies to regulate Hookah smoke in public areas objectively.

Is Hookah Worth The Cool Factor? – Hookah With Trendy Image Is Distracting The Focus From Its Harms

The trend of smoking Hookah and waterpipe has been rapidly gaining popularity in the United States equally amongst adults and the budding youth. Despite numerous studies highlighting the harmful effects of hookah, many young individuals choose to ignore the health warnings in favor of the relaxing and trendy image portrayed by hookah smoking.

To counteract this many health advocates and social health researchers argue that instead of just highlighting the potential consequences of health, health bodies and educational reforms should also focus on reducing hookah’s charm and romanticism, in order to cut down on this trend.

Circumstances Contributing Towards Hookah Smoking

  • The initiation of Hookah smoking was due to behavioral follow-up.
  • The normative status of Hookah smoke led to the positive attitude amongst the first time smokers.
  • Hookah smokers were more aware of the cons in comparison to the individuals who never smoked Hookah or waterpipe ever before.

A University of Pittsburgh School of Medicine study, published in Nicotine & Tobacco Research, examined a sample of 569 first and second-year students at the University of Florida.  The study investigated the circumstances in which individuals first started smoking from a Hookah, in order to determine the factors that led to their decision.

Participants were questioned twice about their opinions, knowledge, and behaviors over a seven-month period, on the matter of hookah smoking. During that time, 13 percent of the students started smoking hookah tobacco.

The researchers argued that the participants’ inclination towards hookah smoking was due to the fact that they had positive attitudes toward hookah smoking, which meant they viewed the activity as fun, relaxing, pleasurable and even sexual, and considered a form of social engagement.

The researchers further added that while the health hazards posed by smoking cigarettes are well known, hookah smoking is not perceived as having any sort of impact on a person’s health. All these factors combined increased the likelihood of participants to smoke hookah tobacco.

Time To Go Over The Social Acceptance Of Hookah

According to Jaime Sidani Ph.D., M.P.H., the study’s lead author and senior research specialist in the Program for Research on Media and Health (PROMH) at University of Pittsburgh, the participants who had less favorable opinions on hookah were less likely to initiate hookah smoking. It is necessary that in conjunction with focusing on educating about the health hazards of hookah, regulatory authorities should also try to minimize the sensational yet grim side of hookah smoking.

The researchers added that educational programs can cut down hookah usage if they can dismiss the positive portrayal and the way hookah is marketed as fun and engaging. This will make hookah smoking seem less attractive and reduce its social acceptance, which will result in fewer individuals initiating hookah smoking in the first place.

Air Quality In Hookah Lounges – A Public Health Hazard

The fumes released as a result of burning tobacco contains numerous chemicals which are present either in the gas phase or bound to other particles in the air. A measure of these particles in the air is a sure shot assessment of the presence of pollutants in the air.

In the past, restaurants and bars which allowed indoor smoking were assessed for air quality and the results of the particular studies revealed that all the customers and employees in those places were equally exposed to hazardous levels of toxic pollutants in the air.

Steven C. Fiala, MPH, and fellow researchers carried out their investigation of air quality in ten Hookah lounges operating in Oregon via an aerosol monitor, published in American Journal of Public Health. In order to assess the air quality in the most unaltered manner, the measurements were made in the Hookah lounges during their peak working hours and the results were then analyzed and interpreted utilizing the Air Quality Index set forth by United States Environmental Protection Agency (EPA).

The study concluded that toxins released into the air as a result of burning tobacco were present in high concentration in Hookah Lounges. The quality of sampled air, when measured against the Air Quality Index, was ranged from unhealthy to hazardous to breathe for humans. According to guidelines of EPA the presence of toxins and pollutants in these ranges can cause a plethora of health conditions to the people who breathe in it.

It is about time that individual states reevaluate their indoor smoking laws in order to omit any loopholes which may entitle the Hookah lounges to some form of an exemption hence protecting all of the related individuals from the grave health risks posed by second-hand smoke.

Policies that Can Limit Hookah Smoking

For health policy advocates need to divert their attention towards the budding forms of modern day tobacco products e.g. Hookah, e-Hookah specifically formulating legislation targeting this domain of tobacco use with the keen emphasis on its use amongst the teenagers and adolescents.

Programs put in place to control tobacco use should target and prevent youth from falling prey to it since most of the adults addicted to tobacco use highlight their adolescence as the age of initiation. When it comes to cigarettes the trend of smoking amongst the youth has been remarkably severed by the interventions making the cigarettes less available, less affordable and less desirable (by regulating the marketing of cigarettes) to them.

Centers for Disease Control and Prevention (CDC) has published a detailed study carried out by Daniel S. Morris and other public health workers highlighting some important recommendations and comments regarding how policy intervention can turn out to be a major step in curbing the Hookah use among youth and overall. Some of the recommendations are as follows:

Price Regulation

According to the study, the price is the main factor which has a direct impact on the buying power of youth. If the tobacco used in water pipe/Hookah becomes available on the market including the additional taxes that are otherwise applied on the cigarette and related products then it will help slow down the rapid sales of flavored tobacco which is the most popular form of tobacco among Hookah smokers.

Hana Ross has strongly emphasized on the effect of tobacco products (cigarettes) on the sale amongst youth in her study published in Health Economics. According to Hana’s research, the sales of cigarettes sees a major fall of almost 7% for every 10% increase in the prices of the cigarette. If the same hypothesis is applied to the sale of Hookah tobacco then it is fair to say that substantial decrease of Hookah smoking trend amongst the youth is fairly expected. CDC has suggested that if the prices of Hookah and Hookah tobacco were to be increased 2 folds than the expected decrease in consumption of such products can be as much as 60%.


Impact On Health Should Be Well Perceived

It has been pointed out by many types of research that the people who are inclined towards Hookah smoking because they look towards it as a safer alternative to smoking cigarette are often not well aware of the health risks posed by smoking Hookah.

The common belief among the youth is that since Hookah smoke contains less nicotine it contains less toxic materials hence a safer option to meet the smoking needs. It is the need of the hour that the entire Hookah smoking population group is to be educated regarding the harms and health risks of it so that their misconceptions and false assumptions can be addressed well in time.

Is Hookah Bad For You 

CDC has recommended that proper warnings pertaining to the health risks presented by water pipe and Hookah smoking should be made a part of the labels and advertisements. The labels can also accompany graphics so that the strong nature of the message is conveyed as suggested by Victoria White in a research report published in Addiction. At the moment, U.S. Federal Law requires appropriate warnings to be displayed on the labels of cigarettes but there is a lack of any such laws when it comes to Hookah tobacco.

Correct labeling of Hookah tobacco and related products to Hookah smoking may, in turn, help to correct the false assumptions and misconceptions to some extent.

Check And Balance On Flavored Tobacco Sale

The general social acceptance regarding Hookah smoke is fairly due to the fact that Hookah tobacco sale majorly constitutes of flavored variants and the peculiar sweet smell associated with the smoke. Unlike, the cigarette smoke which is pungent and leaves an odd stench behind, Hookah smoke smells pleasant and sweet leading to the belief that smoking Hookah tobacco is better than smoking a regular cigarette.

Shisha tobacco is sold in assorted appealing flavors which can even be a mixture of many as per the requirement of the customer of a hookah store. The benefit of the flavor to the hookah smoker has just initiated smoking hookah is that it is less difficult to inhale a flavored smoke than the usual cigarette smoke.

In 2009 a revision of the Tobacco Control Act led to the ban on all forms of flavored cigarettes in the United States. Food and Drug Administration of U.S. (FDA) does not require having an act approved by the Congress in order to instate a ban on flavored tobacco products of any kind. If a similar ban is imposed on the flavored shisha tobacco as well it will certainly be a giant leap towards making hookah smoking a less desirable act amongst the youth.



Promotion Of Smoke-Free Laws

Clean indoor air legislation is in effect in almost 30 states of U.S. as mentioned earlier. Such legislation ensures that smokeless or non-smoking environment is ensured in particular areas where these are enforced. But such laws lack proper words in their definitions which lead to the added advantage of Hookah tobacco smoking being exempted from them hence, allowing hookah smoking in the smoke-free areas.

Laws protecting the smoke-free regions have two-tier applications in a way that they not only protect the non-smokers from inhaling the second-hand smoke but also put a strict check on the smoking from becoming a social norm. The idea behind adding Hookah smoke to the smoke-free law is to ensure that the somewhat prevalent social acceptance of Hookah smoking is not allowed to flourish. Hookah bars and Hookah lounges should also be regulated by a set of laws in terms of their online presence where it should be mandatory to mention the harms and possible risks to health posed by Hookah smoke.

CDC suggests that the right step to monitor the spread of Hookah smoking in the form of apparently relaxing Hookah bars is to add Hookah smoke and related products into the smoke-free laws, so that not only unnecessary exposure to second hand Hookah smoke is avoided but also the misconceptions about the social and general acceptance of Hookah tobacco products can be curbed.

Keeping in view the recommendations of CDC and relevant studies the following two steps can act as a guideline towards policy advocacy to manage the undue spread of Hookah smoking as a social norm.

Step 1

The first step in order to minimize the use of hookahs among this age group is to reduce its appeal, i.e. de-glamourize it.

Studies consistently suggest a relationship between tobacco promotion and advertising and the likelihood of smoking in young adults. According to a longitudinal review of nine studies including 12,000 baseline nonsmokers aged 18 and younger, it was noted that the degree of receptivity and vulnerability among these adolescents was strongly linked with tobacco advertisements. Adolescents were found to be ‘enticed’ by the advertisements and developed an urge to experiment with cigarettes.

Step 2

Another step is to make hookah smoking safer, instead of completely banning it will be easier to limit the tobacco and all other related ingredients used in hookahs. By doing this will make it safer for consumers to enjoy smoking hookah, without sacrificing their health. Moreover, by forcing hookah bars to implement their regulations, more users will be able to enjoy this recreational activity knowing their health won’t be harmed drastically.

Governing health bodies such as the FDA are now regulating all tobacco products, including hookah tobacco. FDA now regulates the manufacturing, import, sales, packaging, labeling, advertisement, promotion, and distribution of hookah tobacco. This includes components and parts of newly-regulated tobacco products but at the moment do not include accessories such as lighters, tongs, or external burners.

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