Many Of The Hookah Labels Are Quite Misleading

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 scientists added that evaluating pH levels was necessary as higher pH levels enabled nicotine to rapidly absorb into the bloodstream and get transported to the brain, therefore higher ph levels had a higher addictive effect.

They further added that pH levels varied significantly among unwashed, washed and herbal hookah tobacco products that they had analyzed.

Senior author of the study and a research scientist in the Department of Health Behavior at Roswell Park Dr. Mark Travers, PhD, said, “The nicotine content of waterpipe tobacco is highly variable, much more so than we see with other tobacco products. In this study, we found that many of the labels were erroneous, with actual levels of nicotine varying anywhere from 75 percent less to three times higher than the amount stated on packaging.”

Travers, PhD, who is also a research assistant professor of community health and health behavior in UB’s School of Public Health and Health Professions further added that, “Regulating warning labels will aid waterpipe tobacco users in understanding the product they are consuming..”

Gary Giovino, PhD, a co-author of the study and professor and chair of community health and health behavior at UB added that the study provided an accurate evaluation of Ph levels and nicotine levels on several different hookah products. He also expressed his concern about the need for standard hookah product tests, more accurate product labels and health warnings.

Dr. Jessica Kulak, MPH, the study’s lead author and a PhD candidate in community health and health behavior at UB said that false labels and packaging information provides a false sense of security to hookah smokers and inaccurate information can have adverse health consequences.

She further added that their research would assist the U.S. Food and Drug Administration in regulating hookah products to safeguard users’ health.


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 named 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.

Normally, the tobacco mixed in hookah is different from the one that is found in cigarettes. Firstly, there is more tobacco in hookahs compared to 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.

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 hookah in a large group where each individual shares the hookah using the same pipe. 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 hookahs because “they come in flavors I like.”

Even though hookah smoke passes through water, it can still contain a lot of such toxins and cancer agents. Most of these substances cause lung, bladder and oral cancers. Since most hookah smokers have the tendency to hold most of the smoke in their mouth, even after several puffs, in order to exhale a large cloud of smoke, it significantly increases the risk of developing mouth cancer.

Therefore, to safeguard against such massive health risks, this research is welcomed in providing accurate information to hookah users, so they can make more informed and better decisions regarding hookah use.

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