The Hazards of Waterpipe Smoking

One of the hot trends in tobacco use is waterpipe smoking (the terms hookah, narghile or shisha are also used)(description here). Hookah bars are located throughout the U.S., especially near college campuses. 

While waterpipes vary in design, they all allow for charcoal-heated air to pass through a tobacco mixture and then through a water-filled chamber before being inhaled through a flexible hose. Owing to the use of charcoal, the resulting smoke contains toxic by-products of combustion. 

A study published last year in Food and Chemical Toxicology (abstract here) by researchers at the American University of Beirut and the Virginia Commonwealth University compared the smoke from a waterpipe with that from a conventional tobacco cigarette.  The lead author was Alan Shihadeh and the senior author was Thomas Eissenberg, a member of the FDA Tobacco Products Advisory Committee.

Dr. Shihadeh and colleagues first observed the smoking behavior of 31 waterpipe smokers during a 45- minute period.  They then programmed a smoking machine to puff on a waterpipe to produce a representative session; the mainstream smoke was analyzed for various by-products of combustion.  The results for a 45-minute waterpipe session are seen in the table below, compared with the emissions from a single cigarette.

Mainstream Smoke Emissions From a 45-minute Waterpipe Session Compared with a Single Cigarette
Agent (amount)	Waterpipe	Cigarette
Nicotine (mg)	1.04	0.73
Carbon Monoxide (mg)	155	12
Nitric Oxide (ug)	437	218
Tar (mg)	464	9.4
Benzo(a)pyrene (ng)	52	6.6
Volatile Aldehydes (ug)
Formaldehyde	59	21
Acetaldehyde	383	587
Acetone	118	270
Methacrolein	122	--

mg = milligrams

ug = micrograms

ng = nanograms

The waterpipe smoke contained considerable quantities of toxic by-products of combustion, in addition to nicotine.  Although there are clear differences between a 45-minute waterpipe session and smoking 10 to 30 individual cigarettes daily, the “results were unambiguous,” as the researchers commented. 

Waterpipe smoking produces unacceptable levels of toxic contaminants.  Don’t be snookered by hookah.