Water Pipes Don't Make Smoking Safer

Nicotine and other cancer related toxin levels elevated by using a water pipe to smoke tobacco

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Smoking tobacco out of a water pipe has become very common and is often thought of as a safer alternative to smoking cigarettes. But is that belief backed up by evidence? 

A recent study found that one night of smoking water pipes in hookah bars significantly increased levels of nicotine and other cancer-related agents in healthy young adults.

The researchers concluded that the large intake of toxic chemicals from smoking tobacco out of a water pipe might increase the risk of cancer and other chronic conditions.

"Quit smoking tobacco in any form."

The lead author of this study was Gideon St. Helen, PhD, from the Center for Tobacco Control Research and Education at the University of California, San Francisco and the Division of Clinical Pharmacology and Experimental Therapeutics at the San Francisco General Hospital Medical Center.

The study included 55 healthy adults between the ages of 18 and 48 years old who were experienced water pipe smokers.

The average age of participants was 25 years old, and 44 percent were female.

The participants did not smoke any tobacco for the week prior to the study.

On the day of the study, the researchers collected three urine samples from each participant: one sample before going out to a hookah bar, one sample immediately when they got home from the hookah bar, and one sample the next morning upon waking up.

The researchers tested the urine samples for levels of nicotine, cotinine, NNAL and volatile organic compounds.

Cotinine is produced when nicotine enters the body. NNAL has been found to cause pancreatic and lung cancer, and is produced when tobacco-specific chemicals enter the body. Volatile organic compounds are known to cause cancer and cardiovascular and respiratory diseases.

This study showed that after one night of smoking a water pipe in a hookah bar, the average level of nicotine in the participants’ systems increased by 73 times.

The average level of cotinine in the participants’ urine increased by four times after one night of water pipe smoking.

In addition, NNAL levels doubled after one night of smoking.

The researchers discovered that the amount of volatile organic compounds in each participant increased between 14 and 91 percent.

When the urine samples from the morning after were tested, Dr. St. Helen and team found that the levels of each toxin remained elevated.

Compared to the urine samples taken before the participants went out to smoke, nicotine levels were still elevated by 10 times, cotinine by three times and NNAL by two times on the morning after smoking.

The researchers also discovered that the length of time spent smoking and the number of bowls smoked were associated with the degree to which levels of each toxin increased.

The researchers determined that continuous use of water pipes may increase the risk of cancer and other chronic diseases.

"Water pipe smoking is generally perceived to be a safe alternative to cigarette smoking, even for children and youths. Our study shows that water pipe use, particularly chronic use, is not risk-free,” Dr. St. Helen said in a press statement.

This study was limited because the volatile organic compounds were not specific to tobacco smoke and some of the participants had been exposed to secondhand smoke during the week prior to the study. Furthermore, the findings were based on one single smoking session, so toxin levels may be even more elevated among water pipe smokers who smoke multiple times per day.

This study was published on May 16 in Cancer Epidemiology, Biomarkers & Prevention.

The California Tobacco-Related Disease Research Program, the US Public Health Service and the National Institutes of Health provided funding.

Review Date: 
May 16, 2014
Last Updated:
March 12, 2015