Tobacco is Tobacco is Tobacco

Smoking tobacco out of a hookah is just as bad as cigarette smoking

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) It’s time to debunk myths about hookah smoking being safer than cigarette smoking. As cigarette smoking has plunged over the last decade, teens are turning to hookah smoking .

A recent proposal released by the Centers for Disease Control and Prevention (CDC) outlines ways to level hookah tobacco with cigarette tobacco.

Reducing all tobacco use is the best way to prevent health problems from tobacco.

"Talk to your doctor about the health risks of tobacco."

Daniel S. Morris, PhD, from the Public Health Division of the Oregon Health Authority, led the investigation into youth rates of hookah smoking in the US. Dr. Morris and his team researched how hookah tobacco is affecting American adolescents. A total of 18.5 percent of high school seniors claim to have smoked hookah tobacco in 2011.

Dr. Morris said, “Preventing youth smoking is a priority for tobacco use control programs, because most tobacco users become addicted during adolescence.”

“[H]ookah smoke contains many of the same toxins as cigarette smoke and has been associated with lung cancer, respiratory illness, low birth weight and periodontal disease.”

Hookah tobacco has all the same health risks as cigarette tobacco. Yet hookah tobacco is commonly believed to be “safer” than cigarette tobacco. Hookah tobacco is cheaper, flavored, acceptable to smoke indoors in more places, perceived as less harmful and easily ordered online when compared to cigarette tobacco.

Differences in regulation of hookah tobacco vs. cigarette tobacco:

  • Accurate labeling of nicotine levels
  • Flavoring
  • Taxes
  • Warning labels
  • Smoke-free environments
  • Online ordering

Studies have shown that hookah tobacco nicotine labels are not always accurate. Nicotine levels have been found to be 10 times higher than the label claimed. In 2009, flavored cigarette tobacco, except for menthol, was banned under the Family Smoking Prevention and Tobacco Control Act. Hookah tobacco was not part of the Act and is available in many different teen-friendly flavors.

Hookah tobacco, including flavored tobacco, is considered “pipe tobacco” and is not taxed at the same rate as cigarette tobacco. In Oregon, pipe tobacco is taxed at a rate of $2.83 per lb., while cigarette tobacco is taxed at $24.78 per lb.

Dr. Morris’ team estimated youth hookah smoking would drop by approximately 60 percent from equalizing hookah tobacco taxes to those of cigarette tobacco.

Hookah smoking falls under the indoor smoking exemption of cigar or pipe smoking. While approximately 75 percent of major metropolitan cities in the US don’t allow indoor cigarette smoking, 90 percent still allow indoor hookah smoking.

By allowing indoor hookah smoking, mixed messages about health risks of hookah smoking can confuse adolescents. Rates of hookah smoking for 8th grade students in Oregon nearly doubled from 2.7 percent to 5.1 percent when hookah lounges became popular.

In the US, the Prevent All Cigarette Tracking Act prohibits mailing cigarette or smokeless tobacco, but not pipe tobacco. All an adolescent needs is access to a credit card to order their very own hookah tobacco. Authors concluded, “[S]uccessful strategies for reducing cigarette use among youth and young adults should also work for hookah use.”

This study was published in November in Preventing Chronic Disease: Public Health Research, Practice, and Policy. Funding was supported by Oregon’s Tobacco Prevention and Education Program and Measure 44 tobacco tax revenues. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
November 26, 2012
Last Updated:
December 3, 2012