Hookah Smoking Isn't A Safe Alternative

Smoking water pipes exposed smokers to high levels of carbon monoxide

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

(RxWiki News) Hookah smoking may seem like a less harmful alternative to cigarettes. But the charcoal brick heating the hookah’s tobacco can expose a person to high levels of harmful chemicals.

A recent study tested the blood and urine of a group of smokers after they smoked either cigarettes or participated in a hookah session.

The results showed that nicotine levels were higher in cigarette smokers, but carbon monoxide levels and many other harmful substances were high in the hookah smokers.

"Cut out tobacco in all forms."

Peyton Jacob III, PhD, a research chemist, and Neal L. Benowitz, MD, a tobacco researcher from the Division of Clinical Pharmacology and Experimental Therapeutics, at the University of California at San Francisco, worked with a team of fellow scientists to investigate the harms of hookah smoking.

“Smoking tobacco in water pipes has gained popularity in the United States and around the world. Many believe that water pipe smoking is not addictive and less harmful than cigarette smoking, “ said the authors.

Water pipe, or hookah, tobacco is cut with honey, molasses or the pulp of different fruits to add flavor and only has between 5-10 percent of crude cut tobacco, according to the authors.

Water pipe smoke is produced at roughly half the temperature of cigarette smoke, 450 degrees Celsius versus 900 degrees Celsius.

Both the pleasant flavor and less harsh smoke heat may give smokers the perception that hookah smoking could be safer than cigarette smoking. However, charcoal bricks are used to heat the tobacco in hookahs, which can create carbon monoxide—an unhealthy substance to consume.

Before conducting the study on humans, the researchers used a smoking machine to measure the differences between cigarette and hookah smoke.

The machine found that one session of water pipe smoking produced 100 times the amount of tar, four times the amount of nicotine and 11 times the amount of carbon monoxide than one cigarette.

For the study, 13 healthy people, who smoked both cigarettes and water pipes, volunteered to participate.

The participants smoked an average of 10 cigarettes per day and 3 water pipe sessions per week. The participants were split into two groups and were required to stay for 4 days in the hospital where the trial was being done.

Blood, urine and breath samples were taken from each participant throughout the hospital stay as they were smoking either cigarettes or water pipes throughout each day.

Participants that smoked cigarettes for the study smoked 11 cigarettes per day. Participants that smoked the water pipe smoked during three sessions per day, which lasted around 45 minutes each.

The results showed that nicotine levels were higher from cigarette smoking, but carbon monoxide levels were 2.5 times higher in water pipe smokers. The authors said that carbon monoxide exposure was a risk factor for cardiovascular and pulmonary disease.

“In addition to delivering toxic substances from the charcoal and tobacco, the heat causes chemical reactions in the mixture which produce toxic volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). Some PAHs are highly carcinogenic and can cause lung cancer,” Dr. Jacob said in a press release.

The researchers found the following toxins in hookah smoke:

  • Acrylamide, a VOC, which can damage the nervous system
  • Acrolein, a VOC, which can irritate the nose, throat and eyes
  • Benzene, a VOC, which may increase the risk of cancers such as leukemia
  • Naphthalene, a PAH, which can damage red blood cells
  • Carbon monoxide, a pollutant that gets in the way of oxygen intake

 “People want to know if it is a lesser health risk if they switch from cigarettes to smoking a water pipe on a daily basis. We found that water pipe smoking is not a safe alternative to cigarette smoking, nor is it likely to be an effective harm-reducing strategy,” Dr. Jacob concluded.

This study was published in March in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

The California Tobacco-Related Disease Research Program, the National Institutes of Health and the General Clinical Research Center at San Francisco General Hospital Medical Center helped support funding for this project. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
April 23, 2013
Last Updated:
November 13, 2013