Comparisons of smoking cigarettes and hookahs "cannot tell us exactly what is 'worse,'" says Brian Primack. "But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize." (Credit: iStockphoto)

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Hookahs deliver 125X more smoke than cigarettes

Hookah smokers may be inhaling far more toxicants than they think.

Researchers reviewed 542 scientific articles potentially relevant to cigarette and hookah smoking and ultimately narrowed them down to 17 studies that included sufficient data to extract reliable estimates on toxicants inhaled when smoking cigarettes or hookahs.

The findings, published in the journal Public Health Reports, show that, compared with a single cigarette, one hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide.

“Our results show that hookah tobacco smoking poses real health concerns and that it should be monitored more closely than it is currently,” says lead author Brian A. Primack, assistant vice chancellor for health and society at the University of Pittsburgh’s Schools of the Health Sciences.

“For example, hookah smoking was not included in the 2015 Youth Risk Behavior Surveillance Survey System questionnaire, which assesses cigarette smoking, chewing tobacco, electronic cigarettes, and many other forms of substance abuse.”

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Researchers note that comparing a hookah smoking session to smoking a single cigarette is a complex comparison to make because of the differences in smoking patterns. A frequent cigarette smoker may smoke 20 cigarettes per day, while a frequent hookah smoker may only participate in a few hookah sessions each day.

“It’s not a perfect comparison because people smoke cigarettes and hookahs in very different ways,” Primack says. “We had to conduct the analysis this way—comparing a single hookah session to a single cigarette—because that’s the way the underlying studies tend to report findings. So, the estimates we found cannot tell us exactly what is ‘worse.’

“But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize. After we have more fine-grained data about usage frequencies and patterns, we will be able to combine those data with these findings and get a better sense of relative overall toxicant load.”

The findings may be helpful in providing estimates for various official purposes.

Hookahs and high school

“Individual studies have reported different estimates for inhaled toxicants from cigarettes or hookahs, which made it hard to know exactly what to report to policy makers or in educational materials,” says coauthor Smita Nayak, a research scientist at the Swedish Center for Clinical Research and Innovation. “A strength of meta-analysis is that it enables us to provide more precise estimates by synthesizing the currently available data from individual studies.”

These estimates come at an important time, the researchers say. The Centers for Disease Control and Prevention recently reported that, for the first time in history, past 30-day use of hookah tobacco was higher than past 30-day use of cigarettes among US high school students.

Additionally, about one-third of US college students have smoked tobacco from a hookah, and many of those individuals were not previous users of other forms of tobacco.

Other researchers from the University of Pittsburgh and from American University of Beirut, the VA Pittsburgh Healthcare System, and Virginia Commonwealth University are coauthors of the study.

This research was funded by the National Cancer Institute.

Source: University of Pittsburgh

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