Up in smoke: Water pipe tobacco smoking poses potential health danger Published May 3, 2012 By Staff Sgt. Kirsten Wicker U.S. Air Forces Central Public Affairs SOUTHWEST ASIA -- Shisha, goza, hookah, narghile, hubble bubble.... Water pipe tobacco smoking may have various names, but there is emerging research that suggests smoking it, no matter what name you give it, could be dangerous to individual and public health. Concern ranges from the effects of high levels of carbon monoxide to the risk of transmission of a communicable disease. Ancient beginnings to modern risks According to the World Health Organization, water pipe tobacco smoking has existed for centuries, originating in India and spreading throughout Asia and Africa. On a global scale, the highest rates of smoking occur in the North African region, Eastern Mediterranean region and Southeast Asia. The water pipe is basic in structure - it has a tray, body, water bowl and hose. Some models can be large or small and some have more than one hose. The tobacco is often sweetened and flavored and is burned by a coal that rests on a tray to keep it lit. The smoker inhales through the hose, creating a vacuum above the water and drawing air through the body of the water pipe and over the tobacco and charcoal. It is rising in popularity among the youth cultures of Europe and North America as a social pastime, experts say, largely due to the widespread belief that it is relatively safe because the smoke passes through water before it reaches the smoker, having a filtering effect. In a survey conducted by the World Health Organization, nearly 44 percent of young adults thought it was less harmful than cigarette smoking. The report also revealed that more than eight percent who do not smoke cigarettes have tried it. "Smoking a water pipe could be just as dangerous as smoking cigarettes, although many people are buying into the idea that it is safer," said Col. Eric Nelson, an aerospace and preventive medicine physician serving as the Chief of Aerospace Medicine for the 379th Expeditionary Medical Group. "There is indirect evidence to suggest the likelihood of harm based on the fact that hookah smokers are inhaling the byproducts of burning charcoal as well as tobacco, and bubbling the smoke through water is unlikely to effectively filter that." Hazardous hookah Mayo Clinic physician Dr. Richard D. Hurt compiled a list of several effects to consider that could potentially cause harm: Hookah smoke contains high levels of toxic compounds, including tar (despite misleading labeling saying it does not), carbon monoxide, heavy metals and cancer-causing chemicals (carcinogens). In fact, hookah smokers are exposed to more carbon monoxide and smoke than cigarette smokers. A single session of smoking hookah produces carbon monoxide levels four to five times higher than those produced from smoking a cigarette. According to an article written for eHow Health, when the breath of heavy tobacco smokers was measured, carbon monoxide levels of 30 to 40 parts per million were found. These levels indicate that approximately five to seven percent of blood was not functioning properly. The breath of hookah smokers measured 40 to 70 parts per million of carbon monoxide, resulting in eight to 12 percent of blood being affected. A typical hour-long smoking session involves inhaling 100 to 200 times the volume of smoke inhaled with a single cigarette. A survey carried out this year by the British Heart Foundation found that 84 percent of respondents thought the amount of smoke inhaled was equivalent to 10 cigarettes or fewer. They found that a 40-minute session on a water pipe is the equivalent to the volume of smoke inhaled from at least 100 cigarettes. As with cigarette smoking, hookah smoking is linked to lung and oral cancers, heart disease, emphysema, asthma and other serious illnesses. Hookah smoking delivers about the same amount of nicotine as cigarette smoking does, possibly leading to tobacco dependence. Hookah smoke poses dangers associated with second-hand smoke. Second-hand smoke from water pipes is a mixture of tobacco smoke in addition to smoke from the fuel. There is no proof that any device or accessory can make water pipe smoking safer. Hookah smoking by pregnant women can result in low birth-weight babies. Hookah pipes used in bars, cafes and restaurants may not be cleaned properly, risking the spread of infectious diseases such as tuberculosis and hepatitis. "Primarily, Airmen need to know that smoking hookah or inhaling second-hand smoke from it may not be as safe as they once thought," said Maj. Melissa Meister, 379th EMDG Chief of Public Health. "Recognize there are potential risks and minimize your exposure." The way ahead The World Health Organization reports that there is surprisingly little research addressing tobacco smoking with a water pipe, especially given that there are many millions of current water pipe smokers and that water pipe use is spreading. Researchers admit the evidence is scant, but suggest that smokers of water pipes could be at long-term risk for nicotine dependence, cardiovascular disease and even cancer. "We don't yet have many controlled studies that show evidence of harm," Nelson said. "But the potential risks suggest a need to be prudent, and I would recommend minimizing your exposure. The old saying, 'the dose makes the poison' is true in this case - it's a matter of exposure." There is little regulation for controlling the marketing, sale and use of water pipes and water pipe tobacco. A study group on tobacco regulation recommends it be subjected to the same regulation as cigarettes and other tobacco products, contain strong health warnings on labels, and be prohibited from public places where a ban on cigarettes and other forms of tobacco smoking already exist. Despite a move to enact these public health initiatives in some places, Meister says education is the key to reducing your risk. "Be informed about water pipe smoking even if you chose to smoke it," she said. "Knowing the facts and knowing the risk can help you make a more informed choice."