Water pipes don't protect against tobacco's harm

THE ISSUE The American Lung Association of Hawaii has cautioned college students against smoking with hookah.

WATER PIPES used to inhale tobacco are becoming popular among young people as an alternative to cigarettes, and health officials are expressing concern. Few studies have focused on the water pipes, called hookah or narghile, but they provide no evidence that use of water pipes is less dangerous than cigarettes.

Sterling Yee, president of the American Lung Association of Hawaii, issued a warning this week that young people's use of hookah involves inhaling "high levels of arsenic, chromium and lead into their lungs, no matter how exotic or socially acceptable the delivery method seems to be."

Renee Hollison Betamour, who provides hookah service in Hawaii, maintains that using a water pipe is "vaporizing" rather than combustion. "It's closer to aromatic therapy," she says.

Of course, combustion does occur, beginning in the water-pipe head, where burning charcoals are placed close to moist, fruit-flavored tobacco. The smoke passes through water, where it is diluted, cooled and inhaled by the smoker through a connecting tube. Frequent puffing is needed to keep the coals burning.

Hookah smoking has been practiced for centuries in the Middle East and South Asia, where an estimated 100 million people smoke water pipes daily. The practice has begun to be fashionable in recent years in the United States, where "hookah bars" have opened from Los Angeles to New York and Miami.

Little is known about hookah's health effects, demonstrated by contradictory information issued by different organizations. Yee cited a World Health Organization advisory that a water pipe produces as much smoke during a one-hour session as five to 10 packs of cigarettes. A Florida spokesman for the American Cancer Society told the Miami Herald that a normal session of 45 minutes is equivalent to smoking one pack of cigarettes.

The few studies available have provided "limited data to suggest that water-pipe smoke is at least as toxic as cigarette smoke," according to an article last year in Pediatrics, the official journal of the American Academy of Pediatrics.

However, the article points out "some common myths and misconceptions," including that the nicotine content from water pipes is lower than that from cigarettes, that "water filters out all the noxious chemicals, including carbon monoxide, nicotine and tar," that a hookah "is less irritating and thus less harmful to the throat and respiratory tract than cigarette smoking," and that a hookah is "a healthy choice" because the tobacco contains fruit.

More studies are likely to be conducted if the hookah's surge in popularity continues, while Internet sites peddling hookah products continue praising the practice. Anybody who begins a hookah habit before more studies have been completed is taking an enormous risk.