What's Hookah?? In the past few years, instead of asking my patients "Do you smoke?" I have learned to ask "Do you smoke? (pregnant pause)...ANYTHING?" I found that asking in that manner greatly increases my yield. Couple that with Colorado's legalization of marijuana, and more people are freely sharing the full extent of their substance use with their doctors. Which left me asking the question, "what's hookah?" (I could add here that I was also asking "what's shisha" and "what's snus"?)
Hookahs are water pipes used to smoke flavored tobacco. The flavors are often sweet- chocolate, cherry, licorice or fruit flavored. The heat source is charcoal, and the vapor/smoke goes through a water basin before being inhaled. A common misperception is that this "purifies" the tobacco, so that the smoke is no longer harmful. Hookahs can have multiple tubes allowing several people to inhale at one time, or users can pass around the mouthpiece and take turns inhaling (obviously sharing germs as well as the hookah vapor). Hookah bars seem to be multiplying across the United States, especially in college towns. Austin, Texas, is no exception. A 2013 study of 7 large universities showed that 1 in 10 college students used hookah.
Although hookahs has been around for centuries, we certainly do not have a plethora of double-blind, placebo-controlled meta-analysis studies to clarify exactly the specific health risks of long term use of hookah. What do we know?
- Hookah smoke is "at least as toxic as cigarette smoke" (CDC, 2013)
- Hookah tobacco and vapor contain the same poisons that cause mouth, lung and bladder cancer
- Hookah sessions are usually much longer than cigarette breaks- often up to an hour, increasing the toxin exposure up to ten times higher than traditional smoking
- The nicotine in hookah tobacco and vapor is very addictive (just as in cigarettes)
- Smoke from the heat source, charcoal, can cause carbon monoxide poisoning
- Gum disease is 5 times more common in hookah users than cigarette smokers