I
f you are a parent of a teenager
and you’ve never heard of hoo-
kah, you need to start educat-
ing yourself on the topic. Hookah is an
ancient method of smoking that has had
teens curious for the last several years.
Although cigarette smoking has declined
due to education about the many health
risks and more stringent laws regarding
usage, hookah smoking is on the rise.
A January 2019 Centers for Disease
Control and Prevention (CDC) report
states, “Hookah smoking has increased
among young people. Curiosity and sus-
ceptibility may be associated with ex-
perimentation or established use.”
The study concluded, “Nearly 3 in
10 youth who never smoked a hookah
(6.9 million) reported hookah curios-
ity or susceptibility, and prevalence was
highest among those who had never
used other tobacco products. These find-
ings reinforce the importance of educat-
ing youth about the dangers of all tobac-
co products and dispel misperceptions
about the harmfulness and addictiveness
of hookah smoking. Continued surveil-
lance of youth curiosity, susceptibility,
and use of hookahs can inform public
health policy and practice.”
Unfortunately, many continue to
buy into the idea that hookah smoking
is a fairly safe alternative to cigarette
smoking. Make no mistake: Hookah
smoking is detrimental to your health.
Therefore, it’s imperative that parents
learn the truth about hookah and start
talking to their teens about the dangers.
Why Hookah?
In recent years, there has been a re-
surgence of hookah use around the world,
and it is becoming particularly popular
among high school and college students
who consider it a fun, social pastime.
Hookahs (or water pipes) are used to
smoke specially made tobacco that comes
in different flavors, such as apple, mint,
and cherry. Hookah smoking is typically
done in groups, with the same mouth-
piece passed from person to person.
Brian A. Primack, M.D., Ph.D., as-
sociate professor of medicine, pediatrics
and clinical translation science at the
University of Pittsburgh School of Med-
icine, explains that one of the reasons
hookah has caught on so dramatically
66 WNY Family March 2020
Hooked
on Hookah:
TWEENS & TEENS
— by Myrna Beth Haskell
Teens Experiment
with An Ancient
Smoking Method
is due to its aesthetically pleasing tastes
(similar to e-cigarettes), but also due to
environments.
“Hookah smoking is commonly
done in ‘hookah lounges,’ which are of-
ten dimly lit and beautifully decorated.”
He points out that the act itself is more
aesthetic as well, because the tobacco is
flavored, sweetened, and cooled by the
water, which makes it less harsh than
cigarette smoking. “I have a number of
patients who would be horrified to smoke
a cigarette, but they wholeheartedly em-
brace hookah tobacco smoking. They ex-
press disbelief when I show them data on
what they are actually inhaling.”
Erin L. Sutfin, Ph.D., a developmen-
tal psychologist and assistant professor
in the department of Social Sciences and
Health Policy at the Wake Forest School
of Medicine in Winston-Salem, NC,
agrees with Dr. Primack. “It is well doc-
umented that teens are attracted to fla-
vored tobacco products and use them at
much higher rates than adults,” she says.
The Risks
“It takes a long time to do studies
that accurately quantify health risks, and
the hookah phenomenon is relatively
young in the Western world,” explains
Primack. “That being said, we do have
data that show that hookah smokers are
heavily exposed to hazardous toxins.”
Dr. Primack reports that one hookah
smoking session, which lasts about for-
ty-five to sixty minutes, exposes the user
to about 100 times the smoke volume of
a single cigarette. “It also seems to ex-
pose the user to about forty times the tar,
ten times the carbon monoxide, and two
times the nicotine.”
Sutfin warns, “Hookah smoking
also carries the risk of infectious disease
transmission, such as tuberculosis, in-
fluenza, and mononucleosis, due to the
shared hoses and mouthpieces.”
The burning process itself poses
risks as well.
Dyan Hes, M.D., FAAP, medical
director of Gramercy Pediatrics in Man-
hattan and clinical assistant professor of
pediatrics at the Weill Medical College
of Cornell University, explains, “There
are as much or more carcinogens in hoo-
kah smoke, particularly since the tobac-
co is burned at a higher temperature than
in a cigarette.”
Safe Hookah Products?
Some products boast that they are
tobacco-free, hence safe. Sutfin dis-
agrees, saying, “Smoking herbal shisha
(a non-tobacco alternative) is still dan-
gerous. Although there is not the risk of
addiction since there is no nicotine, there
is still exposure to high levels of carbon
monoxide and other toxins.”
“Most hookahs involve the light-
ing of a piece of charcoal in the hookah
bowl,” Primack describes. “Therefore,
even if there are no other substances, the
user will be exposed to the combustion
products of the charcoal, which include
carbon monoxide.” He reports that hoo-
kah smokers have landed in emergency
rooms with carbon monoxide poisoning.