So is there a way to smoke tobacco without generating the seriously negative effects of cigarette smoking? We would say no, but some folks apparently believe that bubbling tobacco smoke through water before inhaling it somehow "cleans" it.
(Just to be clear, using a hookah is not the same as using an e-cigarette, which contains none of the tobacco-sourced carcinogens of cigarettes.)
However, a new study in the American Journal of Respiratory and Critical Care Medicine puts the kibosh on the concept of safe tobacco smoking — even such "washed" smoke.
Hookahs, or waterpipes or shisha, have been around at least since the 16th century — probably originating in India. From there, their use has spread all over the world, most lately to Southeast Asia and the U.S.
To use a hookah, a quantity of tobacco mixed with molasses (also known as shisha) or other flavoring, is placed in the bowl at the top of the device. A screen is then added and burning charcoal is placed on top of the screen. The charcoal then heats the tobacco, and the resultant smoke is drawn through the water in the large chamber and inhaled by the user.
We have known for years that the tobacco smoke treated in this manner still contains the deadly toxicants found in cigarette smoke, and that these are inhaled by the user. For example, a direct comparison of the blood levels of carbon monoxide linked to hemoglobin found that they are three times higher after using a hookah for 45 minutes than after smoking one cigarette. Levels of nicotine in the blood were similar in both situations.
Senior author of the latest study, Dr. Ronald Crystal from the Weill Cornell Medical Center in New York and his colleagues, assessed clinical and biological changes associated with hookah use. The investigators compared these changes in young hookah users who were light users of the devices, but otherwise didn't smoke tobacco, with the same measurements in non-smokers who didn't use hookahs. These light users had used hookahs to smoke three or fewer bowls of tobacco per week for less than five years; on average they were 24-years old. The hookah users had more cough and sputum, as well as more abnormalities in the cells lining the airways than did the control non-smokers. Taken together, such results indicate early lung damage.
According to Dr. Crystal, hookah tobacco smoking is completely unregulated, even though exposure to the toxic effects of tobacco smoke is highly likely. While regulators fuss over how to regulate electronic cigarettes, which expose users to none of the toxicants found in cigarette smoke, they seem to have missed the likelihood that there's an alternative route to smoking-caused illnesses. Perhaps they'll wake up and smell the smoke soon.