HEALTH RISKS
Numerous studies have shown that extended use of hookah over many sessions can be as detrimental to a person's health as smoking cigarettes. [15][16][17]. Each hookah session typically lasts from 20 - 80 minutes and consists of 50 - 200 puffs which range from 0.15 - 1 litre per puff [18]. This exposes the hookah smoker to considerably more smoke over a longer time period compared with a cigarette which ranges from 0.5 - 0.6 liters per cigarette[19].
While the water absorbs some of the nicotine in the tobacco smoke, the smoker can be exposed to enough nicotine to cause addiction [20] [21]. Furthermore, the water moisture induced by the hookah makes the smoke less irritating and may give a false sense of security and reduce concerns about true health effects [22].
Other research shows that a 45 minute session of hookah tobacco smoking (tobacco molasses) delivers slightly more tar and carbon monoxide (around 5-10%) than a pack of cigarettes.[23] This study has, however, come under criticism for using unrealistically high temperatures for the tobacco (600-650 degrees C) and using arbitrary figures for tar filtration rates.[citation needed] This could possibly have skewed results, as the carcinogenic and toxin levels of smoke increases dramatically with temperature (Wynder 1958). Common practice is to keep temperatures to degrees which do not "char" the hookah; that is within a temperature range of 100-150 C. (Chaouachi K: Patologie associate all'uso del narghile). The effects of these lower temperatures on tar are inconclusive, though Chaouachi indicates the tar would be less harmful.
Some hookah tobaccos claim to contain 0.0% Tar, but this is misleading because tar is made when tobacco burns. However, when smoking a hookah the tobacco is heated rather than burned. More research is needed to determine the exact amount of tar produced in a session before the burning of the tobacco.
The level of impact on a smoker's health is linked to the set-up and components of the hookah as well. A hookah only utilizing the basic components listed above is believe to have much harsher health consequences than one set-up properly and with various safety devices installed: Since the tobacco in a hookah is roasted as opposed to burned, the density and temperature of the tobacco is paramount to ensure a safer quality of smoke[citation needed]. Distancing somewhat the coal from the tobacco and placing a perforated thermal cover (not to be confused with a wind cover) over the bowl will reduce tar output. Using a Heba diffuser around the down stem in the water basin may provide a slightly greater amount of filtration, however a properly conducted study is needed to validate these claims. The use of a nicotine filter at some stage of the smoke cycle, preferably in the hose, may reduce health risks, but once again a properly conducted study is needed to validate these claims.
Hookahs can also be smoked with tobacco-free flavours. These contain Sugar Cane Bagasse with no tobacco, nicotine or tar. This new method of smoking is aimed at replacing tobacco and eliminates its negative health effects. There have been few studies to show the impact of smoking herbal flavours in Shisha pipes.[citation needed][24]
Many articles[25] suggest that there is a "huge bulk of evidence" to determine the effects of hookah smoking. Research is under way by Fogarty International Centre-funded Syrian Centre for Tobacco Studies, Egyptian Smoking Prevention Research Institute, Research for International Tobacco Control-funded Tobacco Prevention and Control Research Group at the American University of Beirut, Lebanon.
As the above mentioned are all US-sponsored and financed institutions, it would be good for balance to also mention the existence of other peer-reviewed ground-breaking research led in other parts of the world, namely Europe and Asia [26]. Most recently, the first aetiological study on Hookah Smoking and Cancer[27] ever carried out was published in the Harm Reduction Journal.
As with all other tobacco and smoke products, using hookahs with open canker sores or wounds in the mouth can greatly increase the chances of gum infection, gingivitis, or in rare cases, gum cancer.
