If you live in a college town or an urban area, you may have seen signs for a hookah lounge. They are also called hookah dens, bars or cafes. Here, people smoke tobacco that is cooled and dispensed through a water pipe.
Hookah tobacco is often enhanced with flavors like mint, chocolate, vanilla, cappuccino or cherry. Hookah tends to attract a "starter" crowd. Health experts say this group may go on to use other tobacco products.
A new study suggests that about one in four female college freshmen will try smoking hookah. That number is for just first-time users. It doesn't count those who tried hookah before college.
The study followed 343 first-year female college students. They said they had no experience with hookah before college. Twenty-three percent of that group later reported they experimented with hookah as freshmen.
The study was published in the Psychology of Addictive Behaviors. It was supported by the National Institutes of Health.
The prevalence of hookah smoking worldwide and in the United States has been rising over the last 20 years. That's according to lead author, Robyn L. Fielder, MS. The rates of those who have tried it "are now almost as high as regular rates of cigarette smoking among college students," she says.
"The popularity and social nature of hookah smoking, combined with the fact that college freshmen are more likely to experiment with risky behavior, could set the stage for a potential public health issue, given what we know about the health risks of hookah smoking," Fielder says.
However, many young women experiment with hookah but do not become regular users, she says.
Hookah smoking is a social experience. A group of people usually passes around a shared mouthpiece. Some lounges offer disposable mouthpieces for better hygiene.
Many hookah smokers consider the practice less harmful than smoking cigarettes. That's in a study by the American Lung Association.
"This is troubling from a public health perspective," the American Lung Association says in a briefing. Evidence shows that hookah smoking has many of the same risks as cigarette smoking. It has been linked to many of the same diseases caused by cigarette smoking.
Water pipe smoking delivers nicotine. That is the addictive drug found in cigarettes. The Centers for Disease Control and Prevention (CDC) say water pipe smoke is as toxic as cigarette smoke. The way hookah is used -- deep inhaling, frequent puffing and long smoking sessions -- may deliver more toxins than cigarette smoking.
A typical one-hour hookah session involves inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette. That's according to studies cited by the CDC.
Users are at higher risk for various types of cancer, reduced lung function and fertility problems. The CDC says hookah is not a safe alternative to smoking.
Almost a half a million Americans die prematurely each year from using tobacco and being exposed to secondhand smoke. That's nearly one in five deaths.
Studies cited by the CDC suggest other risks associated with hookah. Those include:
- Hookah tobacco and smoke contain toxic ingredients. Those are known to cause clogged arteries and heart disease.
- Sharing a hookah mouthpiece can raise the risk of infectious diseases.
- Babies of women who reported smoking water pipes daily while pregnant have lower birth weights than nonsmokers' babies. The babies are also more likely to develop respiratory problems.
- Secondhand smoke from hookahs poses a serious risk for nonsmokers.
- Hookah smoke includes remnants of charcoal used as a heat source.
The American Lung Association on its website says a comprehensive approach to limiting access to hookah smoking is critical to averting a "potentially deadly trend."
"Efforts should be made to restrict hookah use, especially among teens and young adults," the group says.
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