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How Not to Die

Newsflash: Hookah Smoking is Terrible for You

And the latest upgrade could make things even worse.

Nick Keppler

Nick Keppler

Joseph Fuqua II/UC Creative Services

Hookah bars now seem as common as Dominos in college neighborhoods. In recent years, studies have found that one in three students uses the ancient tobacco pipes, and that use among college women is on the rise inhale on a hookah hose by the end of freshman year. 

But those undergrads may not entirely understand the potential side effects of what they're inhaling: A recent study also found that 27 percent of college students believed hookahs did not contain tobacco and 38 percent thought what they were smoking did not contain nicotine (wrong on both accounts). The CDC warns that hookah smoking "is not a safe alternative to smoking cigarettes" and "carries many of the same risks." They point out, for instance, that a typical hookah session involves inhaling about 90,000 milliliters of smoke, versus the 500 to 600 milliliters you inhale when smoking a single cigarette. This has done little to stop an increasing number of young people from smoking the flavored tobacco with their circles of friends. 

The increase in popularity of hookahs has created a market for simpler heating sources for the pipes, which are traditionally heated by placing small chunks of hot charcoal near gooey tobacco. One of these methods involves the use of electronic heating disks and pads, which are now sold in head shops

Ryan Saadawi, a chemistry PhD student at the University of Cincinnati, wanted to know if these electronic heaters were any safer and healthier than charcoal, which can release arsenic, cadmium, and other toxins as it burns. Saadawi, 30, says he became interested in studying the health impacts of hookahs after hearing some of the previously mentioned misconceptions about them.

"One of my friends told me I need to stop smoking hookahs because one hour is worth a hundred cigarettes," Saadawi recalls. He knew this was ridiculous ("smoke a hundred cigarettes in an hour and come back and tell me that," he retorted), but he became interested in the particular health effects of hookah smoking and found there wasn't much research on it. "It's every grad student's dream," he adds, "to have an empty field like that." 

For the study, Saadawi bought charcoal commonly used in hookah smoking. Commercially available charcoal, he says, comes in an array of toxicity levels with no labeling as to which brands release more or fewer toxins. He and his collaborators tested the samples themselves and divided them into higher-toxin and lower-toxin categories.

A commonly used electronic hookah disc, also known as e-charcoal.

Saadawi also created a makeshift hookah from lab equipment, one that included a chamber where a pink liquid media, a substance made to support cells, was placed, essentially washing it in the toxins emitted from burning hookah tobacco. They did this with high-toxin charcoal, low-toxin charcoal, and an electronic heating disk, and then placed a series of lung cells in a petri dish filled with the hookah-fied media to replicate the effect of smoking on the lungs.

Lower-toxin charcoal killed 10 percent of lung cells after 24 hours. Higher-toxin charcoal killed 25 percent, but the electronic heater, he was surprised to learn, killed 80 percent of the lung cells. (It's worth mentioning, however, that those numbers might seem scarier than they should: The lung cells in petri dishes were impacted in ways live lungs are not, Saadawi says. In other words, smoking hookah tobacco with an electronic heater won't kill 80 percent of your lung cells, and the numbers—10, 25 and 80—are only meaningful in comparison to each other.)

Saadawi says another study would have to determine why, but he has a theory: Charcoal, toxic as it is, burns hookah tobacco slowly, meaning most puffs produced contain a lot of the sweeteners (molasses, honey, glycerin) unique to tobacco used in hookahs. Electronic burners produce a hot, constant heat, quickly burning through the sugary stuff and exposing the lungs to a harsh, more toxic tobacco like that from a cigar or cigarette. That's just a theory; more research will tell us if he's right.

He stresses, however, that there is not a strong enough basis of hookah research to inform his hypothesis yet, but he's hopeful that will change. "My PhD is nearly complete," he says. "I'm hoping someone else will take this question on."