Since its meteoric rise in popularity, hookah has come under fire by various organizations, such as the American Lung Association and the Mayo Clinic, who warn of the associated health risks. Issues have arisen from unsubstantiated claims, with opponents claiming faulty testing methodology like the fact that many of these organizations do not release the details of the studies they conduct.

In 2006, Dr. Thomas Eissenberg, a professor who is part of the Institute for Drug and Alcohol Studies at Virginia Commonwealth University, compared hookah smoke to cigarette smoke. A widely circulated fact, which can be found on the Mayo Clinic site, is that smoking a bowl of hookah is equivalent to smoking hundreds of cigarettes. Eissenberg explains the details: “Hookah use can involve some 100 puffs of 500 ml of smoke each, or 50,000 ml of smoke (or 50 liters). A cigarette use episode can involve some 10 puffs of 50 ml each, or 500 ml (0.5 liters).”

This means a person will inhale hundreds of times more smoke in a hookah session over a cigarette, but composition of the smoke is important. Eissenberg explained that an entire bowl of hookah contains almost twice the amount of nicotine than a single cigarette, and about 36 times the tar and 8 times the carbon monoxide (CO). In addition, the Utah Department of Health TRUTH Campaign, a tobacco prevention and control initiative, claims that cooling the smoke makes hookah more dangerous because it encourages people to inhale more deeply and smoke more.

However hookah is a social activity shared by several people once or twice a week, whereas cigarette smokers independently smoke several cigarettes each day. Casual smokers are taking in more harmful substances and much more nicotine than occasional hookah smokers.

“I can tell the difference when I smoke hookah, and when I smoke cigarettes,” says freshman economics major Roberto Armautovic, “and hookah smoke is lighter.”

Is hookah addictive? Eissenberg explains that there is enough nicotine to cause physical dependency. “The data suggest that some hookah smokers show the hallmarks of dependence.” He also talks about the psychological component. He assumes that the social element of it likely increases addiction, but he gives no data to support that. Armautovic says that smoking hookah will not curb his craving for a cigarette and he sometimes smokes the two at the same time.

Khan M. Sajid published research results in the Harm Reduction Journal concerning the carcinoembryonic antigen (CEA) levels of hookah versus cigarette smoke. CEA levels are a marker for cancer and high levels of CEA “may therefore indicate the presence of cancer,” Sajid says. The results of his study found that “the overall CEA levels in exclusive hookah smokers… were not significantly different… from the levels in non-smokers.”

Sajid goes on to say that even medium cigarette smokers do not show high levels, but that levels are significantly higher in heavy cigarette smokers. “However, heavy hookah smoking substantially raises CEA levels,” he says.

The problem with hookah studies is the abundance of factors, and researches tend not to publish their methodologies. Some hookah studies, such as a recent one showing the complications hookah smoking can cause with pregnancy, are based on subjects who are heavy hookah smokers-more than one session per day by themselves, which is more common in the Middle East than America. Other studies are believed to be based on this level of heavy smoking as well.

In addition, hookah is a complicated apparatus. The kind of coals and shisha that are used and how hot the shisha gets, as well as what materials the hookah itself is made of, can affect test results. A study may say that hookah produces very high levels of CO, but if the tobacco is overly heated the results are artificially high.

Many organizations opposing hookah claim that people think hookah is not harmful. “Everyone knows it’s bad,” says freshman business major Patrick Carter, “but it’s a social thing, and nobody cares to do anything about it.”

Armautovic, who regularly smokes hookah, said that if he knew hookah was worse than cigarettes, like some claim, he might consider moving his social interaction out of the hookah lounge.

Anyone under the impression that hookah smoking does not carry with it health risks, can be assured that it does. Yet, like any other substance, the body is much better equipped to handle it in smaller amounts. It is important to know the potential risks, but ultimately it is the choice of the individ

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