Going out to smoke hookah with friends? It’s now on the public record that you’re not alone…. Going out to smoke hookah with friends? It’s now on the public record that you’re not alone. Actually, you’re far from it.

Thanks to a study led by Pitt professor Brian Primack and published this month, we now know that almost a third of U.S. college students (30.5 percent) have exposed themselves to one of the several forms of waterpipe tobacco, such as hookah, narghile or shisha pipe. This result, arrived at by analyzing the 2008-2009 National College Health Assessment, complements Primack’s 2008 insight that inhaling tobacco-infused water vapor finds even stronger popularity at Pitt — 41 percent of Pitt students have done it and about half of the student body want to do it in the future.

Ultimately, individual Pitt students must choose whether (and how) to put tobacco into their bodies, but given the unsettling amount of misinformation lingering on campus, more should be done to educate the student body of the true risks of hookah.

For many students, hookah has become a pleasant exercise in social bonding. Although it might not provide the disinhibiting effects of alcohol, over the years hookah has built around itself a sensational “experience” fit for friendly gatherings among collegiates (much like cigarettes once did). As modern-day hookah bars provide customers with dim lighting, the relaxing hum of music and voices and the sweet tongue-tickle of fruity tobacco flavors, it’s little wonder that more students — on this campus and elsewhere — have taken up the waterpipe.

But for every inch hookah has evolved into a socially reinforcing cultural phenomenon, it carries just as much health risk — risk which should not be understated. Both current and potential users must responsibly weigh the plausible social benefits of hookah with its far-more-plausible threats to their well-being.

Like many students, you might have thought that since hookah bubbles tobacco through water, the resulting smoke is somehow “cleaner” — that it’s not as bad for you as cigarettes. If that’s your understanding, now’s the time to revise it. The fact is that all of the icky, cancer-causing chemicals in cigarettes that primary school teachers taught students to fear are also present — not somehow blunted, but in full force — in hookah.

Hookah smoking is anything but “clean”: A single session can deliver up to 100 times the smoke volume (including high amounts of addiction agent nicotine and breathing toxin carbon monoxide) as a cigarette and 40 times the tar (including the lovely carcinogens), according to the World Health Organization and several tobacco studies, respectively. Regular waterpipe users walk around with just as much if not more tobacco metabolites in their blood as cigarette smokers, and hookah smoking has been associated with “cancer, cardiovascular disease, decreased pulmonary function and nicotine dependence,” according to Primack’s 2012 report.

Of course, given the fledgling status of waterpipe research compared to the decades-long study of cigarette smoking, all scientists can really prove right now is the potential of hookah to do damage. Whereas there is broad empirical evidence of cigarettes shortening millions of lives, no one has yet drawn an arrow of causation between a college student frequenting a hookah bar and developing some health malady. The absence of such causal evidence (which would allow us to cry “public health catastrophe!”) might be a symptom of the diminutive nature of the waterpipe literature, or it may be thanks to a more welcome explanation: Perhaps the way U.S. college students have so far exposed themselves to this clearly dangerous substance has mitigated the negative health effects. As support, some studies suggest that the predominant manner of waterpipe administration is intermittent — that’s consistent with our experiences with Pitt hookah-goers — and Pitt professor Saul Shiffman’s seminal work on tobacco “chippers” allows for the proposition that intermittent waterpipe users may be reducing their risk of physical dependence on nicotine, and therefore worrisome exposure levels to hookah’s bad ingredients.

We’ll probably have to wait a while for answers for the big hookah questions, but that doesn’t excuse making willfully uninformed hookah decisions. So the next time your friends invite you to hookah, just remember — there’s no “free smoke.”