Hooked on hookah

Pitt freshman Logan Armstrong knows smoking hookah isn’t good for his lungs — but compared to cigarettes, he doesn’t see a cause for concern.

“I smoke hookah much less frequently than the average cigarette smoker,” Armstrong said. “A smoker may consume a pack of cigarettes a day, whereas I may only smoke hookah once a month.” 

A recent UPMC study, however, casts doubt on Armstrong’s perception.

According to Brian Primack, vice chancellor for research on health and society at Pitt, Armstrong and other hookah smokers should be more concerned about its dangers. In mid-September, UPMC announced Primack’s study that showed one in five high school seniors have smoked tobacco out of a hookah in the last year. According to the study — which is slated for a future issue of the American Journal for Preventive Medicine — nearly one in three high school seniors smoked hookah frequently enough to consider themselves regular users.

Hookahs are water pipes for smoking specially made tobacco — usually in flavors, including apple, mint and coconut.

Primack said there’s not enough education on the dangers of hookah smoking, as other forms of consuming tobacco — such as vaping — have dominated the conversation. His study will contribute to a relatively quiet, but important conversation. 

“Hookah smoking often gets lost in the shuffle these days. Because people are so interested in what is going on with vaping, they are not paying enough attention to hookah smoking,” Primack said. “This is a mistake, because hookah smoking produces many toxins, often in higher concentrations even than found in cigarettes.”

The study focused on 8,737 high school seniors who researchers surveyed between 2010 and 2013. Primack’s findings revealed frequent users had smoked hookah at least six times in a year.

According to the Center for Disease Control and Prevention, the charcoal used to heat the tobacco in hookahs can raise health risks by producing high levels of carbon monoxide, metals and cancer-causing chemicals. Because hookah smokers smoke for a longer period of time than a cigarette smoker does, smokers using a hookah  may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.

The amount of smoke hookah users inhale during a typical session is about 90,000 milliliters, compared with 500 to 600 milliliters inhaled when smoking a cigarette, according to the CDC. According to Primack’s study, the amount of tar in hookah — compared to cigarettes — translates to between 20 to 40 times more. Primack’s findings also showed 54 percent of people who reported smoking in the past year said they were not current cigarette smokers.

Primack also noted hookah smokers were more likely to be male, Caucasian and living in single-parent households. Compared to their peers, they were more likely to have worse grades, more truancy and active social lives.

Primack said unlike cigarettes, there isn’t enough policy on the restriction of hookah use.

Pitt students who aren’t 21 can socialize at a hookah bar, where the age limit is only 18 — according to Pennsylvania law. Mint Hookah Bar and Lounge, located on Semple Street in South Oakland, is one of Oakland’s popular hookah bars.

Mint’s manager, Ryne Mudrany, said he has noticed an increase in business recently, especially since it opened about three years ago.

“Hookah is more social [than cigarettes] because it’s nicer to sit around with a group of people and make new friends instead of smoking cigarettes alone at home,” Mudrany said.

Mudrany said college students are entirely unaware of what they are doing to their bodies when they inhale hookah.

Ramy Andrawes, owner of the Sphinx Cafe, another Oakland hookah bar on Atwood Street, said the cafe sells shisha — a syrupy tobacco — and other hookah supplies to other bars in Pittsburgh, so it has been especially busy in that regard.

“Hookah bars create an environment where people can meet each other, so hookah is a very social thing to do,” Andrawes said, adding that college students are smart enough to do the research and make informed decisions about smoking.

In Pennsylvania, hookah bars are regulated under the Clean Air Act, and must meet the same guidelines as tobacco shops. The bars must keep records of all tobacco sales, and the health department must issue an approval before patrons can smoke on the premises. Under Pennsylvania law, if the shisha used contains tobacco, bars are banned from serving people under 18.

With Pennsylvania’s stringent tobacco laws, recent data shows cigarettes are on the decline. The CDC published data showing that in 1997, 36.4 percent of students had smoked a cigarette in the last 30 days. In 2013, that number dropped to 15.7 percent.

“A lot of people in college think of hookah smoking as a safer and more compelling alternative to cigarette smoking,” Primack said. “They don’t realize that they are exposing themselves to a lot of very harmful chemicals. When these people get heart disease and cancer down the road, they are going to be very unhappy.”