Crystal

Smoking tobacco – even lightly – through water pipes significantly affects lung function and biology in young adults, a new study by Weill Cornell Medicine researchers shows.

A water pipe consists of a bowl that holds burning charcoal and tobacco. The smoke bubbles through water in the bottom of the pipe and is inhaled through a hose. Water pipes, also known as hookahs, have been used for smoking fruit-flavored tobacco for centuries in the Middle East. More recently, water pipe smoking has become popular in the United States, with at least 20 percent of young adults reporting having smoked this way.

Many users believe water pipes to be a safe alternative to cigarettes. But in their study, published March 23 in the American Journal of Respiratory and Critical Care Medicine, investigators found hookah smoking is, in many ways, more dangerous than cigarette smoking.

“The fact that the smoke bubbles through water has led to the perception that the toxins in the tobacco are filtered out,” said Dr. Ronald Crystal, chairman of Genetic Medicine and the Bruce Webster Professor of Internal Medicine at Weill Cornell Medicine. “But the fact is, water pipe users are inhaling smoke into their lungs just like cigarette smokers do.

“We found evidence of multiple lung abnormalities in water pipe smokers,” he added. “It is clear that even casual water pipe use is not safe.”

One water pipe bowl holds the same amount of tobacco as a pack of cigarettes. Smoking that in one session exposes smokers to at least twice the amount of nicotine, seven to 11 times the amount of carbon monoxide, 100 times more tar, and 17 times the amount of formaldehyde than in a pack of cigarettes, the study found. Those toxins have a measurable physical effect on young smokers, said Crystal.

The study looked at so-called light-use water pipe smokers – those who smoked no more than three bowls a week – whose average age was 24. The researchers evaluated both their clinical symptoms, such as coughing and production of phlegm, as well as biologic signs of lung damage.

They found water pipe users had increased cough and sputum compared with nonsmokers of a similar age, as well as reduced lung capacity. In addition, the hookah smokers showed significant abnormalities in the cells lining the airways in their lungs, suggesting that their lungs are being damaged.

“These results are concerning,” Crystal said. “They suggest that, as these young people continue to smoke water pipes, they will develop clinical lung function abnormalities that can result in serious lung diseases.”

Water pipe use is currently unregulated in the United States. More research is needed to determine the exact effects of inhaling water pipe smoke on long-term health, Crystal said.

“We need large-scale, epidemiologic studies, akin to the ones focused on cigarette smoking in the ’70s and ’80s,” he said. “But for now, if I was advising a young person whether he should smoke a water pipe, I would say no.”

Geri Clark is a freelance writer for Weill Cornell Medicine.