Hookah Poses Significant Public Health Risk for Millennials

03/05/2014 05:44 pm ET | Updated May 05, 2014

If you're currently a college student, odds are you know all about the hookah craze that has been sweeping the nation for the past few years. Hookah bars and lounges have been cropping up across the country, especially in college towns. Young people in particular are flocking to these establishments to engage in what they find a hip and exotic new social experience. According to one study, two out of five college students in the US regularly smoke hookah. Another study found that half of students who admitted to experimenting with hookah said they do not smoke cigarettes. This fact accentuates a troubling reality that public health experts are increasingly worrying about: unlike with cigarettes, many young people are not aware of the dangers they are subjecting themselves to by engaging in this new behavior.

Hookah smoking involves the packing of tobacco in a bowl and the use of charcoal to smoke through a water pipe attached to a hose. Smoking hookah, also called shisha, has historically been associated with the Middle East, and it is especially prevalent among adult men in the region. Researchers believe the rising interest in this practice in the United States is partly due to its popularity among American soldiers, who were exposed to it during the Iraq War.

The fact that this is a relatively novel practice for most Americans undoubtedly contributes to the widespread misunderstanding surrounding it. One survey uncovered that a majority of college-aged hookah users are under the false impression that hookah smoking is less harmful than cigarette smoking. This misconception is partly due to the myth that the water in the pipe filters out toxins. Additionally, the often-fruity flavors associated with hookah smoke are believed to create the impression that it is less toxic. However, extensive research has shown that hookah smoking is, in fact, even more dangerous than cigarettes.

In addition to the known problems associated with all tobacco use, including substantially increased risk of developing various cancers, COPD, and heart disease, hookah smoking presents its own distinct problems. The shared use of the hookah makes it a vector that facilitates the transmission of various communicable illnesses, including bronchitis, tuberculosis, and herpes. Moreover, the charcoal used with hookah smoking can lead to substantial exposure to carbon monoxide. According to one recent study, immediately after a hookah session, smokers exhibit a carbon monoxide level that is three times the normal amount. The extended length of the smoking sessions, even if they are less frequent than typical cigarette smoking, is also highly problematic. The World Health Organization concluded that in the average hookah session, which lasts one hour, the smoker is inhaling as much smoke as would be inhaled with the smoking of 100 cigarettes.

It's time for universities and public health agencies across the country to step up to the plate and ensure that young people understand what they are getting into when they start smoking hookah. There is plenty of evidence illustrating the efficacy of targeted public health campaigns in educating the masses on these types of risks. The 1964 Surgeon General's report on smoking led to a profound shift in the way smoking was perceived in this country. More recently, the CDC successfully executed a bold advertising blitz, which featured graphic images depicting the transformation of former smokers who suffered from significant health problems due to their smoking. The CDC spent $54 million on these ads, which ran for 12 weeks. The agency reported that the ads led to almost 200,000 extra calls to its national helpline, 1-800-QUIT-NOW, and almost half a million extra visitors to its cessation and prevention website,, a 300 percent increase in traffic. This campaign helped a staggering 100,000 Americans quit smoking. There is no reason this success can't be emulated with a similar campaign specific to hookah smoking.

Tobacco smoking is the leading cause of preventable death in the world. In the United States, over 16 million people suffer from diseases caused by smoking tobacco. We spend over $130 billion annually on healthcare expenditures to treat these conditions. These tremendous human and economic costs will only mount if no serious effort to educate the public on hookah smoking is undertaken.