Yes, College Students, Hookahs Are Bad for You

The cultural cred of a hookah bar may come with a side of pancreatic cancer.

It was the first night of college, in that uncomfortable expanse after everyone finished arranging their Target "Dorm Collection" lamps but before anyone had splintered into permanent friend units. A group of us sat in the common room of my all-female dorm, debating what to do on our first night in Washington, D.C.—the big city.

"Why don't we go smoke hookah?" suggested the girl with the nose ring.

"No!" I thought, reflexively falling back on my D.A.R.E. program indoctrination. "That sounds like a drug, and I don't do drugs."

Instead, I meekly asked, "Um, like, what's hookah?"

"Oh, it's like smoking a cigarette, but you smoke the tobacco through water, so it's not as bad for you," the girl said. "My older brother does it all the time."

This was before iPhones, so none of us could find fault with Nose Ring’s impeccable logic.

Thus I spent the first of many college nights lounging in one of D.C.'s vaguely Middle-Eastern hookah bars. In between bites of oily hummus, we’d pass around a mouthpiece—which I coolly resisted wiping before each use—and sucked in smoke that came in flavors like “sweet melon” and “queen of sex.”

It turns out I was one of the 25 percent of college women who try hookah for the first time their freshman year. Perhaps because of their perceived relative safety, hookahs—also known as shishas or water pipes—are growing increasingly popular among young people. Almost twice as many high-school students smoke hookah as smoke e-cigarettes. A survey of eight North Carolina colleges found that 40 percent of students reported having ever smoked tobacco from a hookah—just slightly under the number who said they had ever smoked a cigarette (47 percent). The majority of hookah users think they're safer than cigarettes.

As with many things in life, though, I would have been better off listening to my inner dweeb. A new study suggests that hookahs contain many of the same risks that cigarettes do, including nicotine addiction and the inhalation of carcinogens.

For a paper published last week in the journal Cancer Epidemiology, Biomarkers & Prevention, researchers from the University of California, San Francisco asked a group of 55 regular hookah smokers to abstain from smoking for a week, and then to provide a urine sample.

The participants then spent an evening smoking hookah and gave another sample at the end.

As Healthday reported, the differences between the two urine samples were stark:

“Compared to the urine samples collected after a week of not smoking, the urine sample collected after the evening of hookah smoking had: 73 times higher nicotine levels; four times higher levels of cotinine; two times higher levels of NNAL, a breakdown product of a tobacco-specific chemical called NNK, which can cause lung and pancreatic cancers; and 14 percent to 91 percent higher levels of breakdown products of volatile organic compounds such as benzene and acrolein, which are known to cause cancer, heart and lung diseases.”

The spike in nicotine "raises concerns about the potential addictiveness of water pipe smoking and possible effects on the developing brains of children and youths who use water pipes," study author Gideon St. Helen said in a statement. "I have seen entire families, including young children, smoking water pipes." Nicotine is more harmful to the brains of teenagers and young adults.

Hookahs were among the devices included in the list of tobacco products that the FDA proposed to regulate for the first time last month. Better knowledge of hookahs’ risks might encourage freshmen to find a better way to impress one another—though the other options aren’t great, either.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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