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The objective of this proposal is assess the risks hookah (water pipe) tobacco smoking, and to compare these risks to those of cigarette smoking. To do so we plan to measure exposure of hookah tobacco smokers to nicotine and other toxic substances, including carcinogens. Recently, smoking tobacco in water pipes has gained popularity in the US, particularly in areas with sizable Arab-American populations. Some 300 hookah bars have opened in the US, with about 50 in California. This form of tobacco use is gaining popularity among young people, and a number of hookah bars are located near college campuses. The owner of a hookah bar in the East Bay was quoted as saying “…groups often rent the lounge for private parties. The Hookah Hut is big with fraternities and sororities.” Most users of hookah tobacco believe that it is not addictive, and less harmful than cigarette smoking. It is estimated that about 100 million people worldwide smoke tobacco in water pipes, which are known as hookahs (Indian subcontinent and Africa), shisha, borry, goza (Egypt, Saudi Arabia), narghile, argilhe (Jordan, Lebanon, Syria, and Israel), shui yan dai (China), or hubble-bubble. According to one account, in the 16th century, a physician in India invented a water pipe and claimed that passing tobacco smoke through water would render it harmless. In spite of a long history and widespread use of water pipes to smoke tobacco, there is very little information on the risks of this form of smoking compared to cigarettes. Published data from Lebanon indicates that hookah smokers can absorb higher levels of nicotine and carbon monoxide than average cigarette smokers. It does not appear that studies measuring exposure to nicotine and other toxic substances in US hookah smokers have been carried out.
We plan to carry out these three studies with human subjects. One will involve people who report having smoked in local hookah bars but who are not users of other forms of tobacco. The second study will be carried out on a research ward and will involve people who report having smoked tobacco using a water pipe but do not use other forms of tobacco. A third study will involve people who are both regular cigarette smokers and smoke hookah pipes, and will also be conducted on a clinical research ward. Blood, saliva, and urine specimens will be collected for measuring exposure to toxic substances. The goal will be measure intake of toxic substances from hookah tobacco smoking, and compare intake to that of cigarette smokers. The substances to be measured will include nicotine, carcinogens, and other toxic substances implicated in causing tobacco-related diseases. We hypothesize that hookah tobacco smoking will result in substantial intake of nicotine and other toxic substances, and in some persons, toxic substance intake from hookah smoking will exceed the average intake in habitual cigarette smokers.
It is anticipated that the results of this research will be useful to public health professionals, to researchers interested in tobacco toxicology, and could discourage young people and others from initiating or continuing a dangerous practice. |
