Hookah smoking may seem like a relatively harmless way to spend an evening, but a new study suggests otherwise.
Just one evening of hookah smoking could make nicotine urine levels spike by more than 70 times, and also result in the increase of cancer-causing agents, according to the study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
Researchers from the University of California, San Francisco, examined the urine of 55 healthy people who had used water pipes, or hookahs, before. The participants were asked to abstain from any type of smoking for one week, after which they submitted urine samples to the study researchers.
Then, the participants went to a hookah bar of their choice for an evening, after which they provided urine samples to the researchers again, in addition to information on the amount of time they spent hookah smoking, how many bowls they smoked, and the number of other shared users. The participants also gave urine from the morning after the hookah smoking session to the researchers.
On average, each participant used 0.6 bowls of water pipe tobacco and spent 74 minutes smoking the water pipes. Upon analysis of the participants’ urine after smoking the hookah, compared with before smoking the hookah, urine levels of nicotine were increased 73-fold and levels of cotinine (which is a metabolite of nicotine) were increased four-fold. In addition, levels of the breakdown products of chemicals known to increase cancer were increased in the urine, including NNAL -- which was increased two-fold -- and the breakdown products of volatile organic compounds -- which was increased 14 to 91 percent.
While other studies have also shown that hookah smoking is associated with increased levels of toxins that can lead to health risks, this study is unique in that it reflected the effects after a normal night of hookah smoking. Other studies typically involve smoking hookah in a clinical setting.
“Given that water pipes are frequently smoked in social settings and shared with multiple users, the exposure from controlled clinical research studies may exceed what shared users are exposed to in a naturalistic setting,” they wrote in the study. “Therefore, biomarker levels reported in this study represent more realistic exposures to tobacco smoke toxicants.”
Previously, the same researchers had found that some toxins in hookah smoke are actually found at greater levels than in cigarette smoking, particularly urine levels of benzene byproduct (which raises leukemia risk) and breath levels of carbon monoxide. Those findings were published in the same journal last year.
Clarification: A previous version of this article mistakenly implied that nicotine is a cancer-causing agent; the article has been updated to clarify that it is other agents in hookah smoke that cause cancer.