What’s smokin’: water pipes

Want to put away the cigarettes and talk with some interesting people? Go to a hookah bar, says Aaron Alu, as he takes a leisurely puff from a glass water pipe at the Mirage Coffeehouse and Hookah Lounge in Long Beach.

Apple-scented smoke drifts in the air as the clean-cut police officer looks around genially. “I get to talk to people here that I otherwise wouldn’t ever get to know.” One patron looks up from her laptop and nods in agreement. “I’m sure it’s not great for you,” Alu adds, “but it got me to quit smoking cigarettes.”

Although not even hookah fans suggest that smoking tobacco through a water pipe is healthful, many contend that drawing the smoke through the water removes some of the harmful chemicals. Scientists, however, point out that although the hookah may filter out some irritants, the smoke nevertheless contains high levels of nicotine, carbon monoxide and other toxic chemicals. The trouble is, they can’t say exactly how unhealthful it is, particularly compared with cigarettes.

The potential risks, or relative safety, of hookah smoking has taken on added relevance as hookah bars have begun to sprout up across the U.S. in recent years.

There are more than 400 hookah cafes across the country, according to an online database of hookah bars, with half of them in California, Illinois, New York, Arizona and Florida. California leads the pack with about 90 hookah bars and cafes, and the numbers appear to be growing, says Paul Knepprath, vice president of government relations for the American Lung Assn. of California. Hookah bars are especially popular among 18- to-24-year-olds, he says.

The growing popularity of hookah bars has led the American Lung Assn. and the World Health Organization to issue advisories on the dangers of hookah smoking.

“Any of the major diseases that are associated with cigarette smoking are associated with hookah pipe smoking,” Knepprath says. The long-term dangers, he says, include lung and heart disease, cancer, emphysema and heightened asthma attacks.

But tell that to hookah smokers, who say the wave of relaxation that comes with every puff, along with the fellowship of other smokers, outweighs the risks.

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Old origins, new trend

Typically, a hookah consists of a bowl, which is filled with tobacco, affixed to a hollow tube that extends down into an enclosed jar partially filled with water. The user draws air from a hose affixed to the top of the jar, creating a vacuum in the air and forcing smoke up through the water.

The origins of the hookah are somewhat cloudy, but it has been traced back as far as the 14th century, when water pipes appear to have been used in Africa. By the 17th century, the hookah had spread throughout Turkey, Greece and the Middle East. (It famously made its way into literature in 1865 via the truculent, hookah-smoking caterpillar in “Alice in Wonderland.”) Today, it’s commonly reported that there are an estimated 100 million daily hookah smokers worldwide, but the origin of that number isn’t clear.

The American Lung Assn.’s Tobacco Policy Trend Alert, released in February, describes hookah smoking as the first new tobacco-use trend of the 21st century. This is particularly disheartening, Knepprath says, because the use of cigarettes and other forms of tobacco has declined dramatically in the last 40 years. “In California, we’ve reduced tobacco consumption by more than 60% just since 1989.”

A key sticking point among researchers is the question of just how much nicotine and other dangerous chemicals are contained in hookah smoke, and how much of that is absorbed by the body.

“There’s certainly no evidence that it is safer,” says Dr. David Burns, professor emeritus of medicine at UC San Diego and contributor to the WHO report, “and there is evidence that it contains many of the toxic constituents of tobacco. And you may get them in higher doses than you would from smoking cigarettes because of the very large volume of smoke that you ingest.” Hookah sessions typically last 20 to 80 minutes, and the mildness of the smoke allows for deeper inhalations.

A World Health Organization Advisory issued in 2005 reports that during one 40- to 45-minute hookah session, a smoker could, in theory, inhale the equivalent of 100 cigarettes. A study in the July issue of Pediatrics found that carbon monoxide concentrations in the blood of hookah smokers was quadruple that of cigarette smokers. And in a 2004 review of hookah studies, lead author Thomas Eissenberg at Virginia Commonwealth University reported that hookah smoke generated by a machine appears to contain substantial amounts of nicotine, arsenic, cobalt, chromium and lead.

Apparently it’s a boon for periodontists: Gum disease has been found to be five times as prevalent among hookah smokers than cigarette smokers, according to an online report in the July 2007 British Medical Journal.

But the actual science behind some of the statistics cited about hookah smoke is problematic, says Kamal T. Chaouachi, a Paris-based tobacco researcher who is widely published on the subject.

While not disputing the dangers of hookah smoke, Chaouachi notes that many of the statistics cited about hookah smoke are based on studies conducted using machine-produced smoke, which isn’t consistent with the way hookahs are actually smoked. In addition, the studies vary in the types of tobacco tested, the temperature at which it’s burned, and the type of charcoal used to keep the tobacco lighted, all of which can affect results greatly. Consequently, there’s a wide discrepancy in findings.

Burns, a contributor to the WHO advisory panel, is equally worried about the inconsistencies and overall lack of data on the effects of long-term hookah smoking. “We know very little about the outcome of that behavior, whether people develop substantial levels of disease from use,” he says. “We’re quite concerned at this point in the social history” of the hookah.

And, of course, public-health experts worry that hookah smoking may lead to cigarette smoking. “One of the concerns the American Lung Assn. about any kind of social smoking is that it’s possible gateway to cigarette smoking,” Knepprath says.

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Kicking the cigarette habit

Hookah users dismiss such concerns, and some -- ironically -- see the hookah as a way to give up, rather than start using, cigarettes.

Back at the Mirage, Alu, 34, takes another puff and surveys the scene. He knows the patrons at the other tables, including Kayla, a college student and former cigarette smoker who’s already spent hours there, and Tom, a newcomer who’s hoping the hookah will help quiet his constant cravings for cigarettes.

“I like the cross section,” Alu says. “I can come here and I’ll talk to students. Tom over there is 68, and we would never talk if it wasn’t for being here together.”

As far as the advisability of young adults getting together and smoking, there are plenty of worse ways that they could be spending their time, he says. “It’s a way for people to socialize without drinking at a bar, then driving and endangering people.”

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janet.cromley@latimes.com