A Pack in 30 Minutes

Jo Ann Serota, MSN, RN, CPNP; Carol Rudy, MPH, ARNP, CPNP; Sally Walsh, MSN, RN, CPNP; Jo Ann Serota, MSN, RN, CPNP


J Pediatr Health Care. 2007;21(3):180-181, 209-21. 

In This Article

Questions and Answers

What is hookah smoking?

Hookah or water-pipe smoking, also known as narghile, shisha, or goza, has been used in the Middle East and Asia for more than 400 years (Rosenow, 2006). The hookah apparatus consists of a base that is filled with water, a bowl, a heating device that contains the tobacco and other products, a pipe that connects the bowl to the base, and a hose that is attached to the base to allow the smoke to be inhaled. When the smoker inhales through the hose, the smoke from the tobacco passes through the water into a chamber and then is inhaled (Rosenow). According to the World Health Organization, a 1-hour session of hookah smoking exposes the individual to high levels of toxic compounds including carbon monoxide, heavy metals, and cancer-causing chemicals as well as significant levels of nicotine (Rosenow). One 30- to 60-minute session is equivalent to smoking an entire pack of cigarettes at one sitting (Loffredo, 2006).

What are the health concerns with hookah smoking?

Hookah smoking is a relatively new phenomenon in Western culture. It is the fastest growing fad and worrisome epidemic among adolescents and young adults (Loffredo, 2006). The rationale for this new fad is the misconception that it is less toxic than cigarettes. Few studies document its hazards (Knishkowy & Amitai, 2005). Existing studies from Europe and Asia suggest that hookah smoking may increase malignancy in the lungs, gastrointestinal track, bladder, and lip (Knishkowy & Amitai). Also noted from these studies was a decrease in pulmonary function tests and increase in infectious disease from sharing the water pipe, including tuberculosis. A decrease in male fertility and low birth weight infants was another finding in these studies, along with cardiovascular changes such a elevated heart rate and an increase in blood pressure during hookah smoking (Knishkowy & Amitai).

Is hookah smoking safer than other tobacco products?

A common misperception is that hookah smoking is less dangerous than cigarette smoking, when, in fact, the use of the hookah may result in a higher concentration of absorbed nicotine. Nicotine is a very addictive chemical in the adolescent/young adult population. These toxins are not filtered by the water in the hookah pipe, nor does adding moisture to the smoking tobacco (water pipe) lessen its poisonous effects. Another risky behavior that is currently in vogue is adding marijuana or hashish to tobacco and using alcohol instead of water in the pipe. This practice may lead to addiction and other acute health hazards (Knishkowy & Amitai, 2005).

Why is hookah smoking so attractive?

As adolescents and young adults achieve specific developmental milestones of maturation and autonomy, behaviors that have a strong peer influence, such as hookah smoking, help the adolescent feel accepted by the group. It is an inexpensive social affair with a "feeling good" result. The consequences of tobacco smoking are not considered because of the perception the hookah is less harmful than a cigarette (Knishkowy & Amitai, 2005).

What can nurse practitioners and other health care providers do to educate the adolescents, young adult and parents?

Health care providers need to educate parents and adolescents/young adults that this form of tobacco smoking is more hazardous than smoking cigarettes. All restaurants with hookah bars should comply with current tobacco regulations, including monitoring the age of the hookah participants. Personnel at hookah bars must warn participants about the dangers of this type of tobacco use and its addictive potential. The American Lung Association's tobacco control program advocates for smoke-free air, an increase in tobacco taxes, prevention funding, and restrictions on youth access to tobacco products (American Lung Association, 2006b). According to the American Lung Association's State of Tobacco Control report card of 2006, 26 states, including the District of Columbia, received a passing grade for having laws for a workplace free of tobacco. The remaining 24 states received an "F." There needs to be support from all 50 states for all aspects of the tobacco control program. Legislators need to take a proactive position without bias or financial incentives, and citizens need to demand a tobacco-free environment, increase taxes on all tobacco products, and support prevention funding and restrictions on youth access to tobacco products with severe consequences if the restrictions are not followed.

Parents should strongly discourage all types of tobacco use with their children. If the parent smokes, this does not help deter the adolescent/young adult from smoking. Second-hand smoke is just as dangerous as smoking itself, according to the Environmental Protection Agency. Second-hand smoke was responsible for about 3000 deaths from lung cancer and at least 35,000 heart disease deaths each year (American Lung Association, 2006a). Health education in schools needs to address all the concerns and related health issues from tobacco use.

As pediatric health care providers, we need to continue to be proactive about discouraging tobacco use among our patients. We also need to get involved locally and nationally and support legislation that will curtail tobacco use in the United States.


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