Water pipe smoking causes significant exposure to nicotine and cancer-causing agents

May 16, 2014, American Association for Cancer Research

Young adults who smoked water pipes in hookah bars had elevated levels of nicotine, cotinine, tobacco-related cancer-causing agents, and volatile organic compounds (VOC) in their urine, and this may increase their risk for cancer and other chronic diseases, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"This study reports systemic intake of tobacco-specific nitrosamines and VOCs after a typical -smoking session in a hookah bar setting, thus making the findings generalizable to most water pipe users in the United States," said Gideon St.Helen, Ph.D., postdoctoral fellow in the Division of Clinical Pharmacology and the Center for Tobacco Control Research and Education at the University of California, San Francisco.

After a single evening of water in a hookah bar, young men and women had in their urine a 73-fold increase in nicotine; fourfold increase in cotinine; twofold increase in NNAL, a breakdown product of a tobacco-specific nitrosamine, NNK, which can cause lung and pancreatic cancers; and 14 to 91 percent increase in the breakdown products of VOC such as benzene and acrolein that are known to cause cancer and cardiovascular and respiratory diseases.

"There was also a substantial increase in nicotine levels, which 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," added St.Helen. "Water pipe smoking is generally perceived to be a safe alternative to cigarette smoking, even for children and youths. Our study shows that water pipe use, particularly chronic use, is not -free."

St.Helen and colleagues recruited 55 healthy, experienced water pipe smokers, ages 18 to 48 years, to the study. Participants were instructed to refrain from any type of smoking for a week.

At the end of this period they provided a "before" urine sample and smoked water pipes at a hookah bar of their choice in the San Francisco Bay area. Soon after the visit, they provided the "after" urine sample, and filled a form to provide detailed information on their smoking session including total time spent smoking, number of bowls smoked, and number of shared users. They also provided a first-voided urine sample the next morning, which helped researchers estimate the clearance of the tobacco-related chemicals of interest.

The study participants spent on average 74 minutes smoking water pipes and smoked an average 0.6 bowls of water pipe tobacco per person.

The researchers found that the elevated levels of nicotine, cotinine, and NNAL, which were detected immediately after the water pipe-smoking session, remained significantly elevated in the next-day urine samples, compared with the "before" samples: Nicotine was 10.4-fold higher; cotinine, 3.2-fold; and NNAL, 2.2-fold.

Water pipe-smoking duration correlated significantly with the increase in post-exposure urine nicotine levels, and number of bowls smoked per person significantly correlated with the increase in post-exposure and next-day cotinine levels, respectively. The average increase in nicotine levels was comparable to obtained after smoking at least one cigarette, explained St.Helen.

"I have seen entire families, including young children, smoking water pipes. I have even been offered a smoke by my friend who thought water pipe smoking was 'totally safe,'" St.Helen added. "Our study provides evidence that water pipe smoking leads to significant intake of tobacco-related addictive and harmful substances, and is therefore not without risk, particularly among children and youths."

Explore further: Smoking from hookah not a harmless alternative to cigarettes

Related Stories

Smoking from hookah not a harmless alternative to cigarettes

April 18, 2013
(Medical Xpress)—Smoking tobacco through a hookah is a pastime gaining popularity among the college crowd, but many of them mistakenly believe that using the fragrant water pipe is less harmful than smoking cigarettes.

Non-smoking hotel rooms still expose occupants to tobacco smoke

May 13, 2013
Non-smokers should give hotels that allow smoking in certain rooms a wide berth, say the authors, and instead choose completely smoke free hotels.

Cambodia bans smoking shisha and e-cigarettes

February 27, 2014
Cambodia has banned e-cigarettes and shisha pipes saying the increasingly popular products contain damaging levels of nicotine and are leading young people to take up smoking.

Cambodian leader promises again to stop smoking

March 27, 2014
Cambodia's strongman Prime Minister Hun Sen has vanquished virtually every foe in almost three decades in power but admits he has failed to overcome his smoking habit.

More smoke water pipes -- family habits significant

April 7, 2011
The number of people smoking water pipes is rising dramatically throughout the world. A large proportion of new users are young, and many believe – contrary to facts – that water pipe smoking is less dangerous than ...

Shisha smoking as bad as cigarettes for lungs: study

August 30, 2012
Water-pipe smoking is as bad as deeply inhaling cigarette smoke when it comes to causing respiratory problems, according to a study published on Thursday.

Recommended for you

Chemicals in lavender and tea tree oil appear to be hormone disruptors

March 17, 2018
A new study lends further evidence to a suspected link between abnormal breast growth in young boys—called prepubertal gynecomastia—and regular exposure to lavender or tea tree oil, by finding that key chemicals in these ...

Exposure to low levels of BPA during pregnancy can lead to altered brain development

March 17, 2018
New research in mice provides an explanation for how exposure to the widely used chemical bisphenol A (BPA) during pregnancy, even at levels lower than the regulated "safe" human exposure level, can lead to altered brain ...

Smoking linked with higher risk of type 2 diabetes

March 15, 2018
The prevalence of diabetes has increased almost 10-fold in China since the early 1980s, with one in 10 adults in China now affected by diabetes. Although adiposity is the major modifiable risk factor for diabetes, other research ...

Key drivers of high US healthcare spending identified

March 13, 2018
The major drivers of high healthcare costs in the U.S. appear to be higher prices for nearly everything—from physician and hospital services to diagnostic tests to pharmaceuticals—and administrative complexity.

Pedometer health boost lasts four years

March 13, 2018
Wearing a pedometer to count your daily steps can keep you healthier and more active for as long as four years after using it, a new study shows.

Toilet-to-tap: Gross to think about, but how does it taste?

March 13, 2018
Here's a blind test taste like Pepsi never imagined. Researchers at the University of California, Riverside, recently published a study of recycled wastewater that did not focus on its safety-which has long been established-but ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.