Teens may find hookah smoking glamorous and exotic, but it is every bit as addictive as cigarette smoking — and may be more so. The ancient pastime has seen a revival among high school and college students, says Lauren Indorf, CNP, a nurse practitioner in Cleveland Clinic’s Tobacco Treatment Center.
Hookahs are water pipes resembling slender metal vases. Charcoal is used to heat a sweet, sticky tobacco, producing smoke that is filtered through cooled water. The smoke is inhaled through a flexible hose that is passed from one user to the next. Hookahs come in a wide range of sizes. It’s easy to hide small, 8-inch-tall models in dorm rooms, cars and bathrooms.
Young people may be attracted to the social nature of hookah smoking and to flavors that range from cappuccino to watermelon.
But hookah smokers may share more than tobacco. “What teens may not realize is that sharing the experience also means sharing a lot of risks — specifically mono, colds, strep and other infections that come from sharing the same pipe or hookah,” adds Children’s Hospital adolescent medicine specialist Ellen Rome, MD, MPH.
Herpes and H. pylori, the most common cause of stomach ulcers, can also be passed via the shared mouthpiece. “In other countries, tuberculosis can be transmitted when hookah smokers cough in each other’s faces and can be cultivated from the hookah water,” adds Dr. Rome.
More toxic than cigarettes
Aside from the risk of infection, smoke from the hookah contains the same cancer-causing chemicals as cigars and cigarettes. Hookah smokers also inhale carbon monoxide, heavy metals and other toxic compounds given off by the burning charcoal. And smoking in a group setting creates significant secondhand smoke — especially in so-called hookah cafes.
“Hookah is not a safe alternative to smoking cigarettes — a typical one-hour session involves inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette,” says Ms. Indorf.
And the risks of addiction can’t be downplayed. Hookah smokers typically smoke longer and more often, take more puffs and inhale more deeply than cigarette smokers. They absorb more nicotine in higher concentrations because of the way the smoke is cooled.
How to talk to teens about risks
A positive, problem-solving approach works best, says Dr. Rome: “Discuss with your teen what they get out of hookah smoking — and what they could do instead that would be safer.”
If your teen is looking for closeness with friends, suggest alternatives. Offer to help your teen prepare dinner for friends at your home — or buy the fixings for a shared cooking experience. Or suggest group outings like a bowling night.
Our experts offer these do’s and don’ts:
- Don’t support the habit. You don’t need to give your child funds to frequent a hookah bar.
- Don’t preach. This approach always backfires with adolescents.
- Do be a role model for your child. If you smoke, quit.
- Do talk about smoking’s harmful effects early. Start when kids are age 5 or 6, and keep it up through their teens — even if they don’t smoke.
- Do talk to your teen about how to say “no.” Know your teen’s friends and ask whether they smoke.
- Do practice patience. It may take a while for teens and young adults to quit any kind of smoking, just as it does for adults. When they’re ready to quit, provide plenty of support.
- Do reward your teen for quitting. Plan something special for you to do together.