Hookah and E-Cigs Viewed as Safe by the Young

With the taste of tobacco masked by flavors, such as green apple and bubble gum, hookah may make it easy to forget the harsh effects of tobacco on the body. Similarly, some chemicals used to flavor e-cigarettes, while considered safe by the U.S. Food and Drug Administration (FDA) due to their use in foods, are known respiratory irritants, and have led some to think danger lies in inhalation rather than digestion.

In a study focusing on young adults’ perceptions of various forms of tobacco products relative to traditional cigarettes, researchers found young adults under 25 are more likely to rate hookah and e-cigarettes as safer.

This is concerning as it suggests even a substantial portion of nonsmokers may view hookah as a relatively safer and acceptable way to use tobacco, according to the researchers.


The study, which was published in SAGE’s Health Education & Behavior, surveyed 2,871 smoking and non-smoking individuals between the ages of 18 and 34. According to the study, 62.1% of young adults between 18 and 24, and 54.6% of young adults between 24 and 35 believed e-cigarettes were less risky than cigarettes. In regards to hookah, 32.7% of the younger age group believed it was less risky than cigarettes, while 18.5% of the older group believed similarly.

Hookahs, or waterpipes, have been used by indigenous peoples of Africa and Asia for at least four centuries, according to the World Health Organization (WHO). “According to one historical account, a waterpipe was invented in India by a physician during the reign of Emperor Akbar (who ruled from 1556 to 1605) as a purportedly less harmful method of tobacco use,” as the water filtration of the smoke was believed to decrease toxins, according to the WHO. “Thus, a widespread, but unsubstantiated, belief held by many waterpipe users today—that the practice is relatively safe—is as old as the waterpipe itself.”

The WHO found cigarette smokers puff between eight to 12 times over a five or seven minute period, inhaling between 0.5 and 0.6 liters of smoke. Comparatively, hookah sessions last between 20 and 80 min, with a smoker puffing between 50 and 200 times. “The waterpipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes,” said the WHO.

According to the Centers for Disease Control and Prevention (CDC), studies on smoking in college students have found between 22 and 40% have used hookah.

Additionally, the CDC found e-cigarette smoking in middle and high school students is on the rise, from 780,000 in 2013 to 2,450,000 in 2014. The increasing prevalence has caused organizations, such as the American Lung Association, to call for increases in regulation. According to the organization, a 2009 FDA study “found detectable levels of toxic cancer-causing chemicals, including an ingredient used in antifreeze, in two leading brand of e-cigarettes and 18 various cartridges. A 2014 study found that e-cigarettes with a higher voltage level have higher amounts of formaldehyde, a carcinogen.”

Olivia A. Wackowski and Cristine D. Delnevo, the researchers behind the Health Education & Behavior study, suggest advertising methods, which make e-cigarettes appear “techy,” may give rise to positive attitudes towards the product. Further, labeling the products as safer alternatives may not sway people to switch from cigarettes, but may only encourage product uptake.