Tobacco Addiction: Hookah

Jared Fujikuni Psych 22 April 5, 2013 Tobacco Addiction: Water Pipes An addiction is the compulsive need for and use of a habit-forming substance which is defined by physiological symptoms upon withdrawal. Addiction is more commonly referred to activities in a negative sense because the substance is often harmful to the user. One of the most addicting substances is nicotine, which is found within tobacco. The first thought that comes to mind when referencing to tobacco addiction is smoking cigarettes, but there are many other ways to consume tobacco such as: dip (chewing tobacco), cigars, and water pipes.
Although the water pipe has been around for hundreds of years, it has only recently become popular. It has spread throughout the Middle East to Europe, all the way to North America, targeting pre-teens to young adults in college. There is an abundant amount of research done on the damaging effects of cigarettes, but as the water pipe craze is relatively new, there is still very little information on the health risks that this fresh social nicotine addiction may contain. The water pipe has many different street names which are a lot more exotic and alluring: hookah, shisha, boory, goza, nargile, arghile, and hubble bubble/hubbly bubbly.
Smoking hookah is a sensual and relaxing experience which is often done with a group of people. This bonding social activity gives smoking a different dimension of appeal compared to the normal singular act of smoking a cigarette, but may also contribute to the development of addiction. The water pipe is often an elegant looking device resembling a flower vase that sits on a table in between the party. The group will usually be sitting comfortably around the hookah which encourages long sessions that often include over fifty puffs of the hookah.

The type of tobacco that is smoked through the water pipe is called maassel, which is fermented in molasses and fruit essences. There are many different flavors that appeal to all smokers. The smoke is often sweet or minty and cooled by the water filter which makes it easy for even nonsmokers to enjoy. First the tobacco is placed within a clay bowl covered by aluminum foil which heads the water pipe. Coals are placed on top of the head to heat the tobacco. The vase of the hookah is filled half way with liquid (usually water). The smoker inhales through a tube that is connected to the vase.
The smoke is drawn through the stem of the pipe and filtered through the water before going through the tube that the smoker is inhaling on. The smoker is able to inhale clouds of smoke while simultaneously drawing air over the coals which further burns the tobacco. There are many cafes and bars that are dedicated to smoking hookah. These cafes have become increasingly popular among college students and are popping up all over the United States. Hookahs are also easily purchased through smoke shops or online. Smoking hookah has become a very popular social event because of its slow pace and relaxing feel.
It allows people to partake in an activity which doesn’t require any concentration and allows them to socialize for an hour or so. It is more active than getting together for a coffee but not distracting enough to take away from a conversation. Yet the slow pace of the hookah experience is part of why it might be very dangerous. The total amount of exposure to nicotine through the prolonged smoking pattern is extremely unhealthy. Researchers from the American University of Beirut analyzed smoking patterns at a hookah lounge and reported that smokers inhaled ten times as often as a typical cigarette smoker would.
Not only this, but each inhale contained about ten times as much smoke volume as a single cigarette puff. A single hookah session could have the smoke volume equivalent of one hundred cigarettes. To defend the health risks of hookah smoking, many argue that when inhaling, it is nott necessary to inhale all the way into the lungs, but to simply play with the smoke in the mouth like with a cigar. However, researchers have collected data that estimate absorption of nicotine and other substances contained in hookah smoke state otherwise. Despite the volume of exposure, hookah smokers are still exposed to fewer toxins than cigarette smokers. The studies indicate that hookah smokers are absorbing high levels of toxins and carcinogens that contribute to the development of heart disease, lung cancer, and respiratory diseases” (Harvard, 2008, p. 3). Hookah is often argued as a healthier way of smoking because the smoke is filtered through water, but clearly it does not filter out all of the toxins. There is still enough nicotine getting through to become addicted. The amount of nicotine that is produced by smoking hookah can vary depending on multiple variables: type of tobacco, number of coals, duration of use, and the inhaling technique.
The number of coals which is related to the temperature that the hookah would be burning at has a huge impact on the amount of toxins that are inhaled. If the coals are actually burning the tobacco instead of “baking” or “steaming” the shisha, the tar in the tobacco could be burned which is very unhealthy to inhale. Researchers found that chronic respiratory symptoms were found in younger hookah smokers rather than older ones which suggest that the younger users were smoking more intensely or not being as careful to not burn the tar.
Saliva samples showed that carbon monoxide exposure was twice as high in hookah smokers as in cigarette smokers. As far as long-term health effects, there hasn’t been much research to make any solid conclusions but like in other tobacco related addictions, there was increased chance of periodontal disease, cardiovascular problems, increased heart rate and blood pressure and problems with the child of women who were pregnant while smoking. Despite the health risks (that the majority of smokers don’t even know about), smoking hookah has a huge appeal.
It is a social activity that gives bored young adults something to do as well as relaxes the body. The social aspect of the water pipe makes quitting the addiction much different than quitting smoking cigarettes. The hookah smoker is not only addicted to nicotine but also addicted to a fun activity that encourages socializing. It is easy to see how and why young adults would become addicted to smoking hookah. It is also easy to see why hookah lounges are rapidly popping up across the world as addiction equals profit. “While hookah is alluring, it also appears to be a health hazard.
Clearly, there are safer ways to relax” (Harvard, 2008, p. 3). Two studies were recently done on hookah smokers. The first study wanted to figure out if hookah smoking encouraged cigarette addiction, while the other sought to decipher the demographics of those who smoke hookah based off a study done on female college freshmen. The first study was done on students in Denmark. They tested men that were all non-smokers who occasionally smoked a cigarette but were not yet addicted. Through surveying, they discovered that the men that also occasionally or regularly smoked from a water pipe were more likely to become regular cigarette mokers. Although this is a rather weak study, it shows that the tobacco in hookah still contributes to nicotine addiction. A side point that the study made was that hookah could be a potential gateway for smoking cigarettes. “Special features such as the lower temperature of the smoke and the aromas of water pipe tobacco can contribute to enforcing this mechanism, leading toward smoking cigarettes regularly” (Jensen, 2010, p. 1256). The second study helped determine the appeal of smoking hookah. Syracuse University did a study on female freshmen at a private university in New York through online participation which was paid.
The study based the results on the volunteers who had not smoked hookah before their freshman year. There were many factors that were predicted to determine whether the students would partake in smoking or not. The protective factors: high school GPA, religion, health value, and self-esteem. The risk factors: impulsivity/sensation-seeking, depression, anxiety, and social comparison. “…experimenting with hookah might be part of a normative process of seeking new experiences, as a rate of other substance use peak during the 18-25 age range” (Fielder, 2012, p. 64). Freshmen year is where students are insecure, seek self-discovery, and take risks. “…the transition to college is a likely time for hookah initiation given the increased freedom enjoyed by residential students, the popularity of hookah lounges in college towns, the ability of students under age 21 to get into hookah lounges but not regular bars, media portrayals of hookah smoking as exotic and trendy, permissive social norms about substance use typical of the college environment, and the developmental task of identity exploration” (Fielder, 2012, p. 46). All of these factor into the study and reasoning behind the engagement in hookah addiction. The study results showed that twenty-three percent initiated hookah use during their freshmen year which is not a huge percentage but there were many limitations to this study. A volunteer survey that took place at a private school that targeted women was the make-up for a limited study. The results showed that the biggest correlation with smoking hookah was alcohol intake.
The other predicted factors weren’t strong enough to make a correlation. The study also showed that one-third of the surveys had already smoked hookah before their freshman year which shows the popularity. Despite the actual addiction to nicotine and the appeal of the head rush, one of the biggest aspects to smoking that is often over-looked is the smoke itself. Although the smoke is in some ways mysteriously uncontrollable, the art of the smoke cloud projecting out of the smoker’s mouth gives off a sense of creativity and ownership.
The smoke is art whether it is blown out through technique such as a ring or simply as a cloud. The clouds achievable by smoking hookah are by far the largest. The water pipe’s allure combined with its targeted consumer is the perfect set-up for a generation of nicotine addicts. With still very little known about the long-term health risks, too many risk-seeking college students are falling into the social nicotine trap. It may start off as an innocent activity, but soon enough it could become a daily routine, henceforth an addiction.
Harvard Medical School. (2008). Why waterpipe smoking raises concerns about addiction and other health problems. The Hazards of Hookah. Jensen, Poul Densoe. (2010). Waterpipe use predicts progression to regular cigarette smoking among Danish youth. Tobacco: Waterpipe Smoking. Fielder, Robyn L. , Carey, Kate B. , & Carey, Michael P. (2012). Predictors of initiation of hookah tobacco smoking: a one-year prospective study of first-year college women.

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