Water-pipe Smoking Holds High Cancer Risk, Study Shows

'There is a very dangerous and frankly wrong perception that water-pipe smoking is safe because the water somehow filters out the dangerous toxins in the smoke.'

David Bachar

Hookah (water-pipe) smoking, which is very popular in Israel and elsewhere in the Middle East, greatly increases the risk of esophageal cancer and lung cancer, a new comprehensive study shows.

The study, by researchers at Weill-Cornell Medical-Qatar medical school, is an analysis of 28 studies dealing with the health consequences of smoking a hookah (known in Israel as a nargila, a term that comes from Arabic by way of Persian). The research was published in the International Journal of Public Health, and is based on studies done in countries where hookah smoking has a long tradition, including Egypt, Iran, Azerbaijan, Tunisia, Lebanon, India, Pakistan, Yemen and Saudi Arabia.

A hookah is a stemmed instrument for vaporizing and smoking flavored tobacco or cannabis, whose vapor or smoke is passed through a water basin before inhalation. Hookah smoking is often a social event and even periodic reports of its potential for damage have done nothing to deter it. On the contrary, according to Faten Ghattas, director of the Israel Cancer Association’s Arab division, it has become popular not only in the Arab community, but among other sectors of the population.

Ghattas said the phenomenon began spreading in Israel after the border with Egypt was opened, but intensified after the peace treaty with Jordan was signed. “Starting from the middle of the 1990s, hookah smoking took hold in the Arab community and its use became widespread,” he said. “Today it’s a phenomenon that’s spreading like wildfire in Israeli society and among very young ages.”

The Qatar study was based on 8,714 instances of cancer and control groups totaling 35,746 people. The researchers found that hookah smokers tripled their risk for esophageal and lung cancer.

In the Weill-Cornell Medical-Qatar press announcement, Dr. Ravinder Mamtani, one of the directors of the study and the school’s associate dean for global and public health, was quoted as saying that the need for such a study had become urgent owing to the surge in popularity of hookah smoking.

Not like smoking cigarettes

“There are many studies examining the risks of cigarette smoking but we must understand that smoking from a water-pipe is significantly different because the smoker generally inhales far more smoke, smokes for longer, and there are different concentrations of toxins in water-pipe smoke than in cigarette smoke,” he said.

“Furthermore, there is a very dangerous and frankly wrong perception that water-pipe smoking is safe because the water somehow filters out the dangerous toxins in the smoke. I cannot emphasize enough that this is not true. The water only cools the smoke, it does not filter out the toxins,” he said. These toxins include tar, benzopyrene, arsenic, chromium and lead. Hookah smoke is a product of the combustion of the coal that heats the tobacco, as well as the tobacco itself, unlike cigarette smoke, which stems from the burning of tobacco alone.

Several years ago Ghattas gave a talk to a second-grade class in Ramle and was shocked to learn that eight of the pupils smoked hookahs at home on a daily basis. The most recent Health Ministry report on smoking (2015) showed that 21 percent of Israeli schoolchildren had tried hookah smoking. But the statistics are far higher in the Arab community, where by sixth grade, 34 percent of the boys and 22 percent of the girls had tried hookah smoking. By 10th grade, 54 percent of the Arab boys used a hookah, although the percentage of the girls dropped to 16 percent.

According to the Health Ministry report, 7.6 percent of sixth-graders in Israel smoke hookahs at least once a week; rising to 8.3 percent in eighth grade and 13.8 percent in 10th grade.