The good news? Cigarette smoking rates are dropping. The bad news? More and more people are turning to communal pipes, called hookahs, that allow tobacco smoke to be drawn through water, which researchers have found to be highly toxic.

Just how toxic?

According to the results published in the journal Public Health Reports, one hookah session produces about 10 times the carbon monoxide, 2.5 times the nicotine, 25 times the tar and 125 times the smoke that one cigarette releases. These pose real health concerns so hookah smoking should be more closely monitored, said Brian Primack, M.D., Ph.D., the study's lead author.

The Youth Risk Behavior Surveillance Survey System assesses electronic cigarettes, chewing tobacco, cigarette smoking and other forms of substance abuse. It did not include hookah smoking in its 2015 questionnaire.

For the study, the researchers carried out a meta-analysis of previously published data, reviewing 542 scientific articles possibly relevant to smoking cigarettes and hookahs. They narrowed down the previous works to 17 that offered sufficient data to estimate the level of toxic substances inhaled when cigarettes or hookahs are smoked.

"It's not a perfect comparison because people smoke cigarettes and hookahs in very different ways," said Primack.

For instance, a heavy cigarette smoker may puff on, say, 20 cigarettes a day but a heavy hookah user will engage in just several sessions per day.

The meta-analysis was conducted to pit one cigarette to one hookah smoking session because that's how previous studies have reported their findings.

The results of the current study cannot clearly identify which is worse between cigarette and hookah smoking, but they do suggest that hookah smokers may be exposed to way more toxic substances than they realize.

According to the U.S. Centers for Disease Control and Prevention, more than 9 out of every 100 students in high school reported in 2014 that they engaged in a hookah smoking session. Between 2011 and 2014, rates of hookah use have increased not just in high school students but those in middle school as well.

Supported by the National Cancer Institute, the study also included contributions from Mary Caroll, Patricia Weiss, Ariel Shensa, Steven Farley, Alan Shihadeh, Michael Fine and Thomas Eissenberg.

Photo : Jesse Millan | Flickr

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