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396Smoking tobacco is the leading cause of preventable death In the United States even though considerable success has been found in reducing smoking rates across the states Cobb Ward Maziak Shihadeh Eissenberg 2010 Cigarette smoking is responsible for more than 480 000 deaths per year CDC 2017 Much is known about the health effects of conventional smoking but until recently other forms of tobacco such as water pipe tobacco have not been extensively researched to determine potential harms associated with it Water pipe smoking has been around for centuries it has links to countries of southwest Asia and north Africa Cobb Ward Maziak Shihadeh Eissenberg 2010 Water pipe tobacco goes by many different names such as hookah narghile or shisha The term water pipe has been used to describe the use of instruments that allow tobacco smoke to pass through water before inhalation Nachef Hammond 2008 Due to increasing popularity of use in the United States water pipe use has become an area of concern The reasons for concerns mainly revolve around certain misconceptions regarding water pipe smoking One popular misconception being water pipe tobacco is less lethal and addictive than traditional forms of tobacco use such as cigarette consumption Smith Curbow Stillman 2007
The most common place for the consumption of water pipe tobacco in the United States are in establishments known as hookah bars These venues offer a nightlife vibe that can be very attractive to young people especially those in college In one study biomarkers of nicotine intake and carcinogenic exposure from water pipe smoking in the setting of hookah bars was investigated In the study 55 water pipe smokers were studied Biomarker tests were implemented before entering the hookah bar and after leaving and consuming water pipe tobacco at the venue Urine samples were analyzed for nicotine cotinine the tobacco specific nitrosamine 4 methylnitrosamino 1 3 pyridyl 1 butanol NNAL and mercapturic acid metabolites of volatile organic compounds VOCs St Helen Benowitz Dains Havel Peng Jacob III 2014 The study found an average increase of 73 of nicotine a 4 increase in cotinine a 2 increase in NNAL and a 14 91 increase in VOC mercapturic acid metabolites immediately following water pipe smoking Secondhand smoke SHS from cigarettes is known to carry carcinogens The US department of Health and Human Services estimates that 60 of US non smokers are exposed to SHS U S Department of Health and Human Services 2006 Second hand smoke has some variations to it one being sidestream smoke which would be smoke that is discharged from the lit end of a tobacco product Mainstream smoke would be defined as the smoke that is inhaled by the smoker then exhaled into the environment International Agency for Research on Cancer 2004 Much like conventional ways of smoking water pipe tobacco consumption also emits second hand and third hand smoke
Different respiratory symptoms were surveyed the most common symptom reported being wheezing or nasal congestion when exposed to SHS from water pipe smoke at 22 6 12 53 Those who reported similar symptoms but did not have any exposure to water pipe tobacco at home surveyed at 11 2 6 53 The harms of water pipe tobacco are beginning to become much more obvious to those involved in tobacco research However because of the misconceptions surrounding water pipe use it has been difficult to highlight the dangers of water pipe tobacco properly In order to properly address the issue of young people consuming water pipe tobacco proper dissemination of information is needed Attention needs to be brought to the quality of air inside hookah bars As discussed earlier 8 out of 10 hookah bars had an AQI rating of unhealthy Along with the information known of the air quality in these establishments more efforts should be placed in discussing the significance of tobacco specific biomarkers that can be found in one's body after the consumption of water pipe tobacco