>>NICHOLAS: I kind of look at it as ... kind of a different style of smoking versus like
smoking a pipe or a cigar.
Which I'm not a big fan of.
But hookah is to me - with all the variety of flavors, especially the way it's all set
up 'cause it's a waterpipe, you know - it's actually really clean, really smooth.
Something that you can relax on for an hour or two.
And it doesn't really affect me either way, you know.
>>ASHLEY: It's like the social thing.
You can sit there, and like, drink, and then, you know usually when people drink they say
they like to smoke.
So it's just like a totally different way of how to socialize and drink and just have
a good time.
>>JOSH: Smoking hookahs is not healthy.
And from what I hear smoking a hookah is equivalent to smoking multiple cigarettes.
It's probably not the healthiest choice and I know that myself but, you know when you're
around it all the time and you've got time to kill and ... I smoke hookah.
>>NARRATOR: In June of 2012 the Nicotine & Tobacco Research Journal published a survey of 105,000
U.S. university students, and their current tobacco use.
Hookah was ranked 2nd only to cigarettes as the most popular form of tobacco used on campus.
Dr. Thomas Eissenberg and his research team have conducted numerous studies to understand
the health effects of smoking hookah.
>>DR.
THOMAS EISSENBERG: One of the things we've learned, is that hookah tobacco smoking is
a lot more popular than you think it is.
So when I tell people, for instance, that in a survey of 105,000 university students
in the United States hookah was 2nd only to cigarettes, they're really surprised.
>>BARBARA KILGALEN: A lot of our participants don't think that smoking waterpipe is a problem
because it's filtered by the water.
When you ask them a lot of them will say cigarettes are much more dangerous.
>>JANET AUSTIN: We start immediately trying to figure out how to make it happen.
Months before even it's approved and out in the field we have an idea of how we're going
to do it.
>>DR.
THOMAS EISSENBERG: It never occurred to me that we would find what we found.
When you smoke a cigarette it takes you about 5 minutes to smoke a cigarette.
You take about 10 puffs on average.
Each puff is about 50 milliliters and so you end up inhaling about 500 milliliters.
Maybe a liter of smoke, a thousand milliliters of smoke, when you smoke a cigarette.
A waterpipe most people will tell you to sit down, you relax, you're maybe with friends
when you're smoking a waterpipe or a hookah.
It takes you about 45 minutes to smoke.
During that time, it can take as many as 100 puffs, sometimes 150.
We've seen a minimum of maybe 60.
Each one of those puffs can be about 500 milliliters.
So each puff from a waterpipe is about the same amount of smoke as you get from an entire
cigarette.
And if you're taking 100 puffs of a cigarette sized amount of smoke, then that's about 100
times the smoke that you're getting from a waterpipe.
Now the means can vary.
You can take less; you can take more.
But the bottom line is there's a lot of smoke being inhaled during a waterpipe tobacco smoking
session.
>>NARRATOR: Imagine buying a 1-liter bottle of soda at the supermarket.
The volume of that bottle is approximately equivalent to the volume of smoke inhaled
from a single cigarette.
Now imagine buying 100 of those 1-liter bottles of soda.
That amount of smoke is approximately equivalent to the smoke inhaled from a 45-minute hookah
smoking session.
>>DR.
THOMAS EISSENBERG: And whether it's 60, 80, 100, or even 50 if you want to go lower, that's
still dramatically more smoke that's being inhaled.
And we know the smoke contains nicotine that causes dependency, carcinogens that cause
cancer, volatile aldehydes that cause lung disease, and heavy metals and other toxicants.
I think every hookah smoker I've ever spoken to or emailed or had an online conversation
with will agree with the statement: "Hookah smoking is more dangerous than breathing air."
Many of them will say: "And it's way less dangerous than cigarette smoking."
So they're making the comparison.
And thus far, of all the data generated in my lab, Dr. Shihadeh's lab, Dr. Benowitz's
lab, every other lab, I haven't seen a single piece of evidence that supports the statement
that it's less dangerous than cigarette smoking.