‘Hookah Smoking – An Age-old Modern Trend’

Dear Editor,

We write this letter to share our concern for the recent increasing popularity of hookah smoking among the young people worldwide with surge of hookah bars/lounges. Hookah, also known as shisha, water pipe, nargile, and qalyan, is a traditional form of tobacco consumption used mainly by elderly persons in rural areas of south Asian and Mediterranean countries.[1] Many reasons for the recent fad of hookah bars or lounges have been attributed to acceptance by nonsmokers, conviviality, cultural practices, marketing of various flavours, symbolism, and search for new forms of socialising.[1] The misjudged understanding of hookah being ‘safe and noncarcinogenic’ is the most common reason for upsurge of hookah smoking. Lack of clarity on the tobacco cessation policy about the hookah smoking has resulted in spurt of various hookah bars/lounges throughout the world.

Hookah smokers are known to be exposed to toxic compounds such as nicotine, polycyclic hydrocarbons, carbon monoxide, and nitrosamines.[2] Each puff from the hookah has reported to deliver 12 times as much smoke as a cigarette smoking.[3] Hookah smoking is associated with a number of deleterious health outcomes including lung cancer, esophageal cancer, respiratory illness, low birth weight, and pancreatic cancer.[3] A high risk of possible infectious diseases like tuberculosis, hepatitis C being transmitted through the common mouthpiece used in hookah bars is always present as they are not frequently cleaned.[4] The association between oral dysplasia and hookah smoking has not been correlated yet as the studies between exclusively hookah smokers and potentially oral malignant diseases have not been conducted. Though research between carcinogenic changes and tobacco smoking in the form of beedi, cigarette, or cigars has been documented extensively, the research on hookah smoking is scarce. The authors feel that the lack of a proper data has perhaps resulted in hookah smoking erroneously being considered as a low risk factor even by medical and dental practitioners for potentially malignant disorders. The various oral effects of hookah smoking like premalignant lesions, periodontitis, and oral infections like herpes should be studied extensively. There is always a risk of patient not revealing hookah smoking in case-history as it is considered trivial by patients and practitioner focusing more on beedi/cigarette smoking history. A greater need for public awareness about the carcinogenicity of tobacco in hookah smoking should be created otherwise tobacco would continue to rear its ugly head in this form or other. Lastly, the tobacco control policy should be now more precise and clear to prevent this modern ‘age-old’ fad of hookah smoking for usage, especially to minors.