Hookah pipe smoking is a growing trend, sometimes touted as a "safe" alternative to cigarette smoking. Now, research carried out in New York City and published by Tobacco Control shows that the smoke is putting hookah bar workers at risk of lung and heart disease.

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Many young people mistakenly believe that hookah smoking is relatively safe.

The hookah, or shisha, is a water pipe of Middle Eastern or Indian origin, which is used to smoke fruit-flavored tobacco. The device may also be known as a narghile, arghile or hubble-bubble. It is a social activity, with one hookah normally passed around a group.

In New York City, there are now around 140 hookah or shisha bars or lounges, even though tobacco-based shisha is officially banned. These have traditionally been used by people of Middle Eastern and Indian descent, but young people of all backgrounds are increasingly taking up the habit.

In the US, secondhand smoke causes around 3,000 deaths from lung cancer deaths and 35,000 cardiac fatalities each year among complete nonsmokers. It is the third most common preventable cause of death in the country.

The Centers for Disease Control and Prevention (CDC) describe the hookah as "at least as toxic as cigarette smoking."

A 2014 survey showed that the number of 12th grade students in the US who had smoked a hookah within the previous year rose from 17% in 2010 to 23% in 2014, of whom 25% were boys and 21% girls.

According to the CDC's National Youth Tobacco Survey, hookah smoking approximately doubled from 2013-2014 among middle and high school students.

High levels of toxins found in hookah bar employees

Researchers at New York University's College of Global Public Health (CGPH) and Langone Medical Center tested 10 hookah bar employees in four hookah bars at the end of their work shift.

The employees had raised levels of toxins and markers for inflammation normally associated with pulmonary and cardiac disorders. Some of the employees' results were similar to those typical of heavy cigarette smokers.

The amount of carbon monoxide exhaled by the workers was significantly higher at the end of the shift. The rates for two of the employees were higher than 90 parts per million, a level characteristic of heavy tobacco smokers.

Blood levels of proteins that indicate inflammation, such as interferon, interleukin and tumor necrosis factor, were also higher at the end of the shift. While necessary for normal immune responses, excess levels of these proteins are associated with heart disease and cancer.

Nicotine was detected in the air of the bars, even though tobacco-based shisha is banned in these venues in New York City.

The concentrations of pollutants varied but were directly proportional to the number of smokers and hookahs. Ventilation through doors or open windows was frequently lacking.

Toxicologist and senior study author Terry Gordon, PhD, of NYU Langone, says:

"Hookah use is often exempt from clean indoor air laws that protect people from secondhand smoke. Ours is the first study that links poor hookah bar air quality to damaging effects in workers, and the results recommend closer monitoring of this industry to protect the public."

Gordon says the results "challenge the belief that secondhand exposure to hookah smoke is safe."

The researchers would like to see larger studies into the air quality of hookah bars, and development of regulations to protect both employees and people who frequent such bars.

The dangers of hookah smoking are exacerbated due to the long exposure to more smoke over an extended period. In addition, the frequency of puffing, depth of inhalation and length of the session may cause smokers to absorb higher concentrations of toxins typical of cigarette smoke.

Medical News Today recently reported on research suggesting that one hookah pipe can deliver the same amount of nicotine as 125 cigarettes.