Campaigners are trying to get hookah smoking exempted from England's smoking ban for cultural reasons. Despite there being little research into the health effects, doctors writing in this week's BMJ say the ban should stay in place.
A hookah is a glass based waterpipe used for smoking. It is commonly used in Arabic communities for smoking herbal fruits after meals, but it is becoming increasingly popular among young adults in Western Europe for smoking tobacco, massel (aromatic tobacco), cannabis and bango (an intoxicating plant leaf), write Dr Rashid Gatrad and colleagues.
It is thought that around 100 million people use a hookah daily worldwide. Reports suggest that family attitudes towards children smoking tobacco in waterpipes are far more permissive than attitudes to cigarette smoking.
There has been little research into the health effects of waterpipe smoking, but data show that rising numbers of children in the UK are being exposed to and experimenting with smoking hookah products, write the authors. Children as young as 10 years old are known to smoke fruit flavoured aromatic tobacco in areas with large minority ethnic communities such as Leicester and London.
The nicotine content in hookah tobacco seems to be the same as in cigarettes, but the authors warn that hookah smoking carries a greater risk of carbon monoxide poisoning than cigarette smoking, particularly if smaller hookah pipes and "quick lighting" commercial charcoal are used. There is also some evidence that hookah smoking causes chromosomal damage.
When used for smoking tobacco, the hookah is included in the legislation that came into force in England on 1 July 2007 banning smoking in public places.
The authors believe that including the hookah in the legislation is appropriate since the exposure of non-smokers to tobacco fumes is considerably higher than for cigarette smoking because of the large plume of smoke that the hookah generates.
However, it remains to be seen what effect the legislation will have on smoking non-tobacco containing products that still generate a large amount of smoke, they conclude.
A separate review article also published in this week's BMJ highlights the importance of helping patients to stop smoking as young as possible. It points to evidence that, beyond 40, people lose three months of life expectancy for every further year of smoking.