It seems the average hookah tobacco session might be more dangerous to our health than previously assumed by most.

Summarizing the available data on hookah smoke, researchers in Public Health Reports came to the conclusion that, compared to a singular cigarette, the typical session drops off about 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide in our lungs. "Our results show that hookah tobacco smoking poses real health concerns and that it should be monitored more closely than it is currently," said lead author Dr. Brian A. Primack, University of Pittsburgh School of Medicine researcher, in a statement.

Primack and his colleagues rounded up and analyzed data from 17 studies on the levels of toxicants — a formal term for toxins made from human activity as opposed to animals — produced from hookah pipes that pump out tobacco. Though the estimate was simple enough to agree on, the research team did find that putting their findings in more practical terms, by comparing these levels to cigarette smoke, was difficult.

"It's not a perfect comparison because people smoke cigarettes and hookahs in very different ways. We had to conduct the analysis this way — comparing a single hookah session to a single cigarette — because that's the way the underlying studies tend to report findings. So, the estimates we found cannot tell us exactly what is 'worse.'” explained Primack. “But what they do suggest is that hookah smokers are exposed to a lot more toxicants than they probably realize.” He went on to add that further research on how often and long consumers use their hookahs will enable scientists to better compare how unhealthy in the long run hookah smoking actually is.

In the meantime, Primack, also an assistant vice chancellor for health and society at the university’s Schools of the Health Sciences, hopes the team's research at least brings a sense of awareness to both the public and public health organizations alike. He noted that hookah use currently isn’t asked about in the Youth Risk Behavior Surveillance Survey System ( YRBSS) questionnaire, a national school-based poll that attempts to monitor the prevalence of unhealthy behaviors that “contribute to the leading causes of death and disability among youth and adults.” What is included on that list is cigarette smoking, chewing tobacco, and even electronic cigarettes.

Other surveys, cited by the University of Pittsburgh, have found that around one-third of college students smoked tobacco from a hookah at least once before, with the hookah often being their first introduction to tobacco; and a 2010 study found that 17 percent of high school senior boys and 15 percent of girls had used a hookah in the past year.

Aside from the direct danger, some research indicates that a hookah session now may promote cigarette use in the future.

Source: Primack B, Carroll M, Weiss P, et al. Systematic Review and Meta-Analysis of Inhaled Toxicants from Waterpipe and Cigarette Smoking. Public Health Reports. 2016.