Researchers embark on hookah smoking study

Kawkab Shishani

SPOKANE – Researchers from WSU’s College of Nursing plan to embark on a pilot study on the health and dependency risks of heavy waterpipe smoking for intermittent users, a virtually unexplored topic.

Smoking tobacco through a waterpipe, or hookah, originated in the Middle East and has been a growing trend over the last decade in Europe and the U.S., according to the American Lung Association. Yet there have been few U.S. studies focused on hookah smoking and its effects at the national level. The most comprehensive was published in 2009 by Professor Thomas Eissenberg from Virginia Commonwealth University.
Kawkab Shishani, assistant professor, and Donelle Howell, assistant research professor, in the College of Nursing plan to change that. Outside of determining health risks, Shishani said, their main concern is discovering whether or not sporadic but heavy hookah use leads to dependency, or even a transition to cigarette smoking over time.
Does it lead to dependency?
“There are more hookah bars cropping up all around the country, and there are more stores selling hookahs, which means people are smoking at home,” Shishani said. “Now it’s not only a social practice, but has transitioned into individual use. …Does this lead to tobacco dependency? This is what we want to study.”
Working with Alan Shihadeh, associate professor of mechanical engineering at The American University of Beirut, and several student assistants, Shishani and Howell will research the physiological and subjective effects of hookah smoking on frequent, nondependent users.
Multiple measurements

Each week 24 research participants will attend three one-hour sessions, where researchers will measure their blood pressure, heart rate, carbon-monoxide and cotinine levels; cotinine is a metabolite of nicotine. Researchers also will record reported subjective effects of hookah use, including energy level, mood, nausea, dizziness, headaches and other signs of tobacco reinforcing effects and withdrawal.

In the first session of every week, participants will use a hookah-like smoking apparatus developed by Shihadeh that measures the volume of smoke inhaled per puff and the total number of puffs per session. Researchers will use this data, along with data collected at the two weekly follow-up sessions, to gauge consumption levels and their consequential health effects.
Preventable death
The Centers for Disease Control and Prevention deemed tobacco use the single most preventable cause of death in the U.S. – it kills an estimated 438,000 people each year. The American Cancer Society and American Lung Association have issued warnings that smoking hookahs may be as harmful to personal health as smoking cigarettes.
Shishani said that, despite CDC reports that show a decline in cigarette smoking over the past decade, hookah smoking gains popularity due to its novelty in the U.S.
Hookahs vs. cigarettes
In fact, Eissenberg’s study found that more than 90 percent of beginning hookah smokers believe cigarette smoking is more addictive than waterpipe smoking.
“Hookah smoking in the U.S. is fairly new, so there is this misconception that it’s a safer alternative to cigarette smoking,” Shishani said. “We need to dispel such myths, not only about hookah, but all tobacco products.”
Howell said their ultimate goal is to carry out similar, full-scale studies to find innovative tobacco treatment interventions.
Future work and funding
John Roll, professor and associate dean of research in the College of Nursing and director of the WSU Program for Excellence in Addictions, said countries where hookah smoking is more prevalent often run public health education campaigns on the issue.
“Studies like this one, which help to better characterize the physiological and subjective effects of hookah smoking, are crucial to developing pharmaceutical and behavioral treatment and prevention strategies,” Roll said. “I am confident this will be a pathway for future funding from the National Institutes of Health as well as add to our portfolio of work.”
In August, WSU’s Alcohol and Drug Abuse Research Program granted Shishani and Howell $29,311 for this study through the Faculty Seed Grant Program. The research will commence within the next few months.