According to Eissenberg, studies suggest that smoke from a single hookah session contains approximately 36 times the tar, 1.7 times the nicotine, and 8.3 times the carbon monoxide as the smoke produced by one cigarette. What fraction of those chemicals a hookah smoker actually absorbs isn't known, he adds, because some of these studies involved machines that simulate how people smoke, not actual smokers. "I'm concerned youngsters will go to these hookah bars and get addicted to the nicotine in the smoke," says Norman Edelman, chief medical officer of the American Lung Association. Research shows that hookah smokers have lower levels of nicotine and cotinine, a chemical the body makes from nicotine, than cigarette smokers, but the dose is still ample enough to lead to dependence, experts say. In fact, a survey of Syrians linked frequent hookah use to their belief it would be difficult to quit.
But Adams doesn't think he's in danger of addiction: "I've never woken up in the morning, breaking out in cold sweats, saying 'Ah! I want hookah!' " However, he did recently lose a 19-year-old friend, a longtime cigarette smoker, to lung cancer, which has made him more health conscious. "If I knew hookahs could put me at the same risk as cigarettes," he says, "that would definitely stop me from smoking them."
Most people who are addicted to tobacco get addicted as teens or younger, Edelman says. Since hookahs, which can stand 3 feet tall, can't be carted around in pants pockets, he worries cigarettes might be the next step. Overcoming a hookah addiction would require the same steps as quitting cigarettes, he says. And the mouthpieces attached to hookahs may pose a separate health risk, says Samira Asma, an epidemiologist at the CDC. Although every hookah smoker can get his or her own at the beginning of a session, many groups opt to simplify the hookah hose-passing ritual by sharing a single mouthpiece. This creates opportunities for the spread of infectious diseases such as herpes or tuberculosis, says Asma.
"It's a fad," Edelman says. "The good thing is these trends usually run their course and die, like oxygen bars. I'm hoping the same will happen with this."