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TABLE A <br />Chemicals found in hookah smoke versus cigarette smoke <br />Adapted from Shihadeh and Saleh" <br />Chamieal Yield from ; Yield from <br />1 gm hookah cigarette smoke, <br />tobacco 1 gm tobacco <br />Multiple of <br />average <br />cigarette smoke <br />value <br />Combustion chemistries involved in the produc- <br />. tion of mainstream cigarette smoke and main- <br />stream hookah smoke differ due to widely differ- <br />old bustion. These include carbon monoxide (CO), <br />d metals like arsenic, nickel, cobalt, chromium, <br />d Lebanon." Shihadeh and Saleh carried out strin- <br />d of hookah smoke. They found that hookah smoke <br />ent combustion temperatures and the dry or <br />humid characteristics of tobacco. In both cases, <br />plant-derived organic matter undergoes pyrolysis <br />or volatilization, producing addictive nicotine as <br />well as a number of the same toxicants from com- <br />"tar," and myriad carcinogenic polycyclic aromat- <br />ic hydrocarbons (PAH). Also, hookah smoke con- <br />twins significantly higher quantities of toxic heavy <br />lead,'° and cadmium12, as compared with cigarette <br />smoke." These facts about hookah smoke are a <br />d "screarniiig warning" that hookah srrioking is harmful. <br />In a carefully designed recent study, researchers <br />Shihadeh and Saleh used a smoking machine that <br />d replicated the puffmg mechanics derived from <br />precise measurements of 52 hookah smokers in <br />gently controlled quantitative chemical analyses <br />produced nearly two orders of magnitude greater <br />amount of "tar" from a single smoking session <br />than that produced from a single cigarette. Simply <br />put, hookah smoke produces nearly 100 times more "tai" <br />than cigarette smoke, for each gram of the respective <br />tobaccos. Table A shows that hookah smoke contains <br />several-fold greater quantities of harmful chemicals thus <br />far studied than found in cigarette smoke. <br />In light of these recent chemical data on selected con- <br />stituents of hookah smoke as compared with those of <br />mainstream cigarette smoke, hookah smoke of various <br />fruity flavors, tastes, and aromas may be even more <br />harmful than disease-causing cigarette tobacco smoke. <br />_.__ t --__ _. <br />-- - <br />i i <br />"Tar," mg 802 ~ Range:l-27 ' 100-f <br />Average:11.2 <br />+ F <br />Nicotine, mg 2.9fi j Range: 0.1-2 4-fol <br /> <br />i - Average: 0.77 <br />~ <br /> <br /> <br />Carbon monoxide ~ _ <br /> <br />143 - <br />•- <br />~ Range: 1-22 ~ <br />-- <br />11-fol <br />CO,mg ' <br /> Average: 12.6 <br /> <br />PAH <br />C - __-__ <br />Phenanthrene, Ng ! 0.748 ! 0.2-0.4 2.5-fol <br />(co-carcinogen) lI <br /> <br />Fluranthracene, pg <br />0.221 3 <br />~ 0.009-0.099 <br />4-fol <br />(co-carcinogen) <br />Chrysene, Ng 0.112 ~ 0.004-0.041 5-fol <br />(tumor initiator) -) <br />1_ I <br />honey in Arabic~is a moist, paste-like mixture of about <br />30% crude, cut tobacco, fermented with approximately <br />70% honey, molasses, and pulp of different fruits to cre- <br />ate the fruity flavor and aroma of the smoke when sub- <br />jected to slow combustion with burning charcoal. The <br />combustion processes that produce cigarette smoke and <br />hookah smoke are very different. Mainstream cigarette <br />smoke is produced at 900°C. Hookah smoke is produced <br />at nearly half that temperature at 450°C. Hookah smoke <br />bubbles through water at the base reservoir. During a <br />smoking session, more glowing charcoal is added to the <br />partially consumed hookah tobacco once the original <br />charcoal in the bowl is used up. As the hookah smoking <br />session progresses, the reservoir water becomes increas- <br />ingly brown in color on account of "tar," dissolved chem- <br />icals, and other particulates in the hookah tobacco <br />aerosol. The chemical waste-laden water is discarded and <br />the hookah reservoir is then replenished with fresh water <br />for the next smoking session. <br />~~~hai is in hookah smokc° <br />During the last 40 years of research, nearly 4,800 chemi- <br />cal compounds have been identified in cigarette smoke, <br />including 69 carcinogens.b )n contrast, only five studies <br />have been published in English on the chemical comp- <br />osition of hookah smoke, and those focused on only a rel- <br />atively small number of chemical compounds.'" <br />~~~ho says hookah smoking; isn't addictivc° <br />Hookah smoking is an efficient nicotine delivery system. <br />After a 45-minute hookah smoking session, the concen- <br />trations of nicotine and its longer-lived metabolic prod- <br />uct, cotinine, become significantly elevated in saliva, <br />plasma, and urine.'° Comparison of urinary levels of coti- <br />nine between hookah smokers and cigarette smokers sug- <br />gests that in a single hookah smoking session using 20 <br />grams of hookah tobacco, the hookah smoker is exposed <br />to several-fold greater quantities of the addictive stimu- <br />lant nicotine for up to 45 to 60 minutes. That is equivalent <br />to chain-smoking 15 cigarettes.15 A cross sectional study <br />on hookah smokers from 112 restaurants and cafes in <br />Aleppo, Syria, reported that 96% of weekly hookah <br />smokers and 50% of daily hookah smokers did not smoke <br />75A-22 <br />