(CNN) — The problem, Dr. Brian Primack says, is that hookah smoking is a beautiful thing.
Polished brass, woven rugs and intricate carvings create a culturally-rich atmosphere where friends can relax and socialize.
Unfortunately, smoking hookah delivers the same chemical compounds as smoking a cigarette. In fact, one session (usually about 45 to 60 minutes) delivers approximately 100 times the smoke as a single cigarette, with 40 times the tar and 10 times the carbon monoxide.
A hookah is a water pipe with a smoke chamber, bowl and a hose. The flavored smoke is created with three ingredients — heated tobacco, molasses and fruit. The smoke passes through water and into the mouthpiece, allowing consumers to inhale more deeply than they would when inhaling the dry air of a cigarette.
Hookah bars have been popping up around the country for the last decade.
“We normally cater to 18 to 20-year-olds,” says Lance Freeman of The Egyptian Café & Hooka Bar in Indianapolis, Indiana. “We are a place to come to for people who can’t go to bars.”
Primack’s latest study, published in the June issue of the journal Nicotine and Tobacco Research, finds that 1 in 3 current college students has smoked hookah at some point; more than 50% of those students were not cigarette smokers.
“In my opinion [hookah] is a lot better,” Freeman says. “There’s more flavor, it’s more mellow, it gives this tickle in your throat… it’s very relaxing.”
Primack was giving a lecture on the dangers of smoking at the University of Pittsburgh School of Medicine when a student interrupted him. “He said, ‘No offense, but nobody really smokes anymore — we all do this hookah thing instead.”
That moment launched Primack’s research into the hookah world. “It’s a very interesting public health puzzle. The same chemicals — in one form [are] reviled by many people, but the same people will go across the street and take it in this different format.”
Better education is needed, Primack says, to show the similarities between hookah smoking and cigarette smoking. In a previous study the researcher found 92% of videos on YouTube showed hookah in positive light, compared to just 24% of cigarette videos. And only 26% of hookah bars use the word “tobacco” at all on the first page of their websites.
Primack and his colleagues analyzed the survey responses of 105,012 students at 152 universities across the country for their most recent study. The population that participates in hookah smoking tends to be younger, male and white, but is found across all characteristics.
The researchers don’t know yet if hookah is addictive. Smokers inhale twice the amount of nicotine in one hookah session as they do with a single cigarette, but long-term studies need to be done to see if it interferes with their life in the same way.