With the rise of vaping continuing to increase, electronic (e-) hookahs have been advertised as a safer tobacco alternative, but it’s not all it seems
What is an E-hookah?
The e-hookah, known by various names such as e-waterpipe, and e-shisha, has become a popular product in the younger generations particularly.
The traditional hookah is a distinctive smoking device consisting of two main parts connected by a pipe. The upper part traditionally includes a bowl containing flavored tobacco, covered with perforated aluminum foil, and lit with burning charcoal briquettes. The lower part features a water jar covered by a gasket, with a hose for inhaling and a release valve to clear out stagnant smoke. More recently, the growing hookah tobacco industry has been marketing e-hookahs— which were patented by Philip Morris in 2019—as a less harmful alternatives to combustible-tobacco products. As compared to other vaping devices such as e-cigarettes, e-hookahs are used through traditional waterpipes, allowing the flavored aerosol to pass through the jar before inhalation.
Studying the effect of the e-hookah
A recent study funded by the University of California, Tobacco-Related Disease Research Program studied the immediate effects of e-hookah vaping on vascular health and has revealed that e-hookah’s may not be a safer alternative to tobacco. The research focused on determining the role of nicotine, a common component found in vaping products, on endothelial function and the crucial regulation of blood vessel health.
The study was conducted with a group of 18 healthy adults who were invited to vape three separate vaping sessions, on three separate days.
- vaped e-hookah with nicotine.
- vaped e-hookah without nicotine.
- vaped a sham (fake) vaping session, serving as a control for comparison.
Measurements included assessing brachial artery flow-mediated dilation (FMD), an early indicator of arterial health and analysing human umbilical vein endothelial cells (HUVECs), using the study participants’ blood, in laboratory experiments.
Inclusion criteria were individuals who regularly smoke hookah without a history of cardiopulmonary disease, with blood pressure below 140/90 mm Hg, a body mass index between 18.5 and 30 kg/m2, and a resting heart rate below 100 beats per minute.
Exclusion criteria were individuals who regularly smoked cigarettes, used marijuana in the past year or had a positive urine THC screen, were on prescription medications, pregnant or breastfeeding (confirmed by a urine test), or showed evidence of recent or current tobacco use or exposure with elevated end-expiratory carbon monoxide levels.
Key Findings
The study delivered deep insights into the role of nicotine in e-hookah-induced vascular changes. Vaping e-hookah with nicotine led to a significant reduction in endothelial- dependent FMD, indicating impaired blood vessel function.
They investigators found that vaping without nicotine or sham vaping had no significant impact on vascular health. Laboratory experiments using HUVECs suggested that nicotine, not non-nicotine constituents, was pivotal in diminishing nitric oxide (NO) bioavailability and elevating reactive oxygen species (ROS) bioactivity—critical indicators of vascular health.
Nicotine Levels and Physiological Changes
Plasma nicotine concentrations increased after vaping e-hookah with nicotine, while no changes were observed in the other conditions.
Hemodynamic measurements revealed an increase in heart rate and mean arterial pressure after nicotine-containing e-hookah use, reflecting common physiological changes associated with nicotine exposure.
E-hookah’s having an immediate impact
The study dismantles the concept that flavored e-hookahs, particularly those with nicotine, are harmless or safe alternatives to tobacco products.
It highlights the importance of recognising the vascular risks linked to nicotine-containing e- hookah vaping. The findings highlight the urgency of reevaluating the safety claims surrounding e-hookahs and emphasise the need for long-term research to comprehend the lasting effects of e-hookah use.
Despite the perception that e-hookahs are an innocent choice, the evidence suggests otherwise. Those who vape e-hookahs, especially the young and healthy, need to be aware of the potential risks associated with e-hookahs.
The study’s limitations
This study comes with certain limitations. Although they didn’t specifically investigate flavours’ impact on vascular changes, it’s important to note that they utilised the same flavour in both the nicotine and non-nicotine exposure experiments.
Given that some flavourings alone have demonstrated the potential to impair endothelial cell function, and considering the vast customisation options for e-hookah flavours, future research endeavours should clarify the specific role of flavour-induced effects in this context.
