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Expert Advice

From E-Cigs to Hookah Pipes: Is Any of It Safe?

By Mat Edelson
While cigarette smoking continues to decline nationally, new forms of consumption are popping up. From hookah bars to legalized marijuana, the use of pipes, pot, blunts, e-cigarettes, and cigarillos is on the rise. Researchers are now clamoring to better understand the health consequences of this rapidly changing landscape.
David Abrams has been studying e-cigarettes, nicotine replacement therapies, and the nature of addiction for decades. Abrams draws an important distinction between these new categories of nicotine delivery: With hookah, cigars, and cigarettes, one is looking at “combustible tobacco.” 
 
“It’s the combustion that kills almost all the people who use tobacco,” says Abrams. “It’s the burning of tobacco, the carbon monoxide, over 60 carcinogens and other tars that kill, not the nicotine.” 
 
E-cigarettes, by contrast, don’t involve combustible tobacco. They’re battery operated, with the battery creating an inhalable vapor that delivers tobacco-derived nicotine. Given his druthers, Abrams would prefer that no one use any tobacco. However, if a person is already using cigarettes, cigars, or  hookah, then e-cigarettes, which are used by an estimated 13 percent of Americans who smoke, may be an important step in minimizing harm and even quitting altogether. “In the last six months, the evidence is strongly accumulating that [e-cigs] are at least as effective and may be more effective [for smoking cessation] than nicotine replacement therapies” such as nicotine gum or patches, says Abrams.
 
Abrams is particularly passionate about preventing youth from starting to smoke in the first place. He conducts research and interprets the science for Legacy, the nonprofit anti-smoking agency that produces the highly visible and effective TRUTH campaigns aimed at youth. Abrams acknowledges that for parents dealing with smoking adolescents, conversing about the issue is getting more complex: 12.6 percent of high-schoolers say they use cigars; 22.9 percent of college-age students have tried hookah; and 17 percent of 12th-graders tried an e-cigarette with more than 75 percent of them also trying conventional cigarettes. Throw in marijuana, which is also on an uptick—23 percent of all adolescents have used it, and this is before legalization—and we’re dealing with a very different kind of “stop smoking” talk than just a generation ago. 
 
“It’s not a simple message,” Abrams says. “It’s: ‘I’m very worried about your using any substance. We don’t know how your brain is going to react.  We don’t know who gets hooked, whose brain is allergic to these things. The best thing is to stay away from all drugs. However, if you’re using hookah or lethal cigarettes or cigars, I want you to know that although the research isn’t completely done, there’s good evidence that e-cigarettes are safer. I’d prefer you stop everything if you can.’”
 
E-cigarettes could prove an important public health tool, Abrams believes, but they need prudent FDA regulation, which currently isn’t the case. In the absence of regulation, he adds, many tobacco control and public health advocates are “overreacting to hypothetical and unproven fears.” FDA regulation would set product standards, including labeling that notes how to use them for “reduced harm” as compared to lethal cigarettes, cigars, and hookah.  
 
“E-cigarettes could be an unprecedented gateway to make obsolete the lethal combustible cigarette or cigar,” says Abrams. A just-released Bloomberg School study led by researcher Thomas Sussan found that mice exposed to e-cigarette vapor were “significantly more likely to develop compromised immune responses.” Abrams says that it is premature to generalize what this means going from animals to humans. While e-cigs may not be harmless, overall they are far less harmful and are a tool for those looking to quit more-lethal combustible cigarettes.
 
One thing is clear; the youngster who takes up smoking any kind of combustible tobacco faces an extremely tough road toward quitting. Based on adult data, some 70 percent of adults say they want to quit in any given year, but only about 4 percent accomplish the task. This, notes Abrams, is despite anti-­smoking measures such as increased taxes on tobacco, indoor clean air campaigns, and telephone and Internet cessation programs. The glimmer of good news is this: For those with the resources to use a combination of an FDA-approved nicotine replacement and behavioral therapies, quit rates can be doubled to quadrupled. A recent study also showed that those who used e-cigarettes for one month were 6 times more likely to have quit two years later.
 
Either way, Abrams remains passionate about his task of ending smoking among youth. “As the surgeon general said, 5.6 million of our kids alive today, including possibly my grandchildren, who are 6 and 10, will become addicted to lethal cigarettes and half of them will die prematurely if we don’t do something more than everything we’re doing now. That’s what motivates me to say, ‘We can’t just stay the course.’” 
Image of a cigarettes and other tobacco products
Maayan Pearl

While e-cigs may not be harmless, they are less harmful than smoking combustible tobacco.

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