How hookah use has become a global epidemic

It’s sneaky. In the same way Philip Morris marketed cigarettes equating smoking its brand with the rugged wild west individualism of the Marlboro Man (the cigs became the world’s bestselling), it looks like the popularity of the “Star Wars” franchise has helped make hookah smoking the new cool.

At the time of the first “Star Wars” film in 1977, hookah smoking was limited to some enduring hippies and a few Middle Eastern aficionados. But then along came Jabba the Hutt with his always-by-his-side hookah, and the spark was lit.

One “Star Wars” super-fan said: “When the ‘Return of the Jedi’ action figures came out in 1983, Jabba’s playset included his own little plastic hookah, and I remember going over to play with it at my friend’s house, sticking the end of the hose in the little hole in Jabba’s mouth. Being 4 years old, I had no clue as to what this was … Little did I know I would be in the hookah business 25 years later.”

Then in 2005, when Hasbro put out a “Star Wars” action figure for the bounty hunter Dannik, an extra known as the pipe-smoking alien in the 1997 film, the company added a hookah on his belt. Obi-Wan Kenobi, the old Jedi Master himself, also sat around a hookah with friends to discuss all things Jedi. By the beginning of 2008, hookahs had made appearances in more than 20 different “Star Wars” movies, short stories, novels, comic books and video games.

Little wonder that from 2008 to 2014 the number of high school kids who had smoked a hookah went from almost 9 percent to 13 percent; middle-schoolers jumped from under 3 percent to 5 percent; estimates of hookah use among college students range from 9.5 percent to 20.4 percent. Today hookah-smoking is a global tobacco epidemic causing world-wide degradation of lung function.

Consider these facts:

>> Even though cigarette use is declining, hookah bars that rent water pipes and sell flavored tobacco mixtures are gaining in popularity and remain largely unregulated.

>> Many hookah users believe the practice is less harmful than cigarettes, yet according to the American Lung Association, a single daily water-pipe use is the same as smoking 10 cigarettes. Hookah smoking sessions lasting 45-60 minutes are equal to smoking between 40 and 400 cigarettes.

>> A study in the journal Tobacco Control points out that while smoking one cigarette involves around 10 puffs, each delivering about 50 milliliters of smoke, one 45-60 minute hookah session may add up to 100 inhalations, and each one delivers about 500 milliliters of smoke.

>> Besides triggering bodywide inflammation, hookah use is associated with the spread of infections such as herpes and HPV from several smokers using a single mouthpiece.

The American Lung Association believes, as do we, that hookah smoking is a growing public health threat and that efforts should be made to restrict its use, especially among teens and young adults: “Hookah smoking … may lead to a resurgence in tobacco use among vulnerable populations. Both the American Lung Association and the World Health Organization recommend that laws or regulations prohibiting cigarette or other tobacco use in public places apply to hookah smoking.”

Before you hook up with a hookah, remember, Darrell Winfield, the Marlboro Man from the mid-1970s, died of lung cancer in 2015.

Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email questions to youdocsdaily@sharecare.com.