Many Hookah Labels Mislead Customers About Nicotine Content: Study

Many hookah products have misleading labels — some with triple the amount of nicotine listed on the labels — according to new research from the University of Buffalo and the Roswell Park Cancer Institute.

Hookahs are waterpipes that are used to smoke specially-made, flavored tobacco. In the study, researchers examined the nicotine content and pH levels of 140 different packages of 12 brands of foreign-made and U.S.-made waterpipe tobacco.

“The nicotine content of waterpipe tobacco is highly variable, much more so than we see with other tobacco products. In this study, we found that many of the labels were erroneous, with actual levels of nicotine varying anywhere from 75 percent less to three times higher than the amount stated on packaging,” said Mark Travers, senior author of the study and a research scientist in the Department of Health Behavior at Roswell Park in a press release.

The products were analyzed in three groups based on the type of hookah tobacco, including unwashed, washed or herbal. Overall, nicotine levels in washed products were 236 percent higher than product labeling claimed.

Unwashed products were 71 percent lower than what labels indicated. Herbal products were found to have nicotine levels that were consistent with product labeling.

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The pH levels varied among the three types of tobacco, a finding that the authors said was important. Higher pH levels allow nicotine to absorb more easily and quickly into the bloodstream.

Since there are no labeling guidelines for hookahs in the United States, Gary Giovino said consumers could benefit from hookah regulations. Giovino is a co-author of the study and a professor and chair of community health and behavior at UB.

“This study provides a valuable assessment of the nicotine content and pH levels across a variety of waterpipe tobacco products. There is a need for standardized testing of waterpipe tobacco products, accurate constituent labeling and health warnings,” he said.

Researchers determined the nicotine and pH levels of the tobacco products by gas chromatography. According to the Centers for Disease Control and Prevention, many users think hookah is less harmful, when it has many of the same health risks as cigarette smoking.

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“Regulating warning labels will aid waterpipe tobacco users in understanding the product they are consuming,” Travers said.

Hookah use is hazardous and addictive, and use of the product has increased among adolescents. According to the U.S. Food and Drug Administration, hookah smokers may absorb more harmful chemicals found in cigarette smoke because smoking sessions are longer. A typical smoking session involves inhaling 100 to 200 times the volume of smoke from a single cigarette.

Jessica Kulak, lead author of the study and doctoral candidate in community health and health behavior at UB, said mislabeled products go beyond just incorrect information.

“Misleading packaging and labeling provides hookah users with erroneous information and perpetuates a false impression of safety. Our research supports the U.S. Food and Drug Administration’s efforts to regulate hookah labeling,” she said.