Study finds hookah tobacco labels are misleading

Label information on many hookah tobacco products is misleading and may be misinterpreted by consumers, according to new research on nicotine and pH levels in hookah tobacco. The study, led by Roswell Park Cancer Institute and UB scientists, has been published online ahead of print in the journal Tobacco Regulatory Science.

Hookahs are waterpipes that are used to smoke specially made tobacco, which comes in many different flavors. According to the Centers for Disease Control and Prevention, while many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking. And while hookah use is hazardous and addictive, use of these products has increased among adolescents.

For the new 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 products were analyzed in three groups corresponding to three types of hookah tobacco: unwashed, washed or herbal.

They found the nicotine levels in washed products were 236 percent higher, overall, than the product labeling claimed. Levels in unwashed products were 71 percent lower than what the labels indicated, while herbal products were found to have nicotine levels consistent with product labeling.

Evaluation of pH levels, which were found to vary significantly among unwashed, washed and herbal products, is important, the authors note, because higher pH levels allow nicotine to be absorbed more easily and quickly into the bloodstream.

“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,” says senior author Mark Travers, research assistant professor of community health and health behavior in the UB School of Public Health and Health Professions and a research scientist in the Department of Health Behavior at Roswell Park.

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

Adds Gary Giovino, a co-author of the study and professor and chair of UB’s Department of Community Health and Health Behavior: “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.”

Lead author Jessica Kulak, a UB PhD candidate in community health and health behavior, says 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.”

The research was supported, in part, by a grant from the Roswell Park Alliance Foundation; it also used shared resources supported by Roswell Park’s Cancer Center Support Grant from the NCI (project no. P30CA016056).