Give Online: Help shape patient care for generations to come.

Be Well for Parents - February 2012

Feature: Smoking — The Hookah Habit Is Harmful

Feature: Smoking — The Hookah Habit Is Harmful

Teens may find hookah smoking glamorous and exotic, but it is every bit as addictive as cigarette smoking — and may be more so. The ancient pastime has seen a revival among high school and college students, says Susan Jung, a certified smoking cessation specialist in Cleveland Clinic’s Tobacco Treatment Center.

Hookahs are water pipes resembling slender metal vases. Charcoal is used to heat a sweet, sticky tobacco, producing smoke that is filtered through cooled water. The smoke is inhaled through a flexible hose that is passed from one user to the next. Hookahs come in a wide range of sizes. It’s easy to hide small, 8-inch-tall models in dorm rooms, cars and bathrooms.

Trouble bubbling

Young people may be attracted to the social nature of hookah smoking and to flavors that range from cappuccino to watermelon.

But hookah smokers may share more than tobacco. “What teens may not realize is that sharing the experience also means sharing a lot of risks — specifically mono, colds, strep and other infections that come from sharing the same pipe or hookah,” adds Children’s Hospital adolescent medicine specialist Ellen Rome, MD, MPH.

Herpes and h. pylori, the most common cause of stomach ulcers, can also be passed via the shared mouthpiece. And in other countries, tuberculosis can be transmitted when hookah smokers cough in each other’s faces.

More toxic than cigarettes

Aside from the risk of infection, smoke from the hookah contains the same cancer-causing chemicals as cigars and cigarettes. Hookah smokers also inhale carbon monoxide, heavy metals and other toxic compounds given off by the burning charcoal. And smoking in a group setting creates significant secondhand smoke — especially in so-called hookah cafes.

“Hookah is not a safe alternative to smoking cigarettes — a typical one-hour session involves inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette,” says Ms. Jung.

And the risks of addiction can’t be downplayed. Hookah smokers typically smoke longer and more often, take more puffs and inhale more deeply than cigarette smokers. They absorb more nicotine in higher concentrations because of the way that the smoke is cooled.

How to talk to teens about risks

A positive, problem-solving approach works best, says Dr. Rome: “Discuss with your teen what they get out of hookah smoking — and what they could do instead that would be safer.”

If your teen is looking for closeness with friends, suggest alternatives. Offer to help your teen prepare dinner for friends at your home — or buy the fixings for a shared cooking experience. Or suggest group outings like a bowling night.

Our experts offer these dos and don’ts:

  • Don’t support the habit. You don’t need to give your child funds to frequent a hookah bar.
  • Don’t preach. This approach always backfires with adolescents.
  • Do be a role model for your child. If you smoke, quit.
  • Do talk about smoking's harmful effects early. Start when kids are age 5 or 6, and keep it up through their teens — even if they don’t smoke.
  • Do talk to your teen about how to say “no.” Know your teen’s friends and ask whether they smoke.
  • Do practice patience. It may take a while for teens and young adults to quit any kind of smoking, just as it does for adults. When they’re ready to quit, provide plenty of support.
  • Do reward your teen for quitting. Plan something special for you to do together.
Cleveland Clinic’s Tobacco Treatment Center

If you smoke, chew or dip, Cleveland Clinic’s Tobacco Treatment Center offers the one-on-one support and the resources you need to quit. In individual sessions – and, starting in 2012, group appointments – participants receive a combination of behavioral therapy and medication that is proven to increase the likelihood of success. To see a certified smoking cessation specialist at any of our eight community locations, call 216.444.8111.

Related Content

Tip: Remember Sunscreen Even When the Days Are Short

Tip: Remember Sunscreen When the Days Are Short

Don’t let the gray skies of winter fool you. Your family needs sunscreen year-round. Ultraviolet A and B rays still penetrate the clouds and can lead to skin cancer and premature aging. Well-moisturized skin is better protected from the elements, so find a moisturizer with sunscreen. Look for sunscreen in lip gloss and lip balm too. When spending lots of time outdoors, reapply sunblock just as you would at the beach.

Parents Children's Health Essentials – February 2012 Issue
Feature: 8 Tips for Lowering Cholesterol With Diet & Exercise

Feature: 8 Tips for Lowering Your Cholesterol

We all want to be heart-healthy, and ensuring healthy levels of cholesterol — a fat, or lipid, carried through the bloodstream — is the first step.

Low-density lipoprotein or LDL (bad) cholesterol contributes to plaque buildup along with triglycerides, another lipid. High-density lipoprotein or HDL (good) cholesterol discourages plaque buildup. Plaque can threaten the blood supply to the heart, brain, legs or kidneys, leading to heart attack, stroke or even death.

The preventive cardiology team in Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute is dedicated to making sure these medical emergencies never occur. Registered dietitian Julia Zumpano, RD, LD, of the Weigh to a Healthier Heart Program, and exercise physiologist Michael Crawford, MS, Cardiac Rehabilitation Supervisor, share these tips:

How to lower cholesterol through diet
  1. Cut back on animal fats. Forgo fatty meats, such as chicken or turkey with the skin; processed meats, such as bologna, salami and pepperoni; and fatty red meats, such as ribs and prime cuts of beef, pork, veal or lamb. Also avoid full-fat dairy products such as cheese, cream, sour cream, cream cheese and butter. These foods contain saturated fat as well as cholesterol — both associated with higher blood cholesterol and plaque buildup.
  2. Make friends with fiber. Specifically, get friendly with foods high in soluble fiber. In the gut, soluble fiber can bind to bile (which is made up of cholesterol) and remove it. Look for soluble fiber in oats, flaxseed, barley, dried beans and legumes, fruits and root vegetables, as well as some whole-grain cereals, cereal bars and pastas.
  3. Go veggie. Choose at least one meatless meal per week. Substitute beans, tofu or nuts for red meat or poultry in a bean burrito or a tofu stir-fry to decrease your saturated fat intake and increase your fiber intake. Shoot for one meatless meal —breakfast, lunch or dinner — per day!
  4. Be a loser. If you’re overweight or obese, shed the extra pounds. Weight loss helps lower bad (LDL) cholesterol. Even a small-to-moderate weight loss — just 10 to 20 pounds — can make an impact.
How to lower cholesterol through exercise
  1. Move more. Work up to 90 minutes of cardiovascular exercise per day for optimum heart health and weight loss. Cardiovascular exercise means any activity that uses large muscles repetitively and increases the heart rate. Think walking, cycling, rowing, using the elliptical and swimming. If you find 90 minutes daunting, start with 30 minutes and work your way up a little at a time. For some people, 45 to 60 minutes of cardiovascular exercise is enough.
  2. Pick the right tempo. Aim for a moderate level of exercise. You’ll know you’ve reached it when you are able to carry on a conversation when you exercise, but can’t sing. Higher-intensity (more difficult) exercise is better at raising good (HDL) cholesterol. However, it also increases your risk of injuries, making it harder to continue exercising. Moderate intensity is preferable.
  3. Make a habit of it. Consistency is the key. Work out regularly and you’ll watch your triglyceride levels drop. Triglycerides are the only lipid in the cholesterol profile used for energy. They decrease an average of 24 percent with regular cardiovascular exercise.
  4. Change it up. Variety is the spice of life, so try different exercises to stay motivated, to challenge other muscle groups, to reduce the risk of overuse injuries and to enjoy your physical activity.

Note: If you have heart disease, check with your doctor before beginning an exercise program. If you experience chest pain, pressure, tightness, excessive shortness of breath, lightheadedness or palpitations, stop exercising and consult a doctor.

10-Week Heart-Healthy Weight Loss Program

Achieve your ideal weight and maximize your cardiovascular health in 10 weeks with our Weigh to a Healthier Heart Program, with private nutrition sessions, exercise prescriptions, exercise classes and group support. Let our team of physicians, dietitians, psychologists, counselors and exercise physiologists help you. Check with your insurer about fee coverage.

Related Content

Parents Children's Health Essentials – February 2012 Issue

Free Guide: Tetralogy of Fallot

Free Guide: Tetralogy of Fallot

Tetralogy of Fallot is a common congenital heart defect. About 1,700 babies are born in the United States with this condition each year. Learn more about its symptoms, diagnosis and treatment.

Recipe: Veggie Nuggets

Recipe: Tasty Veggie Nuggets

These aren’t your ordinary fast-food nuggets, but your kids will love them just as much. Serve nutrient-rich veggie nuggets with the fat-free or low-fat dipping sauce of your choice.


1 head of cauliflower, cut into florets (about 6 cups)
4 cups broccoli florets (thawed, if frozen)
1 cup carrots, shredded
2 cups shredded part-skim mozzarella cheese
½ cup skim milk
1½ cups bread crumbs

  1. Preheat oven to 350 degrees. In a food processor, chop the broccoli, cauliflower and carrots until fine. Mix vegetables together.
  2. Add the milk and mozzarella cheese until thoroughly mixed.
  3. Spray a cookie sheet generously with cooking spray. With your hands, shape the mixture into nuggets.
  4. Dip nuggets into bread crumbs and place on cookie sheet.
  5. Bake in oven for 20 minutes, turning nuggets halfway through.

Makes 12 servings, 3 nuggets each


Calories: 97
Fat: 4.4 g
Saturated fat: 2.4 g
Protein: 7.4 g
Carbohydrates: 8.5 g
Dietary fiber: 2.6 g
Sugar: 1.2 g
Cholesterol: 13.5 mg
Sodium: 207 mg
Potassium: 303 mg

Recipe from our Children's Hospital Pediatric Nutrition Support Team

Related Content

Parents Children's Health Essentials – February 2012 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.