Hubbly-bubbly salesmen have been good at promoting flavoured tobacco as harmless, say health experts. But a new study - titled "Waterpipe and Cigarette Smoking among University Students in the Western Cape, South Africa" - suggests that "water pipe" use has increased, especially among students.
The study, published in the American Journal of Health Behaviour, notes that South Africa has been successful at reducing cigarette smoking from 32% of the population in the early 1990s to 20% in 2012.
But researchers say the use of hubbly-bubblies can have more adverse side effects to a person's health than conventional smoking, including the transfer of communicable diseases, such as herpes and tuberculosis.
The study, led by Lara Kruger of the University of Cape Town's School of Economics, used an online questionnaire sent to all registered students at four Western Cape universities.
The results show that students often reduce their hubbly smoking as they get older, suggesting it is largely a social activity.
National Council Against Smoking executive director Dr Yussuf Saloojee says hubblies have all of the health hazards of conventional smoking, including lung cancer and emphysema, but the biggest problem is that youngsters are attracted to smoking hubbly.
"In some studies we have seen that primary school-children refuse to go to school unless they smoke hubbly in the morning."
The study says there is a popular misconception that the health risk is less than cigarettes because the smoke is "filtered" by water and because it is not as regularly used as cigarettes.
Hubbly smokers not only inhale the same chemicals that are prevalent in cigarettes but also more carbon monoxide, says Professor Angela Mathee of the Medical Research Council's Environment and Health Research Unit.
"Carbon monoxide is what people use to commit suicide when they attach a hosepipe to a car exhaust. When you smoke a cigarette it is for two minutes. The carbon monoxide from smoking hubbly for two hours can be quite severe," said Mathee.
