The growing popularity of hookah pipes poses a challenge for life insurance underwriters, a reinsurer has warned.

Gen Re’s London-based Life Chief Underwriter Research and Development Ross Campbell says identifying users should be a priority.

“Many people incorrectly believe smoking this way is less harmful than using cigarettes, especially with non-tobacco products for use in hookah pipes,” he said.

“But this method of smoking itself poses significant health risk.”

The way tobacco is burned in a hookah increases known health risks, and passing the smoke through water does not reduce its harmful toxic effects.

“Charcoal makes tobacco burn at very high temperatures and this increases the levels of carbon monoxide and cancer-causing chemicals emitted,” Mr Campbell said.

“All hookah smoke contains carbon monoxide that increases cardiovascular risk.

“It also delivers polycyclic aromatic hydrocarbons that increase cancer risk and volatile aldehydes that cause lung disease.”

He says hookahs users take 200 puffs in a typical smoking session – more than 10 times the number needed to smoke one cigarette. Hookah smokers inhale about 90,000ml of smoke, compared with 500-600ml from a cigarette.

“These smokers risk nicotine addiction, cancer of the mouth, oesophagus, stomach and lung, as well as reduced respiratory function,” Mr Campbell said.

“Despite the dangers, the attraction of this centuries-old practice is growing – particularly among young people, perhaps due to the communal aspect of the experience.”

He says insurers should expand their questions on smoking to include all sources of tobacco use. “A cotinine test of a water-pipe smoker would also most likely prove positive. However, those who prefer to consume non-tobacco products by this method will only be spotted if hookah pipe use is specifically questioned.”