Addiction Nicotine Addiction What to Expect at a Hookah Lounge By Terry Martin Terry Martin Facebook Twitter Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction. Learn about our editorial process Updated on August 23, 2022 Fact checked Verywell Mind content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Sean Blackburn Fact checked by Sean Blackburn LinkedIn Sean is a fact-checker and researcher with experience in sociology, field research, and data analytics. Learn about our editorial process Print Svetlana Batura / EyeEm / Getty Images Table of Contents View All Table of Contents What Hookah Lounges Are Like Hookah Bars in the U.S. Hazards of Hookah Lounges Hookah Health Risks A Word From Verywell Hookah lounges are commercial establishments where people gather to smoke flavored tobacco from a hookah pipe. Other names for a hookah lounge include hookah bar, hookah cafe, hookah den, and shisha bar. Originating in India and spreading to several Middle Eastern countries, traditional hookah lounges are coffee houses that also serve hookah. However, as they have gained popularity in Western cultures, many hookah bars in the United States have evolved. A hookah is a water pipe used to smoke flavored, sweetened tobacco. Other terms sometimes used for hookah include argileh, narghile, shisha, hubble-bubble, and goza. What Hookah Lounges Are Like Though not exclusively, hookah bars in the United States are commonly decorated in trendy, modern themes to appeal to young patrons. Hookah is generally smoked in small groups, so many lounges offer grouped seating with comfortable couches, benches, or even alternative seating like bean bag chairs grouped around a hookah table. Some hookah bars offer outdoor patio seating, but they are primarily indoor establishments. Most hookah lounges offer a variety of enticing tobacco flavors, from fruity flavors like apple, mango, and cherry to herbal and spicy flavors like mint and cinnamon. The flavors make hookah appealing to both smokers and nonsmokers. Though hookah may be the primary business for some establishments, hookah lounges can also be situated within restaurants, bars, and nightclubs, where alcohol and food are served in a social atmosphere. Some hookah bars provide entertainment from large flatscreen televisions and DJs to belly dancers and live music. How Hookah Pipes Work A hookah pipe is a long, glass structure. There is a tobacco chamber, filled with flavored tobacco and topped with burning charcoal. Flexible tubes are hooked up to the pipe. People who are smoking hookah hold one tube per person, using the mouthpiece on the end of the tube to inhale. Smoke from the burning tobacco passes through a water chamber in the hookah pipe. This cools the smoke before it's inhaled. The tobacco used in a hookah is often flavored with sweeteners like molasses or honey to make it more palatable. Aside from tobacco, people may smoke tobacco-free herbal shisha (often a blend of tea leaves and honey) or marijuana using a hookah. Hookah Lounges in the United States While smoking bans have become more strict with increased public awareness of the dangers of tobacco smoke, hookah bars seem to be an exception as they continue to obtain indoor smoking permits. Other commercial locations that are allowed smoking permits include cigar bars and tobacco purveyors. The first hookah lounges in the United States were coffee and tea houses that mainly served immigrant communities. Hookah was an additional offering at these establishments, not the main focus. Hookah lounges in the United States started out in big cities like New York and Los Angeles, eventually spreading throughout the country. Other establishments quickly caught on and started offering hookah. Hazards of Hookah Lounges Many young adults have taken to this form of smoking, in part because it's considered to be a unique and acceptable way to socialize with friends, often in a fun atmosphere. Whether or not you smoke hookah, there are risks associated with simply spending time in hookah bars where others are smoking. Researchers from Johns Hopkins studied the air in several hookah bars over nine months. In particular, they measured nicotine, carbon monoxide levels, and particulate matter in hookah smoke. Their findings showed that the air in enclosed spaces where hookah is smoked is laden with carbon monoxide and breathable particulate matter from tobacco smoke—in concentrations even higher than those in public spaces where cigarette smoking is allowed. Nicotine content was not as high, but it was measurable. The polluted air and secondhand smoke in indoor spaces where hookah is regularly smoked put patrons at risk, even if they are not smoking hookah themselves. These findings are supported by studies of homes in which hookah is smoked indoors. One study found that homes where hookahs were smoked inside had even higher levels of air pollutants than in homes where cigarettes were smoked inside. Like the studies done in hookah bars, carbon monoxide was one of the pollutants found in higher levels in hookah-smoking households. Even rooms adjacent to where people smoked had detectable levels of carbon monoxide, which suggests that in establishments where the hookah lounge seating is separated from other areas like dance floors or dining room seating, patrons are likely still exposed to indoor pollution and secondhand smoke. Carbon monoxide exposure in the air is linked with cardiovascular and airway diseases like: Asthma Atherosclerosis (hardening of arteries) Cardiomyopathy Chronic obstructive pulmonary disease (COPD) Cystic fibrosis Respiratory infections Even Nondaily Smokers Face Increased Health Risks Health Risks Associated With Smoking Hookah The fun atmosphere of hookah bars is a big draw for many, but there are also many who try hookah because of the common misconception that hookah is a safe way to smoke tobacco. It isn't, and some of the facts about hookah smoking may be surprising. People who smoke hookah may inhale even more toxins than people who smoke cigarettes do. This is because a hookah pipe allows you to inhale more smoke at one time. The toxic agents in hookah smoke can potentially cause a number of health conditions including: Bladder cancerClogged arteriesDecreased fertilityEsophageal cancerHeart diseaseLung cancerMouth irritationOral cancerReduced lung functionStomach cancer Just as with smoking cigarettes, the babies of people who smoke hookah while pregnant are at higher risk of having a low birth weight and respiratory disease. In one study, researchers focused on 55 healthy people with some level of hookah smoking experience in the past. Participants were asked to abstain from all tobacco use for a week. They then spent an evening smoking at a hookah bar. Urine samples were collected and tested. Researchers found that nicotine levels after were as much as 70 times higher in people who spent one night at a hookah bar, compared to their nicotine levels before they went in. Additionally, NNAL, which is a carcinogen that is specific to tobacco smoke, was present in participants in twice the amount as before, and volatile organic compounds (VOCs), also hazardous to breathe in, were detected in elevated amounts between 14% and 91%. Health Risks and Diseases of Smoking A Word From Verywell Hookah is not a safe way to smoke tobacco. Tobacco is inherently dangerous, whether smoked or used in a smokeless form. Smoking hookah inside can be even more damaging due to the effects of secondhand smoke. Additionally, all tobacco products contain nicotine, which is an addictive drug. The best way to steer clear of the risks associated with tobacco and nicotine is to avoid using tobacco products and nicotine in any form. If you already use tobacco, learn about how to get started with quitting tobacco products. 1:23 Click Play to Learn More About Hookah This video has been medically reviewed by John C. Umhau, MD, MPH, CPE. 11 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Patel MP, Khangoora VS, Marik PE. A review of the pulmonary and health impact of hookah use. Ann Am Thorac Soc. 2019;16(10):1215-1219. doi:10.1513/AnnalsATS.201902-129CME Centers for Disease Control and Prevention. Hookahs. Patel MP, Khangoora VS, Marik PE. A review of the pulmonary and health impact of hookah use. Ann Am Thorac Soc. 2019;16(10):1215-1219. doi:10.1513/AnnalsATS.201902-129CME Palamar JJ, Zhou S, Sherman S, Weitzman M. Hookah use among U.S. high school seniors. Pediatrics. 2014;134(2):227–234. doi:10.1542/peds.2014-0538 Sutfin EL, Song EY, Reboussin BA, Wolfson M. What are young adults smoking in their hookahs? A latent class analysis of substances smoked. Addict Behav. 2014;39(7):1191-1196. doi:10.1016/j.addbeh.2014.03.020 Zhou S, Weitzman M, Vilcassim R, et al. Air quality in New York City hookah bars. Tob Control. 2015;24(e3):e193-e198. doi:10.1136/tobaccocontrol-2014-051763 Rice VH. Water pipe smoking among the young: The rebirth of an old tradition. Nurs Clin North Am. 2012;47(1):141-148. doi:10.1016/j.cnur.2011.10.011 Torrey CM, Moon KA, Williams DA, et al. Waterpipe cafes in Baltimore, Maryland: Carbon monoxide, particulate matter, and nicotine exposure. J Expo Sci Environ Epidemiol. 2015;25(4):405-410. doi:10.1038/jes.2014.19 Centers for Disease Control and Prevention. Hookahs. St Helen G, Benowitz NL, Dains KM, Havel C, Peng M, Jacob P. Nicotine and carcinogen exposure after water pipe smoking in hookah bars. Cancer Epidemiol Biomarkers Prev. 2014;23(6):1055-1066. doi:10.1158/1055-9965.EPI-13-0939 Bernat JK, Ferrer RA, Margolis KA, Blake KD. US adult tobacco users' absolute harm perceptions of traditional and alternative tobacco products, information-seeking behaviors, and (mis)beliefs about chemicals in tobacco products. Addict Behav. 2018;71:38-45. doi:10.1016/j.addbeh.2017.02.027 By Terry Martin Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.