Addiction Nicotine Use Hookah Smoking and Its Risks Hookah can be just as harmful as cigarettes and other tobacco products 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 September 22, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Armeen Poor, MD Medically reviewed by Armeen Poor, MD Armeen Poor, MD, is a board-certified pulmonologist and intensivist. He specializes in pulmonary health, critical care, and sleep medicine. Learn about our Medical Review Board Print Table of Contents View All Table of Contents What Is Hookah? Toxins in Hookah Hookah vs. Cigarettes Health Concerns As of Dec. 20, 2019, the legal age limit is 21 years old for purchasing cigarettes, cigars, or any other tobacco products in the U.S. Hookah smoking is often mistaken as a healthier alternative to cigarette smoking, primarily due to its sweet smell and taste and the fact that people typically smoke hookah only occasionally. But there's no such thing as a healthy smoking option. Hookah is not healthier than cigarettes, and it carries risks similar to those of cigarette smoking including cancer, heart disease, and lung disease. Verywell / Brianna Gilmartin What Is Hookah? A hookah is a water pipe that is used to smoke sweetened and flavored tobacco. Other names people use for hookah are narghile, argileh, shisha, hubble-bubble, and goza. The pipe is usually quite large and consists of a water chamber, a tobacco chamber, and one or more flexible tubes stemming from it that allow multiple people to inhale at the same time. Hookah tobacco is often sweetened with molasses, fruit pulp, or honey, with additional flavors such as coconut, mint, or coffee. Flavorings sweeten the taste and aroma of tobacco, making it especially appealing to young people. Aside from tobacco, It's important to note that hookah can be used to smoke herbal shisha, marijuana, and hashish. Hookah smoking is thought to have originated in India or Persia in the 1500s. Since then, hookah smoking has gained popularity around the world. 1:23 Click Play to Learn More About Hookah This video has been medically reviewed by John C. Umhau, MD, MPH, CPE. How the Hookah Works The tobacco chamber in a hookah consists of a bowl containing burning charcoal that is placed on top of the flavored tobacco. Charcoal is separated from tobacco by perforated aluminum foil. As the charcoal heats the tobacco below, smoke is created. When a person inhales through the stem (hose) of the hookah, the smoke is pulled through the water chamber, cooling it before it is inhaled into the lungs. Smoking Statistics From Around the World Toxins in Hookah It's a common misconception that hookah smoking removes nicotine and other toxins from tobacco. While water-cooled smoke is less harsh on delicate lung tissue, the toxicity of the smoke is unchanged and the cancer-causing chemicals present in the hookah tobacco are not filtered out by this process. Hookah smoke contains many of the same harmful chemicals in traditional cigarette smoke, including: Acetaldehyde Acrolein Arsenic Cadmium Carbon monoxide Chromium Cobalt Formaldehyde Lead Nickel Polonium 210, a radioactive isotope Tar Some hookah tobacco products claim they don't contain tar, but that is misleading. Tobacco doesn't ever contain tar until it is burned, or in the case of hookah tobacco, heated. This difference leads some to believe that the toxicity of hookah tar may be less than that of cigarette tar—but this is not the case. Additionally, the charcoal that is used to heat the tobacco contains carbon monoxide, metals, and other cancer-causing agents like polyaromatic hydrocarbons, adding another level of danger for those who smoke hookah. Hookah vs. Cigarettes The average, manufactured cigarette contains between 7 and 22 milligrams (mg) of nicotine, with about 1mg absorbed by the person who is smoking. An average hookah bowl contains as much nicotine as a pack of 20 cigarettes. Nicotine is an addictive drug, so smoking hookah can be every bit as addictive as smoking cigarettes. A person smoking hookah inhales about 90,000 milliliters (ml) of smoke in a single 45-minute session; comparatively, someone smoking a single cigarette inhales 500 to 600 ml of smoke. Someone smoking hookah inhales 9 times the amount of carbon monoxide and 1.7 times the amount of nicotine that someone inhales from smoking one cigarette. Those who smoke hookah may take in more of the additional toxins also found in cigarettes—such as tar and heavy metals—because inhalation through the water pipe requires a stronger and longer drag or inhale. If you or a loved one are struggling with nicotine addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Health Concerns Many health concerns related to hookah smoking are similar to those associated with cigarette smoking, including the risk of cancer, decreased fertility, heart disease, and more. Addiction Smoking a water pipe hookah delivers nicotine just as cigarettes and other tobacco products do. Nicotine is highly addictive and can have a variety of health effects. Nicotine reaches the brain within seconds, where it acts to trigger the production of adrenaline. Adrenaline is a hormone that plays a role in the body's fight-or-flight response. It causes physiological changes, including increased heart rate, respiration, and blood pressure. Because smoking a hookah delivers much more nicotine than smoking a cigarette, it is possible to become addicted after smoking a hookah only a few times. Because smoking hookah often occurs in social settings such as hookah lounges, people often attribute their addiction to the social nature of the activity rather than to the addictive properties of nicotine. Cancer People who smoke hookah are at risk for many different types of cancer, including bladder cancer, esophageal cancer, lung cancer, oral cancer, and stomach cancer. Damage to Women's Health One study found that women who smoke hookah are at an increased risk of premature menopause and reduced bone density. Decreased Fertility Hookah smoking may lead to decreased fertility among both men and women. One study found that sperm motility (the ability of sperm to swim in the proper direction) and sperm morphology (the size and shape of sperm) were negatively impacted in men who regularly smoked hookah compared to men who did not smoke hookah. Heart Disease and Stroke Hookah smoking raises your blood pressure and your heart rate, which may increase your risk of heart attack and stroke. Hookah smoking can also contribute to clogged arteries and heart disease. Lung Disease Even short-term use of hookah is linked with impaired lung function. You might notice you become out of breath more easily when performing physical tasks. Over time, hookah smoking also increases the risk of impaired pulmonary function and lung diseases like chronic obstructive pulmonary disease (COPD). Pregnancy Risks Hookah smoking while pregnant is linked with many risks including chromosomal disorders, ectopic pregnancy, infant disease and mortality, intrauterine growth restriction, and low birth weight. Hookah smoking while pregnant also increases the baby's risk for respiratory illnesses. Secondhand Smoke Secondhand smoke from hookah is also hazardous. If you're in the room with a lit hookah water pipe, you're breathing in cancer-causing toxins just as you would with secondhand cigarette smoke. Secondhand smoke can cause heart disease, lung cancer, and stroke in people who are exposed to it, even if they do not smoke themselves. Spreading Illness Hookah smoking can also spread illness. Since people are usually in a social setting when they smoke, with several people often sharing the same pipe and sometimes the same mouthpiece. Colds and other infections, including oral herpes, can be easily passed from one person to another. A Word From Verywell Hookah tobacco is addictive and as hazardous to your health as traditional cigarettes. The best thing you can do for your health is to avoid all tobacco products because none of them are considered safe. If you are already smoking and looking to quit, there are plenty of resources and support systems available that can help you quit smoking for good. The Best Online Resources for Smoking Cessation 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. 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 Elsayed Y, Dalibalta S, Abu-Farha N. Chemical analysis and potential health risks of hookah charcoal. Sci Total Environ. 2016;569-570:262-268. doi:10.1016/j.scitotenv.2016.06.108 National Institute on Drug Abuse. Is nicotine addictive? Tobacco, Nicotine, and E-Cigarettes Research Report. Jawad M, Jawad S, Mehdi A, Sardar A, Jawad AM, Hamilton FL. A qualitative analysis among regular waterpipe tobacco smokers in London universities. Int J Tuberc Lung Dis. 2013;17(10):1364-1369. doi:10.5588/ijtld.12.0923 Dadipoor S, Kok G, Aghamolaei T, Ghaffari M, Heyrani A, Ghanbarnezhad A. Explaining the determinants of hookah consumption among women in southern Iran: A qualitative study. BMC Public Health. 2019;19(1):1655. doi:10.1186/s12889-019-7917-4 Albeitawi S, Hamadneh J, Al‐Shatanawi TN, Al mehaisen L, Al‐Zubi M. Effect of hookah (water pipe) smoking on semen parameters. Andrologia. 2020;52(10). doi:10.1111/and.13723 American Lung Association. Facts about hookah. Centers for Disease Control and Prevention. Secondhand smoke (SHS) facts. Additional Reading Primack BA, Carroll MV, Weiss PM, et al. Systematic review and meta-analysis of inhaled toxicants from waterpipe and cigarette smoking. Public Health Rep. 2016;131(1):76-85. doi:10.1177/003335491613100114 U.S. Department of Health and Human Services. Adolescents and tobacco: Trends. 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? 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