Hookah Smoking and Its Risks

Hookah smoking is often mistaken as a "healthier" alternative to cigarette smoking, primarily due to the sweet smell and taste of hookah tobacco, and the social aspect that usually leads to hookah smoking being only an occasional habit. But there's no such thing as a healthy smoking option, and hookah smoking can be just as—if not more—dangerous as cigarette smoking.

health risks from smoking hookah — Illustration by Brianna Gilmartin, Verywell

What Is Hookah?

A hookah is a water pipe that is used to smoke sweetened and flavored tobacco. Other names 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 smokers to inhale at the same time.

Hookah tobacco is often sweetened with molasses, fruit pulp, or honey, with additional flavor added like coconut, fruit flavors, mint, or coffee. These flavorings sweeten the taste and aroma of the tobacco, making it especially appealing to young people.

Hookah pipes have been in use for about 400 years, originating in India and Asia. In the early 1600s, Hakim Abdul Fath, a physician from India, invented the hookah, mistakenly believing the health hazards of tobacco smoke would be minimized by passing it through water before inhalation.

In the 1990s, flavored tobacco became popular in the Eastern Mediterranean countries, and hookah use grew from there to eventually spread around the world.

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 users draw on the stem (hose) of the hookah, the smoke is pulled through the water chamber, cooling it before being inhaled into the lungs.

Toxins in Hookah

It is a common misconception that smoking from a hookah removes nicotine and other toxins from the 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:

Carbon monoxide
Tar
Arsenic
Chromium
Cobalt
Cadmium
Nickel
Formaldehyde
Acetaldehyde
Acrolein
Lead
Polonium 210, a radioactive isotope

Some hookah tobacco products claim they don't contain tar, but that information is misleading. The fact is, no tobacco contains 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, which 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 to hookah smokers.

Hookah vs. Cigarettes

A typical manufactured cigarette contains between 7 and 22 milligrams of nicotine, depending on the brand, with about 1 mg being absorbed by the smoker. 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.

Smokers inhale 500 to 600 ml of smoke in the 20 puffs it takes to smoke a cigarette. If they're smoking hookah, which is typically an event lasting 45 minutes to an hour, smokers inhale approximately 90,000 ml of smoke and take as many as 200 puffs on the water pipe.

Compared to traditional cigarette smoke, hookah smoke has about six times more carbon monoxide and 46 times more tar, and hookah smokers may take in more of these toxins because inhalation through the water pipe requires a stronger drag for a longer period of time.

It has been estimated that a single hookah session can cause smokers to absorb approximately the same amount of nicotine and other chemicals as they would if they smoked two to 10 cigarettes a day, depending on how often they smoke hookah.

Health Concerns

Hookah smokers are at risk for many of the same illnesses as cigarette smokers, such as

Hookah use is also associated with decreased lung function and heart disease, and it can have a negative effect on fertility.

Secondhand smoke from a 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 with secondhand cigarette smoke.

Hookah smoking can also spread illness. Because it is usually smoked in a social setting, with several people sharing the same pipe and sometimes the same mouthpiece, colds and other infections, including oral herpes, can be easily passed along.

A Word From Verywell

Hookah tobacco is addictive and every bit as hazardous to a smoker's health as traditional cigarettes. A one-hour session of hookah smoking can expose smokers to as much nicotine and toxins as they would get from an entire day or more of cigarette smoking.

In the short-term, hookah smoking raises blood pressure and heart rate, which may increase the risk of heart attack and stroke. In the long-term, hookah smoking can contribute to a variety of cancers, heart disease, and lung disease.

The best thing you can do for your health is to avoid all tobacco products because none of them are considered safe.

Don't be lulled into thinking that smoking cessation is something you can put off until later in life. The longer you wait, the more you risk. Luckily, there are plenty of resources and support systems available that can help you quit smoking for good.