A hookah is a water pipe that allows a person to smoke tobacco, often combining it with sweet flavors, such as apple, chocolate, coconut, licorice, or watermelon.
People have used hookahs for centuries in ancient Persia and India. Today, people often smoke a hookah as a group, at home or in cafes or lounges.
Other names for a hookah include water pipe, narghile, or shisha, the latter being a word that can also refer to the flavored tobacco.
Some people have misconceptions that hookah smoking is not harmful to their health or not as dangerous as other smoking types. In this article, we look at the health risks associated with hookah smoking.
A hookah has several universal components, including a water bowl, metal body, a head with holes in the bottom, and a flexible hose with a mouthpiece.
The device works by burning charcoal that will then burn a tobacco mixture, as well as heat up the water. The smoke the charcoal generates helps move the tobacco through the water and hose and up to the mouthpiece.
Using a hookah exposes a person to tobacco smoke, which contains harmful components, such as carbon monoxide. The water in the hookah does not filter out these components.
Even if a person does not smoke directly from the hookah, they can still inhale secondhand smoke if they are nearby.
Some of the potential health effects of hookah smoke include:
- Complications of lung function, such as chronic obstructive pulmonary disease (COPD) and bronchitis.
- Increased risk of heart conditions, such as heart disease and heart attack.
- Increased risk of cancer, especially lung, throat, and mouth cancer.
- Premature skin aging, since smoking tobacco can decrease the amount of oxygen that reaches the skin.
- Increased risk of infectious diseases, such as mononucleosis and oral herpes.
People may also increase their risk of respiratory infections if they share the hookah mouthpiece with others.
According to the Centers for Disease Control and Prevention (CDC), smoking tobacco through a hookah has "many of the same health risks as cigarette smoking."
For example, the tobacco smoke still delivers nicotine, a highly addictive substance. Hookah smoke also requires charcoal to be burnt, which interacts with tobacco, creating fumes that can be just as toxic as cigarette smoke.
People who use a hookah may be exposed to the toxins in the smoke longer than if they smoked cigarettes.
According to the CDC, a person puffs on a cigarette an average of 20 times, but they may take 200 puffs during an hour-long hookah session.
Also, smoking a hookah delivers more than 2.5 times the amount the nicotine as cigarette smoke, according to the National Institute on Drug Abuse, quoting research lead by the University of Pittsburgh School of Medicine. This volume of nicotine has the potential to be highly addictive.
Manufacturers have released newer versions of hookahs that use electric heat instead of charcoal. The makers call these e-charcoal heat sources and often market them as a safer alternative to traditional charcoal hookahs.
The CDC say that experts have very little knowledge about the health risks of electronic tobacco products at this stage.
However, the University of Cincinnati report early research that a team of its chemists is doing to look at the components of smoke generated by e-charcoal. The researchers say they have found that e-charcoal smoke kills 80 percent of sample lung cells 24 hours after exposure.
This risk is more significant than the higher-toxin charcoal the team tested, which kills 25 percent of lung cells. The lower-toxin charcoal was found to kill 10 percent of sample lung cells.
As a result, the researchers conclude that e-charcoal hookah options could potentially be more dangerous than their charcoal counterparts.
More published scientific research is now needed to confirm these early results.
Some hookah bars sell non-tobacco products, which they may advertise as having no harmful effects. This is a myth, as the smoke still contains carbon monoxide, a harmful compound, and other toxins.
Other myths about hookah smoking include:
- Hookah smoking is not addictive. Hookah smoke contains nicotine, a highly addictive compound.
- The water in hookah smoke filters harmful ingredients. The water in hookah smoke does not filter out any harmful chemicals.
- Cigarettes "burn" the lungs because they use heat, and hookah smoke is cooler, so it does not burn. Smoke from a hookah can still damage the heart and lungs, even after cooling down.
While some people believe hookah smoking is a safer and more social alternative to smoking tobacco, it does not offer health benefits and poses several significant health risks.
Hookah smoking also puts other people at risk of inhaling secondhand smoke. So, to reduce the risks of damaging the lungs and other organs, it is best for people to avoid smoking tobacco products, including by using a hookah.