7 Key Facts You Should Know About Smoking Hookah

Hookah is gaining in popularity here in the U.S., in part because people believe it a safe way to smoke tobacco,  but this is a misconception.  

From the amount of toxins present to the volume of smoke inhaled during a single hookah session, it is not even remotely close to a safe activity.

Let's take a look at some of the most important facts about hookah.

Water-Cooled Hookah Smoke Contains Tobacco Toxins

Hookah Pipe
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It is a common misconception that hookah smoke is safer than traditional cigarette smoke because it's passed through water in the hookah pipe.

While water-cooled smoke is less harsh on delicate lung tissue, the toxicity of the smoke is unchanged.  The cancer-causing chemicals present in the hookah tobacco are not filtered out by this process.

Additionally, the charcoal that is used to heat the tobacco contains carbon monoxide, metals, and other cancer-causing agents, adding another level of danger to smokers.

Hookah Smokers Are Exposed to Tar

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Some hookah tobacco products may 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.  Researchers feel that the toxicity of hookah tar may be less than cigarette tar because of this difference, but it still contains toxins.

Hookah smokers may even take in more tar and carbon monoxide than cigarette smokers because inhalation through the water pipe requires a stronger drag for a longer period of time.

Recent research bears this out.  A team of researchers led by University of Pittsburgh School of Medicine reviewed 542 scientific papers for information on the toxicity of cigarettes compared to hookah.

They found that compared to a single cigarette, a single hookah session delivers 25 times more tar. 

Hookah Is as Toxic as Traditional Tobacco Products

Man smoking a cigarette next to hookah pipe. Design Pics / David DuChemin/Perspectives/Getty Images


Nicotine is the addictive chemical in cigarettes and is a poison that has long been used in pesticides.


Both cigarette smoke and hookah smoke contain numerous toxins, including arsenic, lead, nickel, tar, carbon monoxide, formaldehyde, acetaldehyde, acrolein and polonium 210, a radioactive isotope. 


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

Sharing the Hookah Pipe Can Spread Illness

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Hookah is usually smoked in a social setting, with several people sharing the same pipe.  Because the mouthpiece is passed from person to person, colds and other infections, including oral herpes can be passed along.  

Hookah Smoking Is Addictive

Man smoking a sheesha (water pipe), Aqaba, Jordan
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Most hookah smokers don't worry about becoming addicted to hookah tobacco because they smoke it occasionally in a social setting. It's a false sense of security however.  The facts about nicotine in hookah is an eye-opener.

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

A typical hookah bowl contains as much nicotine as a pack of 20 cigarettes.  It has been estimated that daily hookah smokers absorb approximately the same amount of nicotine and other chemicals as they would if they smoked 10 cigarettes a day.

Young Smokers Are Swapping Cigarettes for Hookah

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The good news is that teen cigarette smoking in the U.S. is dropping, due in large part to an increased awareness of the dangers associated with tobacco use.  While one in three high school seniors report having tried smoking at some point, only one in fifteen is a regular daily smoker, down from one in four in 1997.

The bad news is that teens appear to be swapping cigarettes for other hazardous smoking alternatives.   Smokeless tobacco, electronic cigarettes and hookah use are all on the rise with American youth.  

According to a study published in July of 2014, approximately 18 percent of high school seniors across the U.S. have tried hookah.  And in Canada, the numbers are higher - one in four high school seniors have experimented with hookah.  

Research also shows that approximately 40 percent of American college students have tried hookah.  Hookah lounges are popping up close to college campuses all over the country.

Hookah Smokers Face Many of the Same Health Risks as Cigarette Smokers

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Cancers associated with hookah use include:

Additionally, hookah use is associated with decreased lung function, heart disease and can have a negative effect on fertility.


A Word From Verywell

Hookah smoking exposes people to many of the same toxins that are present in cigarettes.  Additionally, secondhand smoke from hookah is hazardous to health, even if you're not actively smoking.  If you're in the room with a lit hookah water pipe, you're breathing in cancer-causing toxins.

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

If you're on the fence about quitting tobacco, take a look at the article below.  It will help you put the value of quitting now as opposed to later in perspective, and offer practical tips on how to get started.

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


Journal of American Academy of Pediatrics. Hookah Use Among U.S. High School Seniors. July, 2014.

UPMC/University Schools of Health Sciences. One Hookah Session Delivers 25 Times the Tar of a Cigarette. January 11, 2016.

U.S. Dept. of Health and Human Services. Office of Adolescent Health. Trends in Adolescent Tobacco Use Updated December 27, 2016.

U.S. National Library of Medicine. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. May, 2010.

University of Waterloo.One in Four High School Seniors Now Try Waterpipes March 26, 2015.

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