Is Hookah Smoking Safe?

Hookah Fumes, Benzene Uptake and Increased Risk for Leukemia


Hookahs are water pipes that are used to smoke preparations of tobacco that come in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. And though these flavors may seem alluring, there is no reason to believe the smoke from hookahs is any less harmful than cigarette smoke. Indeed, many of the same heath risks exist.

Unfortunately, there seems to be a disconnect between the known risks of hookah smoking and the beliefs of many individuals.

In one study, nearly 60 percent of hookah lounge patrons between the ages of 18 and 30 did not believe the practice was harmful.

Anatomy of a Hookah

Hookah use among youth is on the rise, according to the Centers for Disease Control. There are now hookah cafes in the U.S. and around the world, including in the UK, France, and Russia. Hookah lounges are often located in college towns and are especially popular with young adults.

If you are not familiar with these devices, they can usually be identified based on their component parts. The modern hookah has the following parts:

  • Head
  • Body
  • Water bowl
  • Hose
  • Mouthpiece

While components are consistent, the styles, dimensions, and shapes of hookahs can vary quite a bit. In many set-ups, charcoal is used to heat the tobacco, which can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.

The composition of what’s smoked can also vary.

Water pipe tobacco is a pasty concoction made from about 5 to 10 percent tobacco that is fermented together with items to add flavor, including honey, molasses, and pulp of different fruits.

The different ingredients that are smoked and the different temperatures involved in the smoking means that hookah smoke can vary in its delivery of chemicals, much more so than the variability of cigarette smoke, experts believe.

Health Risks

According to the CDC, hookah smokers may be at risk for some of the same diseases as cigarette smokers, including:

Potential Risk for Leukemia

Most recently, hookahs have been in the news because of a study showing levels of a benzene metabolite in 105 hookah smokers and 103 non-smokers. Benzene is a known carcinogen.

Urine samples were taken from the ‘morning of’ and the ‘morning after’ hookah smoking events. Results showed that for smokers, uptake of the benzene metabolite, SPMA, increased 4.2-fold after smoking hookah tobacco at a hookah lounge and 1.9-fold after smoking in a private event.

Secondhand smoke was also a concern, as non-smokers' uptake of SPMA increased 2.6-fold after attending an event at a hookah lounge.

In an older and smaller study comparing hookahs to cigarettes, there was a greater exposure to benzene and high molecular weight polycyclic aromatic hydrocarbons (PAHs) with hookahs, but less exposure to 1,3-butadiene, acrolein, acrylonitrile, propylene oxide, ethylene oxide, and low molecular weight PAHs. Investigators speculated that this might result in a different clinical cancer risk profile between cigarette and water pipe smoking, but never suggested a reduced risk.


CDC. Hookahs. Accessed November 2014.

Study: Young People Downplay Health Risks Of Hookah Smoking. Accessed November 2014.

MedicalNewsToday. Hookah smoke increases benzene exposure, risk for leukemia. Accessed November 2014.

Jacob P, 3rd, Abu Raddaha AH, Dempsey D, et al. Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking. Cancer Epidemiol, Biomarkers & Prev. 2013;22(5):765-772

Continue Reading