What is Hookah and is it a Safe Smoking Choice?

Is it a Safe Way to Smoke Tobacco?

Group of people smoking hookah at an outdoor cafe. Ashok Sinha/Photodisc/Getty Images

What is Hookah?

Also known as narghile, argileh, shisha, hubble-bubble, shisha, or goza, a hookah is a water pipe that is used to smoke flavored and sweetened tobacco. The hookah pipe houses separate chambers for the tobacco and water. One or more flexible tubing stems allow consumers to inhale the tobacco smoke.

Hookah tobacco is often flavored with molasses, fruit pulp, or honey and has had additional flavor added, such as coconut, fruit flavors, mint or coffee.

Flavorings sweeten the taste and aroma of hookah tobacco, making it more appealing to young people, especially.

How the Hookah Works

The tobacco chamber in a hookah consists of a bowl that contains burning charcoal on top of the flavored tobacco. Typically the charcoal is separated from the tobacco by perforated aluminum foil.

The charcoal heats the tobacco below, creating smoke. When users draw on the stem of the hookah, the tobacco smoke is pulled through the water chamber, where it is cooled before being inhaled into the smoker's lungs.

Does Hookah Tobacco Contain Nicotine and Other Toxins?

People often think that smoking from a hookah removes the nicotine and other toxins from the tobacco. This is not true.  Drawing tobacco smoke through a hookah pipe only changes the temperature of the smoke.  The chemical makeup remains the same.

And, just like cigarette smokers, people who smoke hookah are at risk for many of the same illnesses that follow smoking.

Oral cancerlung cancer, stomach cancer, cancer of the esophagus, respiratory diseases, heart disease, and fertility problems are all associated with hookah smoking.

Key Facts about Hookah:

  • One bowl of hookah tobacco contains as much nicotine as 70 cigarettes.
  • An hour of hookah use exposes smokers to 100-200 times the volume of smoke in a typical cigarette.
  • Compared to traditional cigarette smoke, hookah smoke has about 6 times more carbon monoxide and 46 times more tar.
  • Hookah smoke contains many of the same harmful chemicals in traditional cigarette smoke: carbon monoxide, tar, arsenic, chromium, cobalt, cadmium, nickel, and lead.
  • Burning charcoal used to heat tobacco exposes smokers to additional carbon monoxide and polyaromatic hydrocarbons.

A Little History about Hookah

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, 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 out of that, spreading around the world.

Today, hookah is a popular pastime for young people in the United States, with hookah lounges popping up in big cities and around college campuses across the country.

What is a Hookah Lounge Like?

A hookah lounge offers patrons the opportunity to smoke with a group from a communal hookah pipe. Usually placed in the center of a table with numerous stems to smoke from, the hookah is packed with one of a variety of flavored tobaccos on the menu.

Hookah lounges often serve alcoholic drinks and food as well as tobacco.  

What is the Trend with Hookah Smoking Today?

Hookah use is on the rise around the world, and here in the United States, kids are experimenting with it younger and younger. According to The Monitoring the Future Survey, which looks at trends in legal and illicit drug use among high school seniors around the nation,  23% of the 12th-grade students surveyed said they'd used hookah in 2014, up from 17% in 2010.   

The CDC's National Youth Tobacco Survey reported that between 2013 and 2014, hookah smoking among middle school and high school students just about doubled.


Anti-smoking campaigns have increased awareness of the dangers of smoking around the country, resulting in a measurable reduction in cigarette smoking among all age groups.  Now, similar efforts need to be made to educate young people about the dangers of hookah smoking.

In Summary

Hookah tobacco is addictive and every bit as hazardous to a smoker's health as traditional cigarettes. Additionally, a one-hour session of hookah smoking exposes 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 may contribute to a variety of cancers, heart disease, and lung disease.

Protect your health and stay away from hookah tobacco.  There is no such thing as safe tobacco, and hookah use is no exception.


Centers for Disease Control and Prevention. Hookahs. Updated Sept 14, 2015. Reviewed February 22, 2016.

Centers for Disease Control and Prevention. Dangers of Hookah Smoking. Updated and Reviewed: November 15, 2015.

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