The Risks You Face From Hookah Smoking

Hookah Facts and General Information

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

A hookah is a water pipe that is used to smoke flavored and sweetened tobacco. Other names for hookah are narghile, argileh, shisha, hubble-bubble, shisha and goza. The pipe is usually quite large with one or more flexible tubing stems that allow multiple smokers to inhale at the same time.

Hookah tobacco is often flavored with molasses, fruit pulp, or honey with additional flavor added, like coconut, fruit flavors, mint, or coffee.

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

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. He was wrong. More on that in a bit.

In the 1990s, flavored tobacco became popular in the Eastern Mediterranean countries, and hookah use grew out of that, spreading 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 of the hookah, the smoke is pulled through the water chamber, cooling it before being inhaled into the lungs.

Hookah Smoking is Addictive

Most hookah smokers don't worry about becoming addicted to hookah tobacco because they smoke it only occasionally in a social setting.

It's a false sense of security, however.  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.

How Hookah Compares to Cigarettes

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

An average hookah bowl contains as much nicotine as a pack of 20 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.

Does Hookah Tobacco Contain Toxins?

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.  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: carbon monoxide, tararsenic, chromium, cobalt, cadmium, nickel, formaldehyde, acetaldehyde, acrolein, and lead.  

Hookah smoke also contains polonium 210, a radioactive isotope.

Compared to traditional cigarette smoke, hookah smoke has about 6 times more carbon monoxide and 46 times more tar.

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

What About the Tar in Hookah Tobacco?

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.

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. 

Health Concerns for Hookah Smokers

People who smoke hookah are at risk for many of the same illnesses that follow cigarette smoking. Oral cancerlung cancer, stomach cancer, and cancer of the esophagus. 

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

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.

Finally, hookah smoking can 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 passed along.  

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 percent of the 12th-grade students surveyed said they had used hookah in 2014, up from 17 percent 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. 

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. 

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.

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.

If you're on the fence about quitting tobacco, do some reading. 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

Sources:

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

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

Centers for Disease Control and Prevention. Hookahs. Updated and Reviewed: December 1, 2016.

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.

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