The Truth About Hookah Smoking

Hookah smoking is rapidly gaining in popularity as a social activity. Hookah users inhale tobacco smoke that passes through a water-filled chamber. Teens and young adults are among the largest groups of users. But did you know that hookah use is more dangerous than cigarette smoking?

Page updated on Mar 25, 2016 at 3:21 PM

The Dangers of Hookah Smoking  

Used for centuries, hookah originated in ancient Persia and India. It is typically practiced in groups, with a tube passed from person to person. It is known by many different names, including narghile, argileh, shisha, hubble-bubble, and goza. But don’t be confused by the exotic names: hookah smoking is not safe. It carries many of the same health dangers as smoking cigarettes.

Hookah Use in the United States

  • Hookah smoking is most common among university students 
  • In 2010, nearly one in five 12th grade students had used a hookah in the past year 
  • Youth and the community should recognize hookah use as a dangerous practice and not a safe alternative to cigarette smoking.    

Hookah is NOT a safe alternative to cigarettes

  • Hookah smoke is as toxic as smoke from cigarettes and contains addictive nicotine 
  • Hookah smokers may absorb higher concentrations of the same toxins found in cigarette smoke 
  • Using a hookah is equivalent to, and can be worse than, smoking cigarettes  
    • An hour-long hookah session includes 200 puffs, while an average cigarette is 20 puffs 
    • The volume of smoke inhaled during a typical hookah session is 150 times the smoke inhaled  by a person smoking a cigarette  
    • Even after passing through water, hookah smoke contains high levels of carbon monoxide, heavy metals, and cancer causing chemicals 

Health Effects of Hookah

  • Hookah smoking has the same negative health effects as cigarette smoking, including:  
    • Cancer (oral, lung, stomach, and esophageal) 
    • Reduced lung function 
    • Decreased fertility 
    • Women giving birth to babies with low-birth weight 
    • Secondhand smoke is hazardous to non-smokers  

      Additionally, hookah smoking may transmit infectious diseases (such as herpes, tuberculosis, influenza and hepatitis) when sharing hookah mouthpieces  

Alexandria Public Health Experts Comment on Hookah Use

“Smoking a hookah should be considered a ‘gateway drug’ – hookahs are a gateway to cancer, chemotherapy, and radiation treatments. There is NO safe level of hookah use.” 

-- Stephen A. Haering, MD, MPH, FACPM, Health Director 

“Selling sweet-flavored tobacco to naïve high school and college kids in a cool dispenser (a hookah) is really just selling kids candy-flavored poison in attractive packaging. I find those selling hookah products just as morally reprehensible as those selling hard drugs to our kids. Both are dealers in death and disease.” 

-- Bob Custard, REHS, Former Environmental Health Manager

Additional Resources

  • Centers for Disease Control and Prevention (CDC) Hookah website 
  • American Lung Association’s Hookah Smoking fact sheet.