Hookahs

Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon.^1,2

Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking.^1,2

Hookah is also called narghile, argileh, shisha, hubble-bubble, and goza.^1,2

Hookahs vary in size, shape, and style.²

A typical modern hookah has a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece.^3,4

Hookah smoking is typically done in groups, with the same mouthpiece passed from person to person.^1,2,3,4

Hookah Use

Health Effects

Hookah Smoke and Cancer

• The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.^1,4
• Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.⁴
• Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.^1,4
• Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.^4,7

Other Health Effects of Hookah Smoke

• Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.^1,4
• Infections may be passed to other smokers by sharing a hookah.²
• Babies born to women who smoked water pipes every day while pregnant weigh less at birth (at least 3½ ounces less) than babies born to nonsmokers.^5,8
• Babies born to hookah smokers are also at increased risk for respiratory diseases.⁸

Hookah Smoking Compared With Cigarette Smoking

• While many hookah smokers may think this practice is less harmful than smoking cigarettes, hookah smoking has many of the same health risks as cigarette smoking.^1,2
  • Water pipe smoking delivers nicotine—the same highly addictive drug found in other tobacco products.²
  • The tobacco in hookahs is exposed to high heat from burning charcoal, and the smoke is at least as toxic as cigarette smoke.^1,2
• Because of the way a hookah is used, smokers may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.^1,2
  • An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs.^1,2
  • The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500–600 ml inhaled when smoking a cigarette.⁴
• Hookah smokers may be at risk for some of the same diseases as cigarette smokers. These include:^3,4
  • Oral cancer
  • Lung cancer
  • Stomach cancer
  • Cancer of the esophagus
  • Reduced lung function
  • Decreased fertility

Hookahs and Secondhand Smoke

• Secondhand smoke from hookahs can be a health risk for nonsmokers. It contains smoke from the tobacco as well as smoke from the heat source (e.g., charcoal) used in the hookah.^1,5,9

Nontobacco Hookah Products

• Some sweetened and flavored nontobacco products are sold for use in hookahs.¹⁰
• Labels and ads for these products often claim that users can enjoy the same taste without the harmful effects of tobacco.¹⁰
• Studies of tobacco-based shisha and “herbal” shisha show that smoke from both preparations contain carbon monoxide and other toxic agents known to increase the risks for smoking-related cancers, heart disease, and lung disease.^10,11

References

1. American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. [PDF–222 KB] Washington: American Lung Association, 2007 [accessed 2015 Sep 14].
2. American Lung Association. Hookah Smoking: A Growing Threat to Public Health Issue Brief.. [PDF–1.34 MB] Smokefree Communities Project, 2011 [accessed 2015 Sep 14].
3. Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review. International Journal of Epidemiology 2010;39:834–57 [accessed 2015 Sep 14].
4. Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. American Journal of Health Behavior 2010;34(3):275–85 [accessed 2015 Sep 14].
5. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012 [accessed 2015 Sep 14].
6. U.S. Food and Drug Administration. Electronic Cigarettes (e-Cigarettes) [last updated 2013 April 25; accessed 2015 Sep 14].
7. El-Hakim Ibrahim E, Uthman Mirghani AE. Squamous Cell Carcinoma and Keratoacanthoma of the Lower Lips Associated with “Goza” and “Shisha” Smoking. International Journal of Dermatology 1999;38:108–10 [cited 2015 Sep 14].
8. Nuwayhid, I, Yamout, B., Ghassan, and Kambria, M. Narghile (Hubble-Bubble) Smoking, Low Birth Weight and Other Pregnancy Outcomes . American Journal of Epidemiology 1998;148:375–83 [accessed 2015 Sep 14].
9. Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indoor Air Quality in Virginia Waterpipe Cafés. Tobacco Control 2012 Mar 24 doi:10.1136/tobaccocontrol-2011-050350 [cited 2015 Sep 14].
10. Shihadeh A, Salman R, Eissenberg T. Does Switching to a Tobacco-Free Waterpipe Product Reduce Toxicant Intake? A Crossover Study Comparing CO, NO, PAH, Volatile Aldehydes, Tar and Nicotine Yields. Food and Chemical Toxicology 2012;50(5):1494–8 [accessed 2015 Sep 14].
11. Blank MD, Cobb CO, Kilgalen B, Austin J, Weaver MF, Shihadeh A, Eissenberg T. Acute Effects of Waterpipe Tobacco Smoking: A Double-Blind, Placebo-Control Study. Drug and Alcohol Dependence 2011;116(1–3):102–9 [cited 2015 Sep 14].