Hookah pipes — More or less harmful than cigarettes?

Originally Published: July 25, 2003 - Last Updated / Reviewed On: April 17, 2014
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Hi Alice,

My friends and I occasionally (once a week or so) like to smoke the "Hookah" or sometimes referred to in Arabic as an "argeelay." The tobacco that it comes with smells really good and comes in all kinds of flavors, such as apple, mango, mixed fruit, etc. Anyway, I consider myself to be pretty healthy in that I have never experimented with drugs, never smoked cigarettes, and rarely drink alcohol. My question is about the health effects of smoking a hookah. The rewards are mostly relaxation after a long day of studying for law school. The hookah provides this through smell, flavor, and sound of the water that filters the tobacco when you puff on it. However, I don't know what the health risks are. How does it compare to cigarettes? People say that it's much safer than cigarettes... and according to the packaging that comes with the tobacco, there are far fewer harmful ingredients... in fact, it's mostly tobacco & molasses. It's a very popular trend these days. It's time we get a good source of information. So what's the verdict?

— Moose & Co.

Dear Moose & Co.,

Hookah smoking is a trend that has ebbed and flowed in terms of popularity in America over the years. Hookah pipes (also known as water pipes, sheesha, nargile, and argileh) originated in what is today Turkey and are now popular throughout the Middle East as a leisurely, social, after-meal activity. Across the United States, bars and cafes that offer hookah pipes are popping up. In a hookah pipe, the tobacco (often fruit flavored) is heated by coals, and the resulting smoke passes through tubes and water so that it cools down by the time the person inhales. The tobacco mixture used in the pipes is usually 30 percent tobacco and 70 percent fruit flavorings, molasses, and/or honey — though the amounts can vary by manufacturer.

Some people feel that smoking a hookah is safer than other methods of tobacco smoking since the water is thought to filter out the harmful compounds before the smoke is inhaled. But, compared to cigarettes, hookah smoke has similar health risks as well as some unique considerations.  Research comparing the two found that hookah smoke contains the same cancer-causing agents found in cigarettes. Hookah smoke, like cigarettes, produces carbon monoxide (a contributor to heart disease), and smoking hookah is similarly addictive.

Both hookah and cigarette smokers are exposed to:

  • Nicotine: The addictive chemical in tobacco products. Research suggests that hookah smoke delivers equal or greater amounts of nicotine compared to cigarettes, meaning hookah smoking has the potential to be addictive.
  • Tar: The brown, sticky material that leads to cancer, emphysema, and other health problems in smokers, as well as causes stains on teeth and fingers.
  • Carbon monoxide: A colorless, odorless gas that is toxic to humans. The amount produced by a hookah pipe depends on several factors, including the kind of tobacco, the type of charcoal, and the size of the pipe being used. In general, using commercial (quick-lighting) charcoal makes for higher levels of carbon monoxide. Also, smaller hookah pipes appear to deliver the most carbon monoxide, followed by cigarettes, with larger hookahs producing relatively less.

Hookah smokers in particular, can be exposed to:

  • Charcoal or wood cinder combustion products, which can increase the amount of cancer and heart disease causing agents in the smoke;
  • Additional smoke inhalation, compared to cigarette smokers, due to both the typical length of time spent smoking hookah as well as the second hand smoke from others in the vicinity;
  • Communicable diseases spread through saliva and the sharing of the hookah’s pipe, such as hepatitis, meningitis, and tuberculosis.

So, while the rumors may still persist, the research on hookah smoking speaks clearly about the health impacts, both similar and unique as compared to cigarette smoking. If you are interested in more information on smoking, hookah or cigarettes, Columbia Health has general information, as well as specific resources for people interested in quitting.

If you’re looking for some new forms of relaxation, yoga, or meditation might do the trick. Many people find regular forms of physical activity, whether heading to the gym or joining a group program, to reduce stress. Just spending time with trusted friends and family in a social environment has many of the same stress reducing benefits without the health-risks of hookah. Finally, if you're a Columbia student, you can also get a free Stressbusters backrub or take part in a stress management workshop.

Alice