Hookah pipes — More or less harmful than cigarettes?

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 and 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 currently 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. 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. Additionally, the fact that hookahs filter the smoke through water allows people to take deeper inhales with less discomfort, which leads to a higher tobacco content in each inhalation. Both hookah and cigarette smokers are exposed to:

  • Nicotine: This is 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: This brown, sticky material may lead to cancer, emphysema, and other health problems in smokers, as well as causing stains on teeth and fingers.
  • Carbon monoxide: This is 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 persist, the research on hookah smoking speaks clearly about the health impacts, both similar and unique as compared to cigarette smoking.

It sounds as though your hookah smoking has a social aspect to it. Research shows that occasional social smoking can lead to regular smoking, so there’s a concern that occasional hookah sessions could lead to a dependence, habit, or addiction, further increasing health risks associated with its consumption. It’s also been found that people who surround themselves with non-smokers are less likely to smoke themselves. So if you’re planning on quitting hookah smoking and you notice pressure from your friends to continue smoking with them, you might want to reconsider the people with whom you're spending time. 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, help reduce stress. Additionally, 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.

Just some thoughts to consider before you let it burn,

Last updated Sep 27, 2019
Originally published Jul 25, 2003