Hi Alice,

I smoke hookah on occasion, but am not a regular hookah smoker. Recently some of my friends have expressed interest in smoking hookah but are concerned about the health side effects; needless to say, for very legitimate reasons. However, non-tobacco shisha, made simply of herbs and molasses, claims to be a healthier alternative to regular shisha that contains tobacco. Though I can assume it is not without its shortcomings, is it still healthier then regular tobacco products, as it claims?

Dear Reader,

Hookah pipes have a reputation for being the lesser of evils when it comes to smoking options, and from certain perspectives, this is true. Smoking a hookah doesn't have to mean smoking tobacco or taking in nicotine, which are common substances associated with smoking. But hookah smoking has its own demon — combusted charcoal — which carries health risks even when non-tobacco shisha is used.

When charcoal is burned to create the hookah effect, it releases chemicals in the process, namely carbon monoxide (CO) and polyaromatic hydrocarbons (PAH). In addition to inhaling byproducts of the shisha, waterpipe smokers also inhale fairly large quantities of these combustion-related toxins — a hidden health risk associated with hookah smoking, even for non-tobacco shisha.

One recent study found that in a typical hookah smoking session, participants inhaled more carbon monoxide than someone who smokes a pack or more a day of conventional cigarettes. While hookah tobacco (or non-tobacco shisha) can be bought with very trace amounts of nicotine, or even be tobacco-free, most hookah devices are solely designed for charcoal burning to be the mechanism of inhalation. Tobacco tends to burn more slowly than many of the fruit and molasses contents in non-tobacco shishas. And so, while it is true that you aren't inhaling tobacco smoke, the sustained burning of the charcoal carries the risk of extended exposure to these chemicals. Even at low levels of exposure, both CO and PAH have corrosive and carcinogenic properties, just like most combustion by-products. For more information on how hookah smoking stacks up with cigarette smoking and some general information on hookah smoking and its history, check out Hookah pipes — More or less harmful than cigarettes? in the Go Ask Alice! archives.

The social context of hookah smoking can be quite enticing because the shared pipe can evoke a communal atmosphere. Like any other decision about substance intake, it is a personal choice, hopefully one made after balancing all options.

Don't let claims of "healthier" hookah products create a smokescreen between you and an informed choice on whether to partake in a hookah ring. If you do decide to smoke hookah occasionally, know the risks and enjoy the experience.


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