Hookah bars, lounges, and cafes have popped up all over the country. If you pass by one, it may look inviting. Many people think hookah is safe and fun, but it has health risks just like any tobacco product.
Hubbly bubbly, shisha (glass bottle), or narghile, hookah is a glass waterpipe used to smoke tobacco mixed with molasses, honey, or dried fruit. You might see many people around low tables as they share a hookah, listen to music, and talk.
But hookah can cause many of the same health problems as smoking cigarettes, says Jennifer Folkenroth, national senior director of tobacco programs at the American Lung Association in Cincinnati. Here’s what to know about hookah.
What Is a Hookah and Why Do People Smoke It?
A hookah is a waterpipe where a variety of tobacco flavors are mixed. The top of the hookah contains burning charcoal. Air heats up to pass over the charcoal before moving through the tobacco mixture.
You'll breathe in the smoke directly from a tube and shared mouthpiece. Young adults and teens commonly use hookah. One survey found that about 8 adults out of 100 under 30 years old smoked hookah over the past year.
“Since it’s smoked through a device, many of them assume it’s a safe alternative to cigarettes,” explains Folkenroth.
Is hookah smoke filtered?
Hookah smoke isn’t filtered because the water can't remove the harmful chemicals.
“It contains many of the same unhealthy [chemicals] found in cigarettes, like nicotine, tar, and heavy metals,” says Folkenroth.
Do hookahs get you high?
Yes, one session of hookah smoke provides much more nicotine and carbon monoxide than one cigarette.
“High amounts of carbon monoxide constrict (shrink) your blood vessels, which creates a ‘high’ feeling,’” says Folkenroth. “You’ll also get a more intense nicotine buzz than you would through a cigarette.”
There’s also a mental component to your high, too. “Hookah lounges tend to be very social and vibrant, which can enhance any physical buzz you get from the hookah,” says Folkenroth.
Are Hookahs Safer Than Cigarettes and Vapes?
Hookahs aren’t safer because they can expose you to:
More smoke than with cigarettes
Twice as much nicotine
Burning charcoal
Nine times more carbon monoxide
Thirty times more tar
Chemicals from the hose
“Hookah smoking sessions tend to be longer, so you’re exposed to more nicotine,” says Folkenroth.
In fact, a daily hookah session is like smoking 10 cigarettes in a day and other research suggests the smoke can expose you to much higher levels of toxins, too.
“Our tag line is quit, don’t switch,” says Folkenroth. “We have more tools than ever to help people stay quit for good, with proven strategies like behavioral counseling combined with FDA-approved smoking cessation medications.”
How much nicotine is in hookah compared to cigarettes?
There’s almost twice as much nicotine in hookah than a single cigarette.
“A typical cigarette requires about twenty puffs, while the average hookah user sits for about an hour and takes over 100 puffs,” says Folkenroth. “They’re exposed to much more smoke over a greater period of time.”
When you smoke a hookah, very little nicotine is filtered out when the smoke passes through the water.
Can you get addicted to hookahs?
Hookah has higher levels of nicotine, so you can get addicted. “Hookah smoke contains higher levels of nicotine, which is an addictive drug that has lasting damaging effects,” says Folkenroth.
Can Hookahs Affect Lung Health?
Many people assume hookahs are better for your lungs, but the smoke may be more toxic. That's because hookah also has burning charcoal, which has harmful chemicals such as:
- Carbon monoxide
- Heavy metals
- Sweeteners and flavorings
- Other toxic chemicals like tar
“The [harmful chemicals] can cause inflammation and damage the small cells in your lungs,” says Folkenroth.
Can hookahs cause cancer?
Hookah tobacco and smoke are filled with toxic chemicals. And exposure to the mixture can raise your risk for:
- Lung cancer — more than double the risk
- Bladder cancer
- Stomach cancer
- Esophageal (throat) cancer
- Oral (mouth) cancers
“Every time you breathe in hookah smoke, you increase levels of toxic agents in your bloodstream and starve your body of oxygen,” says Folkenroth. “This has a major impact on your overall health.”
Is hookah smoke like secondhand smoke?
Secondhand hookah smoke contains:
- Tobacco smoke
- Charcoal smoke
- Tar
- Chemicals
Both types of smoke are health risks if you're nearby, even if you're not smoking.
“Only about 15% of the hookah smoke is inhaled by the person who uses it,” says Folkenroth. “The rest is left to hover in the air for others to breathe. You can inhale these toxic chemicals and poisons without ever putting your lips on the mouthpiece of the hookah.”
One study showed four times higher carbon monoxide levels in rooms next door to hookah smoking than those of smoking homes.
What are the other long-term health impacts of smoking hookah?
Long-term hookah use can have a big impact on your heart and can raise your:
Resting heart rate
Blood pressure
Risk for heart attack and stoke
Chance for coronary artery disease
Risk of chronic obstructive pulmonary disease (COPD)
One study found that about 10 long-term hookah smokers out of 100 had COPD.
“The moment you quit, your lungs can start to repair themselves,” says Folkenroth. “But the longer you smoke hookah, the more likely it becomes that at least some of the damage will be irreversible.”
If you are pregnant and smoke hookah, your baby may have a higher risk for:
Low birth weight
Respiratory disease
Is There a Safe (Nontoxic) Hookah?
You may have heard that electronic hookahs (e-hookahs) are safer, but it's filled with vape juice. Although e-hookahs avoid using charcoal, you still inhale harmful, heated chemicals.
“They look like standard hookahs, but the method of delivery is a bit different,” says Folkenroth.
There's no research to show that e-hookahs are any safer than regular ones, she says. “You’re still exposed to the same sorts of chemicals.”
What about flavored hookah? Is that safer?
Hookah flavors, also called herbal shisha, contain fruits and herbs without tobacco. But you're still exposed to carbon monoxide and harmful chemicals because the shisha is heated up.
“One form of hookah called shisha is touted as being healthier since it has fruit in it,” notes Folkenroth. “But it contains the exact same levels of carbon monoxide and other toxins that raise your risk to develop smoking-related cancers, heart and lung disease.” The flavorings themselves also release more chemicals that may damage your lungs.
Does the water in hookah make it less harmful?
No, the water doesn’t filter out the toxic chemicals. You still get the same harmful substances like nicotine, tar, and heavy metals.
Can I get sick from sharing a hookah?
Yes. Many people share the same mouthpiece and breathe the same air during a hookah session. It’s a breeding ground for germs.
“Most people also cough when they use a hookah, so you’ve got a group of folks constantly coughing into each other’s faces,” says Folkenroth. You can also spread other nasties, like the herpes virus and tuberculosis, via the shared mouthpiece.
My ancestors smoked hookahs without issues. Why should I worry?
Hookah has been smoked in India for over 400 years, but it was as unhealthy as it is today. People were just more likely to die from other causes first.
There’s also been an increase of nicotine and other toxic agents placed in tobacco products over the last couple decades,” says Folkenroth. “They may be even more dangerous than they were 500 years ago.”
Safe Practices If You Choose to Smoke Hookahs
National groups like the CDC and American Lung Association say there’s no safe way to smoke hookah.
But if you choose to smoke a hookah:
- Wait till you're 21 or older.
- Keep your sessions to 30 minutes or less.
- Use hookah less often.
- Go outdoors.
- Get high-quality charcoal (avoid quick-light).
- Use clean water.
- Clean and sanitize your hookah.
Does the FDA regulate hookah tobacco?
The FDA doesn’t regulate hookah tobacco, so you won’t know for sure what you are getting. Smoke-free laws prevent use in bars and restaurants in some states and cities, but many have loopholes that still allow hookah.
Is it OK to smoke hookah occasionally?
“There’s no safe level of use,” says Folkenroth. “You will still be exposed to nicotine and other chemicals that have a lasting, damaging effect on your brain and body.”
The American Lung Association has many great resources to help you quit.
Takeaways
A hookah is a water pipe used to smoke tobacco mixtures. While it’s often thought to be a safe way to smoke, it carries the same health risks as when you use a cigarette or vape. Hookah use damages your heart and lungs and raises your risk of developing lung, bladder, esophageal, stomach and oral cancer. There’s no safe amount of hookah use.
Hookah FAQs
If I've smoked a hookah, do I need to be checked for lung cancer?
There aren’t lung cancer screening guidelines for hookah smoking. Tell your doctor if you use hookah to see what they recommend. And let your dentist know also, since you’re at higher risk for oral cancer.
Can a hookah expose me to carbon monoxide?
Yes. Hookah exposes you to nine times more carbon monoxide a cigarette does.
Why doesn't hookah water filter out the harmful chemical?
Water just cools the smoke down, but it doesn’t filter out the toxins because they don’t dissolve in water.
