Trusted Content

The Dangers Of Hookah Smoking

Medically reviewed by

David Hunter, MA.Ed, LPC

February 28, 2019

Smoking tobacco or anything through a hookah is not any safer than a cigarette filter, and due to the duration of use and other factors, hookah smoking is in many ways less safe than the alternative.

A hookah is a smoking apparatus in which tobacco or some other substance is placed at the top of a vertical shaft that terminates at a water-filled chamber at its base. Air is drawn through a flexible tube connected to the water-filled chamber above the water line. When air is pulled through the tube, it forces air through the water-filled chamber, from the top of the shaft, where lit tobacco or other substances are burning. The water filled chamber acts as a filter for a larger particulate matter.

While the substance used to be placed directly atop the head of the chamber, today hookah charcoal is available for sale in conveniently sized briquettes. While convenient for lighting and keeping lit, these briquettes contain additional toxins not found in cigarettes and can increase the risk of certain cancers as well as other serious health issues.

Why Is The Use Of A Hookah Dangerous?

Though hookahs have been in use for centuries, in the last decade, use of the apparatus has gained new popularity, spurring the opening of “hookah cafes” throughout the Middle East, modern Europe, and even in the United States. This highly visible social activity is increasing the use of hookahs among youth populations. One CDC report indicates an 18 percent increase in hookah use among university students.

Health risks from hookah are similar to cigarettes, but carry a larger number of toxins in some cases, depending on whether or not the coal briquettes are used. Hookah smoke from those briquettes contains carbon monoxide and other toxins that do not get filtered through the water enough to reduce their effect. These toxins have been linked to increases in lung, stomach, bladder, and throat, and mouth cancers.

Smoking tobacco through a hookah carries risks as well, increasing the risk of heart disease, high blood pressure, and lung or respiratory health issues. It also delivers highly addictive nicotine. Someone smoking using a hookah as opposed to a cigarette is likely to smoke for longer, increasing their exposure to nicotine and the toxic substances. According to the Centers for Disease Control and Prevention (CDC), the average hookah user inhales 200 times, while the average cigarette smoker inhales 20 times. This difference indicates a significantly higher level of exposure to the substance being smoked.

The highly social nature of hookah smoking also increases the risk of the spread of illness or disease, as the apparatus is shared among groups. Those in the room with hookah smokers, whether engaging in smoking or not, are at risk for secondhand smoke exposure.

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Adverse Health Risks Associated With Hookah Smoking

There are many adverse health risks associated with hookah smoking, including cancers and cardiovascular disease. These include:

  • Lung cancer
  • Stomach cancer
  • Bladder cancer
  • Esophageal cancer
  • Oral cancer
  • Heart attack
  • Stroke
  • High blood pressure

Why An Afternoon In A Hookah Cafe Is Dangerous

The potential health risks associated with hookah smoking were made more apparent after one University of California study, which examined levels of nicotine, cotinine, tobacco-related nitrosamine, and other toxic compounds, including harmful volatile organic compounds (VOCs) in the urine of individuals prior to entering a hookah cafe, and following. The results were astonishing, with users showing 73 times the increase in nicotine levels, and between a 14 and 91 percent increase in levels of cancer-causing VOCs.

Other studies on indoor air quality in spaces where hookah use is permitted to indicate unsafe levels of cancer-causing agents. One study in Oregon examined air quality based on the Environmental Protection Agency’s (EPA) air quality index, which rates the safety of concentrations of particulate matter in the air on a scale from harmless to hazardous. In each of the 10 hookah cafes examined, levels of particulate matter in the air ranged from dangerous to hazardous and posed a threat to employees regularly exposed through second-hand smoke.

Another study indicated the particulate matter in the air of hookah cafes is on average 69 times higher than in outdoor air, once again exceeding safe levels as recommended by the EPA.

Apart from general particulate matter, the chemicals released into the air compound the dangers of even a single exposure at a cafe or social venue in which hookahs are being used. High-level nicotine exposure, apart from addiction risk, can have adverse and immediate effects on the cardiovascular system, including the constriction of blood flow and an increase in blood pressure and heart rate.

Hookah Smoking And Addiction Risk

Appearances can be deceiving. While passing the hookah may seem like a fun and social experience, it carries with it a high addiction risk. Despite the delivery, nicotine is still a highly addictive substance, and someone using a hookah may quickly develop a dependence on the drug. Withdrawals from nicotine include a headache, gastrointestinal upset, anxiety, and cravings. These symptoms may be more severe for hookah users as the levels of nicotine tend to be higher than for someone who smokes cigarettes.

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