Yes, Hookah Is Just as Bad for You as Cigarettes

Smoking hookah may look glamorous to some, but it’s every bit as addictive as cigarette smoking — and maybe more harmful.

Hookahs are water pipes resembling slender metal vases. Charcoal is used to heat a sweet, sticky tobacco, producing smoke that is filtered through cooled water. The smoke is inhaled through a flexible hose passed from one user to the next. 

Whether you regularly partake in this ancient pastime or you’re just now learning about it, pediatrician Ellen Rome, MD, MPH, explains the health risks of smoking hookah. Plus, she gives some insight on how to address hookah smoking habits with your teen.

Reasons why smoking hookah is harmful

While hookah comes in many flavors like watermelon and cappuccino, these familiar tastes don’t make them any less harmful to your health.

It’s more toxic than cigarettes

One of the biggest myths you hear about hookah is that it’s a better alternative to cigarettes. But the smoke from a hookah contains the same cancer-causing chemicals as cigars and cigarettes.

According to a 2019 study review, hookah smokers are exposed to even higher levels of the same toxins and by-products found in cigarettes. “Hookah is not a safe alternative to smoking cigarettes,” says Dr. Rome. “A typical one-hour session involves inhaling 100 to 200 times the volume of smoke inhaled from a single cigarette.”

Hookah smokers inhale carbon monoxide, heavy metals and other toxic compounds given off by the burning charcoal. Dr. Rome also points out that smoking in a group setting creates significant secondhand smoke — especially in hookah cafes.

“Hookah smokers also typically smoke longer and more often, take more puffs and inhale more deeply than cigarette smokers,” Dr. Rome adds. They absorb more nicotine in higher concentrations because of the way the smoke is cooled.

It hurts your lungs

In addition to the standard carcinogen exposure you get from smoking, hookah's oil-based flavorings are incredibly inflammatory and damaging to small airways in your lungs.

Hookah’s heating elements have metal coils that can also release heavy metal ions that can cause inflammation and substantial damage to your lungs. In addition, smoking a hookah can lower your lung’s immunity and potentially increase your risk for diseases like bronchitis or pneumonia.

It puts you at risk for mouth diseases

Because hookah is often smoked in a shareable, social setting, it can increase your risk for mouth diseases. And the risks don’t stop there. The Center for Disease Control and Prevention (CDC) reports that tobacco juices from hookahs can irritate your mouth and increase your risk for developing oral cancers and gum disease.

Herpes, which causes lip/mouth cold sores, and H. pylori, the most common cause of stomach ulcers, can also be passed via the shared mouthpiece. And breathing plus coughing in others’ faces while sharing a hookah can expose you to colds, flu and other respiratory viruses.

It’s rough on your heart

Hookah can also put a strain on your heart. Short-term hookah smoking can cause symptoms like high blood pressure and increased heart rate. But there are risks for developing long-term issues as well. The same 2019 literature review showed that heavy hookah smoking is linked with developing conditions like ischemic heart disease or heart failure.

What’s the difference between hookah, cigarettes and vaping?

What is the main thing that hookah, cigarettes and vaping have in common? They all pose significant health risks. But there are other similarities and differences between the three. And while you may think one is safer than the other, that’s not the case.

Here’s how they compare to each other:

1. Hookah:

• What it’s made of: Hookah involves smoking specially prepared tobacco (often flavored) called shisha, which is placed in a bowl on top of the hookah device. The tobacco is often mixed with molasses, honey or fruit pulp.
• How it works: Hot charcoal is placed on top of the shisha, heating it to produce smoke. The smoke passes through water in the base of the hookah device before being inhaled through a long hose.
• The health risk: Despite the water filtration, hookah smoke contains harmful chemicals, including nicotine, carbon monoxide, heavy metals and carcinogens. A typical hookah session can expose you to more smoke over a longer period than cigarettes. Specifically, an hour hookah session delivers around 200 puffs per session, which is the equivalent of 100 cigarettes (5 packs). Even shared, that is a lot of nicotine and toxins.

2. Cigarettes:

• What it’s made of: Cigarettes are rolled papers filled with tobacco leaves, often mixed with additives and chemicals.
• How it works: When lit, the tobacco burns, producing smoke that is inhaled through the filter end of the cigarette.
• The health risks: Cigarette smoke contains thousands of chemicals, including tar, carbon monoxide and carcinogens. This createsa high risk of lung cancer, heart disease, respiratory issues and other health problems.

3. Vaping (E-Cigarettes):

• What it’s made of: Vaping devices use liquids or vape juices that typically contain nicotine, flavorings and other chemicals. Some may also contain THC or CBD.
• How it works: The device heats the liquid to create an aerosol (often mistakenly called vapor) that is inhaled.
• The health risks: Vaping’s health risks include lung damage from inhaling chemicals as well as heavy metals, which are aerosolized from the vape device itself. Vaping can also be highly addictive due to the nicotine content, and some devices allow users to consume large amounts of nicotine quickly. The vaping devices also create toxic waste for the environment with their lithium batteries and plastic cartridges.

How talk to your teen about smoking

You may be worried about your teen getting into hookah and believing the incorrect hype about it. Dr. Rome recommends tackling this topic through a positive, problem-solving approach. “Discuss with your teen what they get out of hookah smoking — and what they could do instead that would be safer,” suggests Dr. Rome. “Let them come up with alternative ideas for safer fun.”

If your teen is looking for closeness with friends, suggest other options like preparing dinner together or group outings like a shopping trip, bike ride, a picnic or a hangout at a local coffee shop.

Dr. Rome also offers these do’s and don’ts for addressing smoking with your child:

Do:

• Communicate the risks. Young people may be attracted to the social nature of hookah smoking and to the well-advertised flavors that include names such as Adalya Love 66, Al Fakher Grape with Mint, Fumari White Gummi Bear), Fumari Mint Chocolate Chill, or Cardamon Cheesecake. However, hookah smokers may share more than just tobacco – so explain to them that it’s not any better just because it tastes better.
• Be a role model for your child. If you smoke, try your best to quit, too. It’s easier said than done, but it’s important for them to have a good role model to follow.
• Talk about smoking’s harmful effects early. Start when kids are age 5 or 6, and keep it up through their teens — even if they don’t smoke.
• Talk to your teen about how to say “no.” Peer pressure can be the biggest thing pushing your child to smoke. It’s important to teach them how to set boundaries and not feel pressured to follow the crowd. Know your teen’s friends and ask whether they smoke.
• Practice patience. It may take a while for teens and young adults to quit any kind of smoking, just as it does for adults. When they’re ready to quit, provide plenty of support.
• Reward your teen for quitting. Plan something special for you to do together.

Don’t:

• Support the habit. You don’t need to give your child funds to frequent a hookah bar.
• Preach. This approach always backfires with adolescents. Instead, Listen-Ask-Share. Listen actively to what your child is saying, and ask clarifying questions to understand their feelings and concerns. Ask if it’s ok if you share your thoughts on the topic. And if they say no, respect that choice.
• Use in front of them. “Do as I say, not as I do” has not been a great behavior change model.

The takeaway

Whether it’s you or your child who is experimenting with hookah, it’s important to understand the risks behind it. You may have heard that certain types of smoking are less risky than others, but hookah can pose just as much of a risk as cigarettes. It’s best to stay away from all types of nicotine inhalation for the sake of your well-being (and those around you).

Talk to your healthcare provider if you want to learn more about the risks or how smoking hookah may affect you or your child’s health. And don’t be afraid to ask for help with quitting.