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3 Reasons Why Smoking the Hookah is Harmful

This tobacco trend is toxic for teens

man smoking hookah

Smoking hookah may look glamorous to some, but it’s every bit as addictive as cigarette smoking — and maybe more harmful. But that hasn’t stopped this ancient pastime from seeing a revival among high school and college students.


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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 that is passed from one user to the next. Hookahs come in a wide range of sizes and it’s easy to hide small, 8-inch-tall models in dorm rooms, cars and bathrooms.

Adolescent medicine specialist Ellen Rome, MD, MPH, offers three reasons why smoking a hookah is harmful and how to raise the discussion with your teen.

1. Sharing health risks

Young people may be attracted to the social nature of hookah smoking and to flavors that range from cappuccino to watermelon. However, hookah smokers may share more than just tobacco.

“What teens may not realize is that the risks that come with sharing a hookah range from mono, colds, strep and now potentially COVID-19,” says Dr. Rome. “These risks are amplified by the close proximity of those sharing the hookah and by coughing in each other’s faces with use.”

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.

“In other countries, tuberculosis can be transmitted when hookah smokers cough in each other’s faces and can be cultivated from the hookah water,” says Dr. Rome. “Today, we worry more about spread of COVID-19.”

Besides the regular carcinogens from smoking, the flavorings are often oil-based, and oil is incredibly inflammatory and damaging to small airways in the lungs. Heating elements that have metal coils can also release heavy metal ions that also are inflammatory in lungs, causing damage that can result in substantial harm. Smoking a hookah​ can lower your lung’s immunity and potentially increase your risk for the coronavirus. (Besides the fact that teens usually smoke in groups, meaning they’re not social distancing!)


2. Hookah is more toxic than cigarettes

Aside from the risk of infection, smoke from the hookah contains the same cancer-causing chemicals as cigars and cigarettes. Hookah smokers also inhale carbon monoxide, heavy metals and other toxic compounds given off by the burning charcoal. Smoking in a group setting creates significant secondhand smoke — especially in hookah cafes.

“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.”

According to a study done on the effects of hookah smoking, plasma nicotine levels were found to be increased in hookah users and the levels were much higher compared to cigarette users.

The risks don’t just stop there.

The CDC reports that tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers and gum disease.

3. Cardiovascular effects

The risks of addiction can’t be downplayed. Hookah smokers typically smoke longer and more often, take more puffs and inhale more deeply than cigarette smokers. They absorb more nicotine in higher concentrations because of the way the smoke is cooled.

Moreover, it’s been shown that heavy hookah smoking has been associated with ischemic heart disease, heart failure and coronary artery disease development.

From dental diseases to cardiovascular problems, understanding the harmful effects of smoking hookah are the first steps you can take to start the discussion with your teen.

How to talk to teens about risks

A positive, problem-solving approach works best.

“Discuss with your teen what they get out of hookah smoking — and what they could do instead that would be safer,” says Dr. Rome. “Let them come up with alternative ideas for safer fun.”

If your teen is looking for closeness with friends, suggest alternatives like preparing dinner for friends outside at home or group outings like a bike ride or socially distant picnic.

Dr. Rome offers these do’s and don’ts:

  • Don’t support the habit. You don’t need to give your child funds to frequent a hookah bar.
  • Don’t preach. This approach always backfires with adolescents.


  • Do be a role model for your child. If you smoke, quit.
  • Do 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.
  • Do talk to your teen about how to say “no.” Know your teen’s friends and ask whether they smoke.
  • Do 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.
  • Do reward your teen for quitting. Plan something special for you to do together.​


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