Side Effects of Hookah Smokers

Hookah smoking is often thought to be safer than smoking cigarettes, however it may be equally or more dangerous.
Hookah smoking is often thought to be safer than smoking cigarettes, however it may be equally or more dangerous. (Image: hookah image by Dmitri MIkitenko from

The hookah (also known as the narghile) is a smoking implement which cools and filters smoke by passing it through a quantity of water. It is typically used to smoke a flavored tobacco blend known as shisha. The hookah originated in India but has been gaining popularity in other parts of the world, such as the Middle East, Europe and North America.


Hookahs, though different in size, shape, and number of hoses, all work in the same way. The tobacco blend or smoking herb is placed in the bowl atop the apparatus. The smoking substance is heated by a special hookah coal that burns slowly and consistently to provide a smoking experience with a long duration. The smoke is pulled down through the down stem into the chamber, where it bubbles up through the water in the hookah. It then is inhaled through one of the tubes by a hookah smoker. Hookahs utilize the same principal as water pipes, as they cool and (to a degree) filter smoke.

Lung Irritation

Due to water filtration, hookahs are not particularly irritating to the lungs of the smoker. As the smoke passes through the water in the chamber, it is cleaned of particulate matter (such as ash or small bits of unburned material). Additionally, the water has a cooling effect on the smoke. These factors combine to provide a "smoother" smoke to the user. Users therefore don't typically have coughing fits, and hot ash doesn't get sucked into the mouth or lungs.


Hookah tobacco usually only consists of pure tobacco, flavoring, sugar and glycerin. This stands in contrast to cigarettes, which are known to contain more than 600 additives, many of which are carcinogens. Therefore, hookah smokers tend to receive less carcinogens than cigarette smokers, not because of the hookah itself, but because of the quality of the tobacco being smoked. However, all smoke contains carcinogens, and tar is not water-soluble, so hookah smokers will still receive a fair amount of carcinogens, and a significant amount of tar.

Carbon Monoxide and Nicotine

Hookah smokers also expose themselves to the dangers of carbon monoxide and nicotine. Due to the fact that hookahs are typically smoked in long sessions, lasting 45 minutes or more, hookah users consume a very large amount of smoke each time they smoke. One session of hookah smoking releases approximately the same amount of carbon monoxide as an entire pack of cigarettes. High amounts of carbon monoxide have been linked to cardiovascular disease. Nicotine levels in hookah tobacco, on the other hand, are low in comparison to other types of tobacco. However, the amount smoked per session means that hookah smokers take in more nicotine in one session than other tobacco users.

Other Health Effects

Due to the cultural phenomenon of "hookah bars" (establishments where hookah smokers can convene and smoke), there is an additional health effect that is not immediately obvious. In hookah bars, hookahs often are provided by the establishment, meaning that many hookah smokers will use the same equipment in a short period of time. Due to sharing hookah hoses, hookah smokers are exposed to viruses and other common contagious diseases from other hookah smokers. This is preventable, however, if the hookah smoker takes care to bring his or her own hookah and always sterilizes the mouthpieces before and after each session.

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