Is hookah harmful?
- Layla Morgan
- Jan 15
- 9 min read
Updated: Jan 25
Hookah smoking is a popular pastime, but there's often confusion about how it affects your health. Many people wonder, "Is hookah harmful?" especially when comparing it to cigarette smoking. After all, hookah smoke passes through water, leading some to believe it's filtered and safer. The truth is that hookah smoking carries significant health risks. In this article, we'll break down the facts and myths about hookah and health, so you can understand the potential dangers and how to enjoy hookah more responsibly if you choose to.
Hookah vs. cigarettes: the myth of "safer" smoking
A common misconception is that hookah (waterpipe) smoking is safer than smoking cigarettes. This belief largely comes from the water filtration aspect and the fruity aromas that make hookah smoke seem less harsh. However, research and health experts have found that hookah smoking is not safer than cigarettes. Here's why:
Tobacco and toxins: Hookah uses tobacco (often called shisha, which is usually flavored with molasses or fruit). Burning this tobacco produces many of the same toxic chemicals found in cigarette smoke, including tar, nicotine, carbon monoxide, heavy metals, and carcinogens. The sweet flavor doesn't eliminate these substances; it only masks them. According to the Mayo Clinic, the water in a hookah does not effectively filter out these toxins. So with each puff, you're still inhaling harmful compounds into your lungs.
Smoke volume: A typical hookah session lasts much longer than smoking a single cigarette. People might smoke a hookah for 30 minutes to an hour, or even more. Over that time, a hookah smoker can inhale a large volume of smoke – potentially equivalent to smoking dozens of cigarettes in one session. In fact, studies cited by the American Lung Association found that hookah users can be exposed to 9 times more carbon monoxide and 1.7 times more nicotine than a single cigarette smoker in one session. The World Health Organization has noted similar concerns; the extended duration and depth of inhalation in hookah use means more exposure to toxins per session.
Nicotine and addiction: Hookah smoke delivers significant amounts of nicotine, the addictive substance in tobacco. Even though hookah smoke might feel smoother, it can contain nicotine levels comparable to cigarettes. This means hookah smoking can lead to nicotine dependence. Some people mistakenly think that because they don't smoke hookah as often as cigarette smokers (maybe just socially on weekends), they're not at risk of addiction. But nicotine is nicotine – if you use hookah regularly, you can develop cravings or dependence on it.
Health risks of hookah smoking
Because hookah exposes you to toxic substances similar to cigarettes, it also carries similar health risks. Here are some of the known or suspected health issues associated with hookah smoking:
Cancer: Like any form of tobacco smoke, hookah smoke contains carcinogens (cancer-causing chemicals). Hookah smoking has been linked to cancers of the lung, mouth, throat (esophagus), stomach, and bladder. The charcoal used to heat hookah tobacco can add additional toxins (like carbon monoxide and heavy metals) that also contribute to cancer risk.
Lung and respiratory problems: Hookah smokers can develop lung diseases such as chronic bronchitis or chronic obstructive pulmonary disease (COPD). The irritation from smoke can cause coughing and wheezing, and long-term use may reduce lung function. There’s also a risk of carbon monoxide poisoning – if a room is not well ventilated, the CO from charcoal and tobacco can cause headaches, dizziness, or worse. In fact, cases of CO poisoning have occurred in hookah lounge settings when ventilation was poor.
Heart disease: Tobacco smoke (including from hookahs) affects the cardiovascular system. It can increase heart rate and blood pressure. Over time, hookah smoking could contribute to hypertension (high blood pressure), arterial hardening, and heart disease. Some studies suggest that hookah use may be associated with an increased risk of heart attacks and other cardiac events, similar to the risks of cigarette smoking.
Dental and oral health: The heat and irritants from hookah smoke can contribute to gum disease and oral cancers. And while hookah smoke smells fruity, it still contains tar that can stain teeth like cigarette smoke does.
Infectious diseases: One risk somewhat unique to hookah is the social sharing aspect. Often, people share a hookah or mouthpiece among a group (though many lounges now provide disposable mouth tips for hygiene). If pipes or hoses are not cleaned properly, or if mouth tips are shared, it is possible to transmit infections. Diseases such as herpes, tuberculosis, hepatitis, or even the flu can be spread via communal hookah use. During the COVID-19 pandemic, this became a big concern as well. Reputable lounges have mitigations like disposable tips and rigorous cleaning protocols to address this, but it's something to be aware of if you're smoking with others.
Secondhand smoke: Just like cigarettes, hookahs produce secondhand smoke that can be harmful to bystanders. The combination of tobacco smoke and charcoal smoke means that people around the hookah (even if not smoking directly) are breathing in a cocktail of pollutants. Secondhand hookah smoke can irritate the lungs and is especially problematic for people with asthma or other respiratory conditions. It also poses risks to children or pregnant women who might be present.
Comparing hookah to other alternatives
You might wonder if newer alternatives like herbal hookah (tobacco-free shisha) or electronic hookah heads (e-hookahs) make hookah smoking safer. Here's the lowdown:
Herbal Shisha (tobacco-free): These products replace tobacco with herbs, tea leaves, or sugarcane fiber soaked in flavor. The benefit is that they contain no nicotine and no tobacco. This eliminates the nicotine addiction risk and some toxins, but not all risks. You're still burning a substance with charcoal, so the smoke will contain carbon monoxide and other combustion by-products. You can still harm your lungs with any type of smoke. So, herbal hookah might be somewhat less harmful than tobacco hookah (primarily due to lack of nicotine), but it's not completely harmless. It should also be noted that because there's no nicotine "buzz," some people might smoke herbal hookah longer or inhale more deeply to compensate, which could expose them to more smoke.
E-Hookahs / vaping devices: Electronic hookah devices heat a liquid (which may contain flavorings, glycerin, nicotine, etc.) to create vapor instead of burning tobacco. These are similar to e-cigarettes or vape pens. The jury is still out on all the long-term effects of e-hookahs, but health experts caution that they are not risk-free. They can deliver nicotine and other chemicals (like propylene glycol, glycerol, and flavor compounds which may produce toxic substances when heated). Some people use e-hookahs as a way to avoid charcoal smoke – which does eliminate carbon monoxide issues – but you might be inhaling other harmful aerosols. The Centers for Disease Control and Prevention (CDC) warns that vaping, including e-hookahs, can cause lung damage or other health problems, and it’s certainly not safe for young people or pregnant women. So while e-hookahs might reduce certain risks (no charcoal, possibly no tobacco), they could introduce new ones, and the long-term health impact is still being studied.
Can hookah be enjoyed safely?
The honest answer from health authorities is that no form of smoking is truly safe. Hookah is not an exception: whenever you inhale smoke from burning materials, you're introducing toxins to your body. The safest option is not to smoke at all. However, understanding that many adults choose to enjoy hookah socially, here are some tips to at least reduce the harm if you do partake:
Moderation is Key: The less frequently you smoke, the better. Treat hookah as an occasional indulgence (like one might a cigar or a drink), not a daily habit. Your body can recover better from infrequent exposure than constant exposure.
Don’t Inhale Deeply: Unlike cigarettes, hookah tends to encourage very deep inhalation (because the smoke is cooler and smoother). Be mindful of how you smoke; you don't need to take massive drags every time. Taking lighter puffs can reduce how much smoke and CO you draw into your lungs.
Use a Personal Mouthpiece: Always use your own mouth tip (any decent lounge will provide disposable tips). This prevents the spread of germs. Also, if you're with friends, consider asking for additional hoses or waiting your turn rather than sharing the same mouthpiece.
Ensure Good Ventilation: If you're at a lounge or hosting a hookah at home, do it in a well-ventilated area. Outdoors is best, or a large room with fans/airflow. This helps dissipate carbon monoxide and secondhand smoke.
Choose Quality and Cleanliness: Go to reputable hookah lounges that clean their equipment thoroughly. Old, unclean hookahs can harbor bacteria or mold. At Hubble Bubble Lounge, for example, we prioritize hygiene by cleaning our hookahs after every use and using fresh hoses or thoroughly sanitized ones. We also use natural coconut coals to avoid quick-light chemicals.
Consider Alternatives: If you're concerned about nicotine, ask for herbal shisha. If you're concerned about charcoal, some lounges offer heat management devices or electric burners that reduce charcoal use. These don't eliminate risk, but they can mitigate specific concerns.
Know Your Limits: Nicotine poisoning (sometimes called a "hookah hangover" or getting "buzzed") can happen, especially in long sessions. If you ever feel dizzy, nauseous, or have a headache while smoking hookah, stop and get some fresh air. Those are signs you've had too much (often due to carbon monoxide or nicotine).
Stay Hydrated: Smoking can dehydrate you. Sipping water or a non-alcoholic drink while smoking can help you feel better and may reduce some irritation to your throat.
Conclusion: informed enjoyment
So, is hookah harmful? The straightforward answer is yes – it has many of the same health risks as cigarettes and in some ways exposes you to more smoke. Hookah should be approached with the understanding that it's not a "safe" alternative to smoking. However, adults can make informed choices about what risks they're willing to take. Just as people still enjoy cocktails (knowing alcohol has risks) or sunbathe (knowing UV rays have risks), many choose to enjoy hookah socially and accept those risks.
The best thing you can do is be aware. Now that you know what's behind that smooth, flavorful smoke, you can decide how and when to partake. If you do enjoy hookah, do it responsibly: not too often, preferably in a controlled setting like a professional lounge that adheres to safety and cleanliness standards.
At Hubble Bubble Lounge, we care about our patrons' well-being. We ensure all our hookahs are hygienic and use quality ingredients, and our venue is 21+ only as required by law (no minors should be exposed to any tobacco). We want you to enjoy the cultural and social experience of hookah, but also encourage you to do so in moderation and with full knowledge of the facts.
In summary, hookah is an enjoyable social activity for many, but it's important not to fool oneself – it does come with health concerns. Stay informed, take precautions, and if you ever have questions about hookah use, feel free to ask our staff or consult medical resources. Your health is irreplaceable, so always balance enjoyment with mindfulness.
FAQs
Is hookah safer than cigarettes because the smoke goes through water?
No, that's a myth. The water in a hookah does cool the smoke, making it feel smoother, but it does not filter out poisonous chemicals. Studies have shown hookah smoke contains tar, nicotine, carbon monoxide, heavy metals, and other toxins similar to cigarette smoke. You might end up inhaling even more smoke over a longer time with hookah than from a cigarette, so it can be equally if not more harmful in that session.
How often is it okay to smoke hookah?
There is no safe level of tobacco smoke – zero is the safest. But if you choose to smoke hookah, doing it less frequently is better. Many health experts suggest limiting hookah (or any tobacco) to special occasions. Smoking once in a while (say, once a month) will have less impact than smoking every week. Remember that even occasional hookah use can affect you (for example, your blood vessels and carbon monoxide levels temporarily), but your body has more time to recover if it's infrequent. The key is moderation – the less, the better.
Does hookah have more nicotine than cigarettes?
It can. The nicotine content in smoke depends on the tobacco and how it's smoked. A hookah bowl can contain as much tobacco as several cigarettes. Over a long session, a hookah smoker might inhale nicotine comparable to or greater than smoking one or more cigarettes. However, because hookah is usually not a daily habit for most people, total nicotine exposure per week might be less than a pack-a-day cigarette smoker. But session for session, hookah can deliver a lot of nicotine, which can lead to dependence if done regularly.
I'm pregnant (or have a medical condition). Is it okay to be around hookah smoke?
Pregnant women should avoid hookah entirely – both smoking and exposure to secondhand smoke. Tobacco smoke can harm an unborn baby, leading to low birth weight and other complications. Similarly, anyone with medical conditions like asthma, heart disease, or anemia should stay away from hookah smoke, as it could exacerbate their condition (e.g., trigger asthma attacks or reduce oxygen delivery in blood due to carbon monoxide). If you have health issues, consult your doctor, but it's generally advised to steer clear of any kind of smoking environment.
What does Hubble Bubble Lounge do to ensure a safer hookah experience?
At Hubble Bubble Lounge, we take several measures: we use disposable mouth tips for each customer to prevent germ spread, and we thoroughly clean and disinfect our hookah equipment after each use. We use natural charcoals and properly ventilate our lounge to minimize excessive smoke buildup. Our staff is trained to prepare hookahs optimally so that they burn cleanly (preventing excessive harsh smoke). While we can't remove all health risks from hookah, we strive to create a setting where those who choose to enjoy hookah can do so as safely and responsibly as possible. We also remind and require that all guests be 21 or older in accordance with tobacco laws and for health responsibility.
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