Hookah: why it is no safer than cigarettes
Risky SubstancesKey points
- Hookah is linked to lung cancer, lung disease and gum disease.
- In pregnancy it is linked to low birth weight.
- Water does not filter out most toxins or carbon monoxide.
- One session often lasts an hour or more.
What the research shows
A systematic review and meta-analysis found that waterpipe smoking was linked to lung cancer, respiratory disease, low birth weight and periodontal disease, with some evidence for other cancers and cardiovascular disease (Waziry et al., 2017).
Secondhand smoke from hookahs also exposes others to toxins; worldwide, secondhand smoke causes hundreds of thousands of deaths a year (Öberg et al., 2011).
Why hookah is not “lighter”
- The water cools the smoke but does not filter out most toxins.
- Charcoal adds carbon monoxide and other combustion products.
- Sessions last long and involve deep, frequent puffs.
- Sharing mouthpieces can spread infections.
Smoking of any kind shortens life (Jha et al., 2013).
Frequently asked questions
Is herbal or tobacco-free shisha safe?
No. Burning herbal shisha with charcoal still produces carbon monoxide, tar and other toxins.
How much smoke is in one session?
The CDC notes that a typical one-hour hookah session can involve 200 puffs, compared with about 20 for a cigarette.
Sources
- Waziry et al. (2016). The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis: Table 1.. International Journal of Epidemiology :dyw021. doi:10.1093/ije/dyw021
- Öberg et al. (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet 377(9760):139-146. doi:10.1016/S0140-6736(10)61388-8
- Jha et al. (2013). 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine 368(4):341-350. doi:10.1056/NEJMsa1211128
Keep reading
Alcohol during pregnancy: no safe amount
What fetal alcohol spectrum disorders are, how common drinking in pregnancy is and why the CDC and ACOG say there is no safe amount or time.
Risky SubstancesAlcohol and your liver: how alcohol-related liver disease develops
How heavy drinking progresses from fatty liver to hepatitis and cirrhosis, the rise of alcohol-related liver disease in the U.S. and how the liver can recover.
Risky SubstancesWeight gain after quitting smoking: what to expect and why quitting still pays off
How much weight people gain after quitting smoking, why heart disease risk still drops by about half and how to limit weight gain.
Risky Substances tools
AUDIT: the WHO alcohol use test
10 WHO questions about how often and how much you drink, and its consequences.
QuizAUDIT-C: quick alcohol check
The first three AUDIT questions: a one-minute screen widely used in U.S. primary care.
QuizFagerström Test for Nicotine Dependence
6 questions to gauge physical dependence on nicotine.
PDF · PlanQuit smoking plan
A personal plan: quit date, reasons, triggers, substitutes and support.
PDF · TrackerSmoke-free days tracker
A monthly tracker with craving ratings and notes.
PDF · DiaryWeekly drink diary
Record how much you drink and in what situations.