Is hookah worse than cigarettes?
Hookah culture and its misconceptions
Hookah lounges may seem like a harmless social activity—but what looks like a unique and relaxing atmosphere on the outside can lead to significant health problems down the road.
Hookah lounges have grown popular in recent years. According to the Centers for Disease Control and Prevention, 2.6 million U.S. adults used hookah, water pipes or pipes in 2017. But while many believe hookah is less harmful than smoking cigarettes, it is not a safe alternative.
To complicate matters, hookah is a tradition and social custom in many Middle Eastern cultures. It’s so engrained in culture—hookah can sometimes be smoked at religious ceremonies or weddings—that it can be hard to avoid. But the health effects of hookah are severe enough to exercise caution.
The hookah industry is also growing in the U.S., with hookah bars, lounges and cafes popping up in college town and urban areas.
Not only is hookah popular, but there are widely-held misconceptions about the safety of it. In fact, 32% of young adults believe that hookah is less harmful than cigarettes.1
With growing popularity and a lack of knowledge about its negative effects, it’s time we clear the air about this trend.
What is hookah?
A hookah is a water pipe that heats and vaporizes tobacco (or cannabis or hashish). It’s believed to have originated in either India or the Middle East, and today there are people all around the world who smoke tobacco from a hookah. Globally, about 100 million people smoke hookah every day!2
Sometimes, the tobacco in a hookah is combined with honey, sugarcane, dried fruits, spices or flavors, giving it a sweet smell. Groups often smoke communally in hookah bars and cafes or at home.
Why do people think hookah is safe?
Historically, it was thought that the smoke from a hookah gets purified when it passes through the water—and this is a misconception that remains today. To be clear, it is not possible for water to filter out the harmful ingredients in smoke.
Is hookah worse than cigarettes?
When smoking hookah, compared to smoking one cigarette, users inhale much more nicotine, tar and carbon monoxide. In addition, the charcoal in hookah contains heavy metals and hydrocarbons. All of these substances are carcinogenic, or have the potential to cause cancer. In fact, research shows at least 82 different types of toxic chemicals and carcinogens are found in hookah smoke. Smoking hookah leads to an increased risk of lung, bladder and oral cancers.
In one hour of smoking hookah, users inhale 100-200 times more smoke than they would inhale from a cigarette.3 Even if you go to a hookah bar and don’t smoke, there are risks from inhaling smoke secondhand.
There are tobacco-free and herbal shisha blends for hookah, but since the water pipe itself includes charcoal, you would still be inhaling carcinogens.
If I smoke or have smoked hookah, do I need to be screened for cancer?
Current lung cancer screening eligibility criteria do not include guidelines for people who smoke hookah, as there is not sufficient research looking at lung cancer risk factors beyond cigarette smoking. As more research is done, it’s possible that future recommendations for lung cancer screening will include risk factors other than smoking cigarettes, such as smoking hookah, cigars or e-cigarettes.
That said—and as stated above—research does show that smoking hookah exposes you to large numbers of carcinogens and can lead to cancer. Until we know more, it is safest to abstain from smoking hookah.
Tobacco use is also one of the leading risk factors for oral cancer. The good news is you may already be getting checked for oral cancer without even realizing it. Your dentist may be able to detect some oral precancers and cancers early—visit your dentist every six months and ask for an oral cancer exam.
While hookah has cultural significance, it isn’t a safer alternative to cigarettes. If you need help quitting smoking, call 1-800-QUIT-NOW.