Last updated : May 12, 2025
Thought to have orginated in India or Persia during the 1500s, hookah smoking has spread worldwide. These large water pipes consist of a water chamber, a tobacco chamber, and one—or more—flexible tubes stemming from the water chamber for inhaling the smoke. You can smoke marijuana and hashish too—it’s merely added in with the tobacco in the bowl.
However, hookahs were designed for smoking sweetened and flavored tobacco called shisha. It’s specially prepared and remains very moist. The tobacco is sweetened using a variety of substances.
They include:
- Molasses
- Fruit pulp
- Honey
- Coconut
- Mint
- Coffee
Adding flavorings not only sweetens the taste of the tobacco and enhances the aroma of the smoke, it makes smoking more appealing to young people.
Is hookah smoking safer than cigarettes?
In short, the answer to that question is no.
A common myth associated with the hookah is that nicotine and toxins found in tobacco are removed as the smoke passes through the water chamber. The water-cooled smoke is easier on the lungs—as far as being less harsh—but the toxicity level doesn’t change.
Shisha contains many of the same chemicals found in traditional cigarette tobacco, including:
- Acetaldehyde
- Acrolein
- Arsenic
- Cadmium
- Carbon monoxide
- Chromium
- Cobalt
- Formaldehyde
- Lead
- Nickel
- Polonium 210—a radioactive isotope
- Tar
Some hookah specific products claim to be free of tar, but that isn’t true. Tobacco doesn’t ever contain tar until it’s burned—or heated, as is the case when smoking a hookah.
How does a hookah work?
Rather than applying a direct flame to the hookah bowl, the user places a layer of aluminum foil on top after loading it. Then, someone places burning charcoal on top of the foil.
As the charcoal heats the tobacco beneath it, smoke forms. When someone inhales through the hookah’s stem, also called a hose, the smoke passes through the water chamber. This cools the smoke before it’s inhaled into the lungs.
It’s like cigarettes on steroids though
Typically, hookah smoking is a group affair and the session lasts an hour or so. The group passes the hose from person to person. Some hookahs are equipped with multiple hoses positioned around the water chamber. Either way, by the time the session ends, users may inhale up to 200 times the amount of smoke they would inhale smoking a cigarette. That means that users are exposed to up to 9 times the amount of carbon monoxide and 1.7 times the nicotine of a single cigarette.
With a higher level of toxins entering the body, hookah smokers may be at increased risk for some of the diseases that effect cigarette smokers. These diseases include:
- Oral cancer
- Lung cancer
- Stomach cancer
- Cancer of the esophagus
- Heart disease and stroke
- Reduced lung function
- Decreased fertility
Secondhand hookah smoke is a health risk for people in the vicinity of the smoking session—even if they aren’t participating themselves.
Spreading sickness
People usually reserve hookah smoking for social settings with several people sharing the same pipe and, oftentimes, even the same mouthpiece. That’s never a good idea. People don’t always exhibit symptoms of a virus or other sickness even though they are contagious.
Up in smoke
The claim that smoking a hookah is better for your health than cigarette smoking is totally false. In fact, people who smoke hookahs ingest more toxins than cigarette smokers. Therefore, they are putting themselves at higher risk of diseases associated with smoking. Forming an addiction to tobacco is a serious risk as well.
If you don’t smoke, don’t start—tobacco or marijuana. Both substances negatively affect your health. Moreover, you put yourself at risk of forming a dependence—or worse, an addiction.
