Smoking Tabacco from a Hookah Water Pipe

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My college-age son is no dummy, but he started doing a very dumb thing. The fact that he wasn’t the only one—an estimated 22% to 40% of all US college students have done the same stupid thing in the past year—was scant comfort. What was this idiocy? Smoking tobacco from a hookah.

Hookahs are water pipes, and they can be simple or quite elaborate-looking. Typically they stand several feet tall and have a long hose attached to a mouthpiece. Hookah smoking is a social fad—it’s often done in groups, with the mouthpiece being passed from person to person. The practice originated centuries ago in Persia and India and has recently become all the rage among American teens and young adults.

The problem: Hookah fans often claim that this type of smoking is basically benign, especially compared with other types of smoking. But that’s a load of BS…as you’ll see below.

If kids you care about are in their teens or 20s, there’s a good chance that they have fallen for the hookah hype—or soon will. Though hookahs are slightly more popular with boys, lots of girls smoke them, too. Arming yourself with information can help you convince youngsters to stay away from hookahs. How do I know? My own son swore off the water pipe parties when I shared the following facts with him…


A typical hookah consists of a bowl to hold the tobacco…a long metal body…a jar half-filled with water (which cools the smoke)…and a flexible hose with a mouthpiece. The tobacco is covered with foil and then with charcoal which, when lit, ignites the tobacco.

Hookah smokers use a special tobacco mixture called shisha (sold online and in stores). This gooey mix contains tobacco plus molasses, glycerin, honey and/or flavorings (chocolate, mint, cherry, licorice, etc.). These added flavors make the tobacco taste better—but contrary to what some hookah smokers believe, they do nothing to “counteract” the harmful effects of the tobacco.

These kids are smoking, pure and simple. They are breathing in all the usual nasty stuff found in cigarettes—including carbon monoxide and other combustion products as well as highly addictive nicotine.


For the new study, researchers looked at the levels of 18 metals (including lead and the “metalloid” arsenic) in 12 different commercially available hookah tobacco mixtures—eight from the US and four imported from the Middle East. They determined the levels of these toxic metals in the tobacco mixtures, in the smoke they produced and in what was left in the water. Findings…

  • The water in the hookah pipe showed very low levels of toxins, suggesting that the water does not filter out the metals. This may disprove a popular belief among hookah smokers, many of whom claim that hookah smoking is basically harmless because of the water’s “filtering effects.”
  • Tobacco formulations from the Middle East (which are popular in the US) contained about twice the level of tested metals as US-grown tobacco. Lead was particularly high in Middle Eastern mixtures—something few hookah smokers may be aware of!


If your kid claims that hookah smoking is safer than cigarette smoking, here’s the info you need to counter his arguments…

  • Hookah users tend to sit at the pipe and smoke for an hour straight—that’s about 200 puffs, compared to 20 puffs for a typical cigarette. Now, suppose a cigarette smoker puffed away for a full hour, smoking 10 cigarettes one after the next. According to an earlier study published in American Journal of Health Behavior, the volume of smoke inhaled per cigarette is about 600 milliliters (ml)—so those 10 cigarettes would deliver 6,000 ml of smoke. In comparison, the volume of smoke inhaled by each user during a typical hookah session is about 90,000 ml! (As my son told me, your lungs can take in a lot more smoke when the water in the pipe cools it down. But of course, the cooling does nothing to remove the toxins.)
  • The charcoal used to heat tobacco in the hookah increases the health risks even further by producing high levels of carbon monoxide and cancer-causing chemicals. The charcoal smoke (like the tobacco smoke) is both inhaled through the hookah and released into the air in the room and inhaled as secondhand smoke. Hookah smokers also are exposed to possible contaminants from the metals and ceramics from which the pipe is made.
  • Like with cigarettes, hookah tobacco and smoke contain numerous toxic substances known to cause clogged arteries, heart disease, and lung, stomach, bladder and oral cancers. Some hookah users claim that they are protected because they “don’t inhale.” However, according to the Centers for Disease Control and Prevention (CDC), “Irritation from exposure to tobacco juices increases the risk of developing oral cancers. The irritation by tobacco juice products is likely to be greater among hookah smokers than among pipe or cigar smokers because hookah smoking is typically practiced (with or without inhalation) more often and for longer periods of time.” Tobacco juice. Ask your young hookah smoker if he’d like some of that!
  • Like all tobacco, hookah tobacco contains nicotine—and thus it is addictive.
  • Hookahs typically are shared by many smokers, so any infectious germs—including those that cause tuberculosis and hepatitis—that are left on the mouthpiece are ready and waiting for the next user. (My son scoffed at this until I pointed out the cold sore on his buddy’s lip and noted that sharing the hookah mouthpiece might give him oral herpes.)

Bottom line: No matter how trendy or exotic a hookah may seem, it is not a safe way to smoke. If anyone you know uses a hookah—or might—send him or her this article.

Source: Joseph Caruso, PhD, professor, department of chemistry, University of Cincinnati. His study was published in Analytical Methods.

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