Hookahs



Overview

• Hookahs are water pipes that are used to smoke specially made tobacco that is available in a variety of flavors (e.g., apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon).^1,2
• Hookah is known by a number of different names, including narghile, argileh, shisha, hubble-bubble, and goza.^1,2

• In recent years, there has been a increase in hookah use around the world, most notably among youth^1,2,3 and among university students.⁵ The Monitoring the Future survey for 12th grade students found that in 2010, 17% of high school seniors in the United States had used hookahs in the past year. This rate was slightly higher among boys (19%) than girls (15%).⁵ Other small-scale studies on young adults indicate that hookah smoking is more prevalent among university students in the United States, with past-year use ranging from 22% to 40%.⁵
• Hookahs vary in size, shape, and composition.²
• A typical modern hookah comprises a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece.^3,4
• New forms of hookah smoking, including steam stones and hookah pens, have been introduced. Like electronic cigarettes, these battery-powered devices turn liquid containing nicotine, flavorings, and other chemicals into a vapor, which is inhaled. Little information on their use and health risks is currently available.⁶

Compared with Cigarettes

While many hookah smokers may consider this practice less harmful than smoking cigarettes, hookah smoking carries many of the same health risks as cigarettes.^1,2

• Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke,² and some users of hookah report being dependent on hookah and having difficulty quitting.⁴
• The tobacco in hookahs is combusted (exposed to high heat).¹
• Due to the mode of smoking—including frequency of puffing, depth of inhalation, and length of the smoking session—hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke.^1,2
• A typical 1-hour-long hookah smoking session involves 200 puffs, while an average cigarette is 20 puffs. The volume of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500–600 ml inhaled when smoking a cigarette.⁴
• Hookah smokers are at risk for the same kinds of diseases caused by cigarette smoking. These include oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility.^3,4

Health Effects

Hookah Smoke and Cancer

• The charcoal used to heat tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.^1,4
• Even after it has passed through water, the smoke produced by a hookah contains high levels of toxic compounds, including carbon monoxide, heavy metals, and cancer-causing chemicals.⁴
• Hookah tobacco and smoke contain numerous toxic substances known to cause lung, bladder, and oral cancers.^1,4
• 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.^4,7,8

Other Health Effects of Hookah Smoke

• Hookah tobacco and smoke contain numerous toxic substances known to cause clogged arteries and heart disease.^1,4
• Infectious diseases may be transmitted by sharing a hookah.²
• Babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights (were at least 3½ ounces less) than babies born to nonsmokers and are at an increased risk for respiratory diseases.⁵

Hookahs and Secondhand Smoke

• Secondhand smoke from hookahs poses a serious risk for nonsmokers, particularly because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah.^1,5,9



References

1. American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use . (PDF–222 KB) Washington: American Lung Association, 2007 [accessed 2013 June 14].
2. American Lung Association. Hookah Smoking: A Growing Threat to Public Health Issue Brief. . (PDF–1.34 MB) Smokefree Communities Project, 2011 [accessed 2013 June 14].
3. Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review . International Journal of Epidemiology 2010;39:834–857 [accessed 2013 June 14].
4. Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States . American Journal of Health Behavior 2010;34(3):275–5 [accessed 2013 June 14].
5. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012 [accessed 2013 June 14].
6. U.S. Food and Drug Administration. Electronic Cigarettes (e-Cigarettes) [accessed 2013 Jun 14].
7. Nuwayhid, I, Yamout, B., Ghassan, and Kambria, M. Narghile (Hubble-Bubble) Smoking, Low Birth Weight and Other Pregnancy Outcomes . American Journal of Epidemiology 1998;148:375–83 [accessed 2013 June 14].
8. El-Hakim Ibrahim E, Uthman Mirghani AE. Squamous Cell Carcinoma and Keratoacanthoma of the Lower Lips Associated with "Goza" and "Shisha" Smoking. International Journal of Dermatology 1999;38:108–10 [cited 2013 June 14].
9. Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indoor Air Quality in Virginia Waterpipe Cafés. Tobacco Control 2012 Mar 24 doi:10.1136/tobaccocontrol-2011-050350 [cited 2013 June 14].

For Further Information

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.