- Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon.1,2
- Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking.1,2
- Hookah is also called narghile, argileh, shisha, hubble-bubble, and goza.1,2
- Hookahs vary in size, shape, and style.2
- A typical modern hookah has a head (with holes in the bottom), a metal body, a water bowl, and a flexible hose with a mouthpiece.3,4
- Hookah smoking is typically done in groups, with the same mouthpiece passed from person to person.1,2,3,4
Tobacco users should quit all tobacco products to reduce health risks.
Hookah smoking is NOT a safe alternative to smoking cigarettes.1
- Hookah use began centuries ago in ancient Persia and India.1,2,3,4
- Today, hookah cafés are gaining in popularity around the world, including Britain, France, Russia, the Middle East, and the United States.1
- Hookah use by youth1,2,3 and college students is increasing.5
- In 2010, the Monitoring the Future survey found that among high school seniors in the United States, about 1 in 5 boys (17%) and 1 in 6 girls (15%) had used a hookah in the past year.5
- Other small studies of young adults have found high prevalence of hookah use among college students in the United States. These studies show past-year use ranging from 22% to 40%.5
- New forms of electronic hookah smoking, including steam stones and hookah pens, have been introduced.
- These products are battery powered and turn liquid containing nicotine, flavorings, and other chemicals into a vapor, which is inhaled.6
- Very little information is currently available on the health risks of electronic tobacco products.6
Using a hookah to smoke tobacco poses serious health risks to smokers and others exposed to the smoke from the hookah.
Hookah Smoke and Cancer
- The charcoal used to heat the tobacco can raise 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 from a hookah has high levels of these toxic agents.4
- Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.1,4
- Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.4,7
Other Health Effects of Hookah Smoke
- Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.1,4
- Infections may be passed to other smokers by sharing a hookah.2
- Babies born to women who smoked water pipes every day while pregnant weigh less at birth (at least 3½ ounces less) than babies born to nonsmokers.5,8
- Babies born to hookah smokers are also at increased risk for respiratory diseases.8
Hookah Smoking Compared With Cigarette Smoking
- While many hookah smokers may think this practice is less harmful than smoking cigarettes, hookah smoking has many of the same health risks as cigarette smoking.1,2
- Water pipe smoking delivers nicotine—the same highly addictive drug found in other tobacco products.2
- The tobacco in hookahs is burned (exposed to high heat) and the smoke is at least as toxic as cigarette smoke.1,2
- Because of the way a hookah is used, smokers may absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.1,2
- An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs.1,2
- The amount 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 may be at risk for some of the same diseases as cigarette smokers. These include:3,4
- Oral cancer
- Lung cancer
- Stomach cancer
- Cancer of the esophagus
- Reduced lung function
- Decreased fertility
Hookahs and Secondhand Smoke
- Secondhand smoke from hookahs can be a health risk for nonsmokers. It contains smoke from the tobacco as well as smoke from the heat source (e.g., charcoal) used in the hookah.1,5,9
Nontobacco Hookah Products
- Some sweetened and flavored nontobacco products are sold for use in a hookah.10
- Labels and ads for these products often claim that users can enjoy the same taste without the harmful effects of tobacco.10
- Studies of tobacco-based shisha and “herbal” shisha show that smoke from both preparations contain carbon monoxide and other toxic agents known to increase the risks for smoking-related cancers, heart disease, and lung disease.10,11
- American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. [PDF–222 KB] Washington: American Lung Association, 2007 [accessed 2013 Dec 17].
- American Lung Association. Hookah Smoking: A Growing Threat to Public Health Issue Brief.. [PDF–1.34 MB] Smokefree Communities Project, 2011 [accessed 2013 Dec 17].
- The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review. International Journal of Epidemiology 2010;39:834–57 [accessed 2013 Dec 17].
- Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. American Journal of Health Behavior 2010;34(3):275–85 [accessed 2013 Dec 17].
- 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 Dec 17].
- U.S. Food and Drug Administration. Electronic Cigarettes (e-Cigarettes) [last updated 2013 April 25; accessed 2013 Dec 17].
- 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 Dec 17].
- 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 Dec 17].
- Indoor Air Quality in Virginia Waterpipe Cafés. Tobacco Control 2012 Mar 24 doi:10.1136/tobaccocontrol-2011-050350 [cited 2013 Dec 17].
- Does Switching to a Tobacco-Free Waterpipe Product Reduce Toxicant Intake? A Crossover Study Comparing CO, NO, PAH, Volatile Aldehydes, Tar and Nicotine Yields. Food and Chemical Toxicology 2012;50(5):1494–8 [accessed 2013 Dec 17].
- Acute Effects of Waterpipe Tobacco Smoking: A Double-Blind, Placebo-Control Study. Drug and Alcohol Dependence 2011;116(1–3):102–9 [cited 2013 Dec 17].
For Further Information
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
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