What is a Hookah and Shisha?
• A hookah is a water pipe used to smoke tobacco through cooled water. The tobacco is heated in the bowl at the top of the hookah and the smoke is filtered through the water in the base of the hookah. Hookah is 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).
• Alternate names for hookahs include: water pipe, goza, hubble-bubble, borry, rhile, and narghile.
• Shisha is the tobacco smoked in a hookah. It is a very moist and sticky tobacco that has been soaked in honey or molasses.
• Hookahs originated in ancient Persia and India and have been used extensively for centuries. Today, hookah cafés are gaining popularity around the globe, including Britain, France, Russia, the Middle East, and the United States.1 An estimated 300 hookah cafés operated in the United States in 2006, and the numbers continue to grow.1 In recent years, there has been a increase in hookah use around the world, most notably among youth.
• 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.
Myths and the Truths
MYTH #1: Hookah smoke is filtered through water so it filters out any harmful ingredients.
TRUTH #1: Smoking tobacco through water does not filter out cancer-causing chemicals. Water-filtered smoke can damage the lungs and heart as much as cigarette smoke.
MYTH #2: Inhaling hookah smoke does not burn the lungs, so it is not unhealthy.
TRUTH #2: The hookah smoke does not burn the lungs when inhaled because is cooled through the water in the base of the hookah. Even though the smoke is cooled, it still contains carcinogens and it is still unhealthy.
MYTH #3: Smoking hookahs are healthier than smoking cigarettes.
TRUTH #3: Hookah smoke is just as dangerous as cigarette smoke. Hookahs generate smoke in different ways: cigarette smoke is generated by burning tobacco, while hookah smoke is produced by heating tobacco in a bowl using charcoal. The end product is the same—smoke, containing carcinogens.
MYTH #4: Smoking a hookah is not as addictive as smoking a cigarette because there is no nicotine.
TRUTH #4: Just like regular tobacco, shisha contains nicotine. In fact, in a 60-minute hookah session, smokers are exposed to 100 to 200 times the volume of smoke inhaled from a single cigarette.
MYTH #5: Herbal shisha is healthier than regular shisha.
TRUTH #5: Just like smoking herbal or “natural” cigarettes, herbal shisha exposes the smoker to tar and carcinogens.
MYTH #6: Shisha tobacco contains fruit, so is healthier than regular tobacco.
TRUTH #6: Tobacco is tobacco, no matter how you look at it. Shisha is often soaked in molasses or honey and mixed with fruit, but it still contains cancer-causing chemicals and nicotine. Stick to traditional methods of getting fruit—eat an orange.
Compared with Cigarettes
- Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke.
- 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.
- A typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette.
- Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility.
• Compared to a single cigarette, hookah smoke is known to contain:
• Higher levels of arsenic, lead, and nickel1
• 36 times more tar
• 15 times more carbon monoxide
• Smoking a hookah requires taking longer and harder drags, increasing levels of inhaled nicotine and carcinogens in the lungs.
• The longer the hookah session, the more nicotine and toxins one takes in.
• A 45 to 60 minute hookah session exposes the smoker to approximately the same amount of tar and nicotine as one pack of cigarettes.
• Sharing mouthpieces without washing them can increase the risk of spreading colds, flu, and infections—even oral herpes.
• Health risks of smoking hookahs include cancer, heart disease, lung damage, and dental disease.
• Do not think that if you are just visiting a hookah bar, that you are in the clear. There are still high levels of damaging secondhand smoke to all who are present.
Health Effects of Hookah Smoke
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.
- 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.
- Hookah tobacco and smoke contain numerous toxic substances known to cause lung, bladder, and oral cancers.
- 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 more often and for longer periods of time.
Other Health Effects of Hookah Smoke
- Hookah tobacco and smoke contain numerous toxic substances known to cause clogged arteries and heart disease.
- Infectious diseases may be transmitted by sharing a hookah.
- Babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights than babies born to nonsmokers and are at an increased risk for respiratory diseases.
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 used in the hookah.