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It seems to have become a common saying, among my college cohorts, that smoking out of a hookah is somehow better for you. The belief among some waterpipe/hookah users is that this method of smoking tobacco delivers less tar and nicotine than regular cigarette smoking and has fewer adverse health effects. However, scientific evidence contradicts this oft-repeated myth.

In the past eight to 10 years, smoking tobacco with a hookah has grown in popularity in the United States, especially among adults 18 to 24.

People who use these devices don’t realize that they could be inhaling what is believed to be the equivalent of a pack of cigarettes in one typical 30-60 minute session with a waterpipe, because such a large quantity of pure, shredded tobacco is used

said Christopher Loffredo, Ph.D., Director of the Cancer Genetics and Epidemiology program at Georgetown University Medical Center.

How do we know the dangers of hookah you ask? Professors at the American University of Beirut in Lebanon, for example, compared the toxicant exposure associated with waterpipe smoking and cigarette smoking among 31 participants between the ages of 18 and 50. Each participant completed two 45-minute sessions, one in which they smoked tobacco using a waterpipe and the other in which they smoked a single cigarette. The level of nicotine and carbon monoxide in the participants’ blood was measured, as was heart rate, puff number and puff volume.

They found that on average, the levels of carbon monoxide to which participants were exposed were higher when they were smoking a waterpipe than when they were smoking a cigarette. Specifically, the peak waterpipe COHb level — amount of carbon monoxide found bound to red blood cells — was three times that observed for cigarette. However, they observed that the peak nicotine levels did not differ — but there was exposure to nicotine through both methods of tobacco smoke. Examining the number and volume of each puff showed that compared with smoking a cigarette, waterpipe tobacco smoking involved inhalation of about 48 times more smoke.

Does it still sound OK?

Because the tobacco is burning at a lower temperature, it is more tolerable to inhale deeply, and in fact you need more force to pull air through the high resistance of the water pathway. That means the tobacco smoke can be penetrating deeper in a person’s respiratory tract than cigarette smoke does. Also, because the cooling water reduces the “harshness” of the smoke, compared to cigarette smoke, the smokers often hold in the smoke for longer.

Couple this with the pleasant aromas and “smooth” nature of the smoking, and you have got a recipe for cardiovascular disaster my friends.

We believe that, compared to the typical cigarette smoker, waterpipe smokers are exposed to larger total amounts of nicotine, carbon monoxide and certain other toxins

said Christopher Loffredo, Ph.D.

It may seem trendy, but remember that you are still smoking tobacco. You are still inviting the increased risk of cancer and all other detriments that come along with smoking. Just because the smoke “feels” better or is “smoother”, does not make it clean.

Another component of the misconception is that people think that the pollutants in the tobacco smoke are somehow “captured” or “filtered” by the passage through the cooling water. While some pollutants are water soluble, the most harmful ones, like tar, are not, and still make it into your lungs just like cigarettes. Even for water soluble pollutants, the contact time between them and the water is not long enough to provide significant removal. Besides, the really bad stuff, i.e. carcinogens still make it into your lungs through the insolubles like tar.

Actually think about it for a moment…You are still smoking tobacco, for longer periods, with more smoke entering your lungs, inhaling more deeply, and holding it in for longer. Would you do all that with a cigarette?

A 5 minute buzz in exchange for increased health risks? Pass.


Here is a CDC Fact Sheet on Hookah versus cigarette smoking with more sources and evidence.


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