Social, But Not Safer

This trend could be “the second global tobacco epidemic since the cigarette”1

Originally a religious practice in Asia and the Middle East, hookah smoking has become a popular social activity for U.S. youth and adults.2

Hookah is a water pipe that is used to burn specially made tobacco that has been mixed with flavors.3

Here are the hookah basics:

  • Hookahs vary in size and style, but a typical modern hookah has a head, metal body, water bowl and flexible hose with mouthpiece.3
  • The flavored smoke is inhaled through the hose, usually shared in groups and passed from person to person.
  • The tobacco mixture in hookah, called shisha (pronounced SHE-shuh), is heated using charcoal.
  • Hookah is also known as narghile, argileh, hubble-bubble, and goza.3
  • Newer forms of hookah include steam stones and battery powered hookah pens. Both of these create a vapor that’s inhaled.


What You Need to Know

What we know about hookah ingredients and impact.


Multiple elements of hookah are dangerous to your health.

  • Hookah smoke contains high levels of toxins, including carbon monoxide, tar and heavy metals.3
  • The charcoal used to heat shisha produces carbon monoxide and other toxins.3
  • Hookahs put out harmful secondhand smoke from both the tobacco and the charcoal.4


Hookah smoking brings many of the same health risks as cigarette smoking — and can spread infection among users.1

  • Several types of cancer, including lung cancer, have been linked to hookah smoking.4
  • Hookah use has also been linked to coronary artery disease, an increased heart rate, high blood pressure, lung damage, carbon monoxide intoxication, chronic bronchitis, emphysema, dental problems and osteoporosis.4
  • Infections and illnesses may be passed between smokers who share a hookah mouthpiece.3


Hookah smokers may be exposed to even more nicotine than cigarette smokers.2

  • Because hookah smoking sessions are longer and tobacco concentrations are high, hookah users may consume larger amounts of nicotine than cigarette smokers.2
  • In fact, a typical one-hour hookah session is equivalent to inhaling the smoke of up to 100 single cigarettes.5 3


Hookah use is on the rise.

  • While cigarette use among youth and adults dropped 33 percent from 2000-2011, use of non-cigarette combustible tobacco products like hookah increased by 123 percent in the same time frame.7
  • Hookah use is high among youth and college students, many of whom are drawn to the various smoke flavors and social activity surrounding hookah.5


Myths About Hookah


Smoking in a hookah bar is safer than using hookah at home.



Hookah that is smoked in a bar contains the same ingredients, including nicotine. Users in hookah bars can inhale more toxic smoke than they might at home due to the concentration of smoke in enclosed spaces. Plus, hookah pipes in bars and cafes may not be cleaned properly, increasing the risk for disease.5 And the secondhand smoke can endanger employees and nonsmokers.6 8


Safe versions of hookah include “nontobacco” hookah, “herbal” shisha and hookah pens.



Studies have shown that smoke from nontobacco hookah varieties can contain carbon monoxide and other toxic agents linked to smoking-related cancers and disease.3 Even hookah pens that do not contain tobacco are not proven safe, as they can contain other harmful chemicals.4

1. The global epidemic of waterpipe smoking, Addictive Behavior (Maziak, W.), 2011. Retrieved from
2. Hookahs, Centers for Disease Control and Prevention, 2016. Retrieved from
3. Hookahs, Centers for Disease Control and Prevention, 2016. Retrieved from
4. Is Any Type of Smoking Safe?, American Cancer Society, 2015. Retrieved from
5. Hookah Tobacco (Shisha or Waterpipe Tobacco), U.S. Food and Drug Administration, 2017. Retrieved from
6. Secondhand hookah smoke: an occupational hazard for hookah bar employees, Tobacco Control (Gordon et al.), 2016. Retrieved from
7. Consumption of Cigarettes and Combustible Tobacco — United States, 2000-2011, Centers for Disease Control and Prevention, 2012. Retrieved from
8. Secondhand hookah smoke: an occupational hazard for hookah bar employees, Tobacco Control (Gordon et al.), 2016. Retrieved from