Is hookah smoking harmless?

Hookah, nargileh, chicha, shisha and ghelyan are all synonyms used to refer to a waterpipe that has been used for over four centuries to smoke tobacco, mainly in Asia and the Middle East. The use of these waterpipes in bars and cafés has grown popular among teens and young adults, and not surprisingly: hookah tobacco smells like candy and is often flavoured with molasses, mint, honey, or fruit flavours like cherry or apple. This is why it has a sweeter aroma and a more pleasing taste than cigarettes. The general perception is that hookah is relatively safe, or at least safer than tobacco. Is this accurate?

Here is how hookah works: when a smoker inhales through the waterpipe, the pressure gradient forces air past the incandescent combustible material, which heats the tobacco and produces smoke. The smoke then passes through the water and into the smoke chamber, where it is inhaled by the smoker.

In a questionnaire completed in Montreal by close to 900 young adults aged 18 to 24, almost a quarter of the participants reported having used a waterpipe in the previous year. In another survey, nearly 60 % of respondents said they believed that hookah is less harmful than cigarette smoking. And yet, a single session of waterpipe smoking can deliver as much tar as an entire pack of cigarettes. In addition, as with cigarette smoking, hookah users inhale nicotine, carbon monoxide, formaldehyde, benzene, toluene, arsenic and other carcinogens.

And while people are less aware of the potential for addiction with waterpipes, the risk is quite real. It appears to depend on several factors, such as the frequency and duration of use, the type of tobacco used, and the volume of smoke inhaled.

According to an advisory released by the World Health Organization, many of the long-term adverse consequences of hookah smoking mimic those of cigarette smoking, including an increased risk of cancer. Pregnant women in particular should avoid hookah smoking, as it has been associated with complications similar to those observed with cigarette smoking.

Hookah smoking is therefore not a “healthier” alternative to cigarettes after all!