Hookah Smoking Delivers Way, Way, Way More Toxins than Cigarettes

A new study shows that smoking hookah exposes smokers to more toxins than comparable sessions of smoking cigarettes. Ethan Welty/Getty Images

The first few times Mallory smoked from a hookah, she didn't even realize it was tobacco. The taste, so different from the occasional cigarette she smoked, was reminiscent of strawberries — sweet, and a little tangy. Plus, she liked hanging out with her friends after class at the hookah lounge. It was a lot more laid back than their usual college bar.

Smoking tobacco from a hookah pipe is becoming an increasingly popular pastime with high school and college students, many of whom may not initially realize the danger. Research published in the journal Pediatrics, for example, reported that hookah use is "increasing significantly among adolescents" and that it seemed to appeal particularly to students with a comfortable socioeconomic status. In fact, the more educated a student's parents, the more likely that student is to smoke hookah.

Inset — Hookah smoking has increased in popularity in the United States among high-school and college students.
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A hookah is a bulbous vase-like apparatus that has one or more hoses with pipes attached. The bottom of the vase is filled with water, and at the top, flavored tobacco called shisha is placed under a screen that is topped with hot coals. When a smoker draws on the pipe, the smoke is pulled down to the bottom of the hookah where it goes underwater before the vapor winds its way back up, through the hose and pipe and into the smoker's mouth.

Now research suggests that hookah smoking exposes people to more toxins than smoking cigarettes. Researchers at the University of Pittsburgh's School of Medicine performed a mathematical summary of previously published data on cigarette and hookah smoking. The results of the meta-analysis were published in the current issue of Public Health Reports.

Of the 542 relevant scientific articles examined by the group, 17 studies were found to have enough data to compare the inhalation of toxins when smoking cigarettes versus hookahs — and this revealed that when compared with a single cigarette, one hookah session delivered a lot more punch. In fact, researchers discovered that one round of hookah smoking results in 2.5 times the nicotine when compared to a cigarette. It also delivers 10 times the carbon monoxide, 25 times the tar and 125 times the smoke of a cigarette.

It's not that the smoke from a hookah itself is more toxic than that from a cigarette, it's that a hookah smoker is more likely to consume much, much more smoke in one session than a cigarette smoker.

Researchers acknowledge they are comparing apples to oranges — a cigarette smoker may smoke a dozen cigarettes a day while a hookah smoker may light up once a day — in a way that makes it difficult to say which delivery method poses a great risk. During a hookah session, it's likely that one single smoker consumes smoke multiple times, and the study does shine a light on the sheer amount of toxicants released in smoking hookah. And this may come as a surprise to hookah enthusiasts.

"It's not a perfect comparison," says Brian A. Primack, M.D., Ph.D., the study's lead author. "Hookah smokers are exposed to a lot more toxicants than they probably realize."

According to a 2013 study published in BMC Public Health, 28.4 percent of college students smoked tobacco from a hookah in 2012, while only 19.6 percent had smoke a cigarette in that same year.