What are the health effects of smoking a hookah pipe?

The health effects of smoking a hookah pipe include increased risk for lung, mouth and bladder cancer. Hookah use is also linked to other unique risks not found with cigarette smoking. For example, infectious diseases can be spread by sharing the pipe or through the way the tobacco is prepared.

Joane Goodroe
Nursing Specialist

Smoking tobacco through a hose attached to a bowl of water is becoming more popular on campuses these days. Researchers say their Internet-based survey of students at eight North Carolina colleges and universities found about 40 percent reported they had used a hookah, also known as a water pipe.

Hookah smoke is flavored and cooler than cigarettes, but researcher Erin Sutfin of Wake Forest Baptist Medical Center says it’s just as bad for health. She says a lot of the users didn’t seem to realize this: “Current hookah users were more likely to report beliefs that it is safer than smoking cigarettes. It is not a safe behavior, and they need to understand that.”

The study in the journal Drug and Alcohol Dependence was supported by the National Institutes of Health. Learn more at

Hookahs—sometimes called water pipes—are used to smoke specially made tobacco that often contains flavorings (e.g., honey, mint, licorice). The hookah pipe uses coals to heat the tobacco mixture, and the smoke that is created passes through tubes and water so it is cooled before it is inhaled.

Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking (e.g., frequency of puffing, depth of inhalation, length of the smoking session), hookah smokers may absorb higher concentrations of the toxic compounds 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 oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility. 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.

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 (with or without inhalation) more often and for longer periods of time. Sharing a hookah may also increase the risk of transmitting tuberculosis, viruses such as herpes or hepatitis, and other illnesses.

Secondhand smoke from hookahs poses a serious risk for nonsmokers, particularly because it contains smoke from the tobacco and smoke from the heat source (e.g., charcoal) used in the hookah.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.