healthHealth and Medicine

Hookah Smokers May Be Exposed To More Toxicants Than Cigarette Smokers


Ben Taub


Ben Taub

Freelance Writer

Benjamin holds a Master's degree in anthropology from University College London and has worked in the fields of neuroscience research and mental health treatment.

Freelance Writer

600 Hookah Smokers May Be Exposed To More Toxicants Than Cigarette Smokers
Each hookah "session" may deliver 125 times more smoke than a single cigarette. Kycheryavuy/Shutterstock

The dangers of smoking cigarettes are well known, although some alternative methods of inhaling tobacco smoke can be considerably more harmful than many people realize. Hookahs, for example, are often used to smoke flavored tobacco by passing the smoke through a water vase and inhaling it through a long pipe. However, according to a new study, those who use hookahs may be exposed to considerably higher concentrations of harmful substances than cigarette smokers.

Also known as waterpipes, shishas or narghiles, hookahs are traditionally used across the Middle East and parts of Asia, and have become increasingly popular in western nations over recent years. For instance, a recent survey conducted by the University of Pittsburgh School of Medicine indicated that around one-third of college students in the U.S. have used a hookah, and that many of these are not regular cigarette smokers. As such, the researchers behind this particular investigation have suggested that “hookah smoking may be attracting many people who would otherwise not have been tobacco users.”


However, scientists from the same institution have now published a new report in Public Health Reports suggesting that the dangers of hookah use may in fact outweigh those of cigarettes. By reviewing the data published in over 500 previous studies into the toxicant (man-made toxic substance) content of both hookah and cigarette smoke, they found that in each hookah session, smokers may inhale around 74 liters (2,500 fluid ounces) of smoke, which is roughly 125 times the volume delivered by a single cigarette.

In doing so, they expose themselves to approximately 25 times more tar than they would receive from one cigarette, as well as 2.5 times the amount of nicotine and 10 times the amount of carbon monoxide. Since cigarette tar has been linked with lung cancer, this statistic is obviously a major cause for concern.

Due to variations in cigarette and hookah use between individuals, it is not possible to accurately state which is '"worse." Vladimir Tronin/Shutterstock

Yet while these figures may provide a pretty compelling argument against the use of waterpipes, the study authors concede that their research has a number of limitations, and that it is very difficult to accurately determine how damaging they truly are in comparison to cigarettes. This is because smoking patterns vary greatly between individuals, and it is not possible to determine how much smoke each person inhales during a single “session.”


Similarly, since the number of cigarettes consumed by each smoker also varies wildly, it is not possible to decipher which of the two modes of inhaling tobacco smoke is the more damaging. Accordingly, lead author Brian Primack claimed in a statement that the study cannot offer a “perfect comparison because people smoke cigarettes and hookahs in very different ways.”

However, while he admits that “the estimates we found cannot tell us exactly what is ‘worse,’” he insists that the data is useful in that it indicates that “hookah smokers are exposed to a lot more toxicants than they probably realize.” This information, he suggests, should be used to help guide public health policies, which he says should involve closer monitoring of hookah smoking.


healthHealth and Medicine
  • tag
  • tobacco,

  • lung cancer,

  • carbon monoxide,

  • smoking,

  • cigarettes,

  • hookah,

  • shisha,

  • narghile,

  • waterpipe,

  • tar