Is Hookah More Dangerous Than Other Smoking Methods?

By Lindsey Weedston 08/16/19

One pull from a hookah pipe can deliver as many “noxious substances” into a person's lungs as one cigarette.

a person smoking hookah
ID 97227513 © Roman Suslenko |

A recent, first-of-its-kind study conducted at the University of California, Irvine, suggests that smoking hookah could expose users to high doses of nicotine as well as carbon monoxide, carcinogens, and dangerous ultrafine particles.

Hookahs are ancient devices most commonly used today for collective smoking of tobacco. They can be found at smoke shops and hookah lounges. According to the university, 20% of college students in Europe and the U.S. have tried hookah.

The idea behind smoking hookah is that it can deliver a significant dose of nicotine without many of the same dangerous particles and chemicals found in cigarettes because it was assumed that the water in the device filtered much or nearly all of that out. However, this study appears to have confirmed this to be no more than a myth, and in fact it could even produce more ultrafine particles than other forms of smoking.

Toxic Chemicals

“One of the big myths about hookah usage is that the water in the bowl actually filters out the toxic chemicals, providing a shield for the smoker,” said lead study author Veronique Perraud. “In the study, we show that this is not the case for most of the gases and that, possibly due to its cooling effect, water actually promotes ultrafine particle formation.”

In fact, they found that one pull from a hookah pipe can deliver as many “noxious substances” into the lungs of the user as they would get from an entire cigarette. At the same time, of course, nicotine ingestion can lead to addiction. The study also looks at multiple cases in which hookah users suffered carbon monoxide intoxication from burning the coals, which can be very dangerous.

Ultrafine particles can also be especially hazardous due to being small enough to reach parts of the pulmonary system that larger particles can’t, and the smallest can even cross the blood-brain barrier. Researchers have only recently been able to trace these very tiny particles, which is part of what makes this new study so unique.

“Typically, researchers would collect samples from a filter capturing smoke and particles from an entire session, rendering one data point,” Perraud said. “But through our technique of testing emissions in the beginning, midpoint and end of a smoking session, we were able to show that a smoker is exposed to a higher quantity of ultrafine particles during the first 10 minutes compared to the rest of the time.”

These results come out of what is actually a two-part study, with phase two currently underway at UCI’s School of Medicine. The second phase will look at the specific health effects of waterpipe smoking.

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Lindsey Weedston is a Seattle area writer focused on mental health and addiction, politics, human rights, and various social issues. Her work has appeared in The Establishment, Ravishly, ThinkProgress, Little Things, Yes! Magazine, and others. You can find her daily writings at Twitter: