Are Hookahs Any Safer Than Vaping?

With the recent uproar over e-cigarettes, or vaping, the lesser-used hookahs are avoiding the spotlight.

There’s no question that the decline in cigarette smoking is a net positive for the health of Americans and other people around the world. The problem is, other methods of ingesting tobacco are becoming more popular.

One of those, e-cigarettes, has certainly been gaining attention recently with its rampant use among teenagers, as well as growing number of injuries and deaths linked to their use. A lesser known, but still quite popular alternative, is the hookah.

hookahsWhat is a hookah?

The hookah, or shisha, was used originally as a religious practice in regions such as India and the Middle East. It consists of a water-filled bowl, a pipe filled with tobacco and flavoring, and a flexible hose that’s used to smoke the tobacco.

Though shisha smoking has been around a long time, it’s only recently that their use has been growing, particularly among teenagers and young adults. The American Lung Association estimates that almost 600,000 high school students (4.1%) and 140,000 middle school students (1.2%) have used a hookah in the last month. The CDC suggests that the social aspect of hookah use may be driving its popularity. Hookahs are typically smoked in groups, and dedicated hookah cafes are becoming increasingly popular not only in Europe and the Middle East, but in the United States.

Are hookahs safe?

Many shisha users think that the water helps filter the smoke, and they perceive it to be safer than cigarette or e-cigarette smoking. The reality, says Dr. Mehdi Mirsaeidi, a pulmonology and critical care medicine expert with the University of Miami Health System, is that hookahs are not a safe alternative to the other methods of smoking tobacco. “Whether you’re talking about cigarettes or e-cigarettes or hookahs, the reality is that nothing is safe here,” he says.

“These products represent the same danger in different packaging.”

In fact, hookahs may pose risks that cigarettes do not, says the America Lung Association. Hookah smoke contains at least 82 different toxic carcinogens and chemicals, including tar, heavy metals and nicotine. What’s more, the charcoal used to heat the shisha tobacco may release dangerous chemicals, such as metals and carbon monoxide. The water? It doesn’t do much to eliminate exposure to hazardous and addictive chemicals in the smoke.

The flavors are another problem with shisha tobacco, according to the CDC. To make them more appealing to younger people, companies add flavors like cherry, chocolate, cappuccino, apple, mint, and coconut to the tobacco.

While flavors enhance the popularity of hookahs among young people, it also enhances their risks.

“The smoke causes problems in the lungs all on its own, but the flavors are causing additional problems,” says Dr. Mirsaeidi.

The reality, he says, is that hookahs are no better than the alternatives. “The bottom line for our community is that none of these products are safe,” he says.


Wyatt Myers is a contributing writer for UMiami Health News.