HookaH

H o o k a H = t o b a c c o + c a r b o n m o n o x i d e + a r s e n i c + t a r
HookaH Hides THe TruTH!
WHaT You don’T knoW… WiLL HurT You!
geT THe TruTH.

some people buy into the myth the water
used in hookah filters harmful substances
such as nicotine.
Nothing is further from the truth. The water only filters 5% of the
nicotine. The remaining 95% is inhaled. Hookah smokers inhale
more tobacco smoke than cigarette smokers because of the large
volume of smoke they inhale in a longer smoking session. When
you smoke hookah, it is still tobacco and contains high levels
of toxic compounds, including tar, carbon monoxide, heavy
metals, and cancer-causing chemicals. In fact, hookah smokers
are exposed to more carbon monoxide, tar and nicotine than are
cigarette smokers.
There are much better ways to spend your time.

Hookah
• Hookahs—sometimes called a water pipe—is used to smoke
specially made tobacco that is available in a variety of flavors that
may appear enticing to young adults. It is flavored tobacco and
puts a person at risk for nicotine addiction. 1,2
• Hookah smoking is typically practiced in groups, with the same
mouthpiece passed from person to person exposing individuals
to infectious diseases. 1,2
• Hookahs originated in ancient Persia and India and have been
used by men, in particular, for centuries. 1,2,3 Today, hookah cafés
are gaining popularity around the globe. 1 An estimated
300 hookah cafés operated in the United States in 2006, and the
numbers continue to grow. 1 These cafés are unregulated
and pose health concerns. In recent years, there has been a
increase in hookah use around the world, most notably among
young adults. 1,2,3
• Hookah is known by a number of different names, including
narghile, argileh, shisha, hubble-bubble, and goza. 1,2
• Hookahs vary in size, shape, and composition. 2
• A typical modern hookah comprises a head (with holes in the
bottom), a metal body, a water bowl, and a flexible hose with a
mouthpiece. 4

compared with cigarettes
While hookah smokers may consider this practice less
harmful than smoking cigarettes, hookah smoking carries
many of the same health risks as cigarettes. 1,2
• Water pipe smoking delivers the addictive drug nicotine and is at
least as toxic as cigarette smoke. 2
• Due to the mode of smoking—including frequency of puffing,
depth of inhalation, and length of the smoking session—hookah
smokers may absorb higher concentrations of the toxins found in
cigarette smoke. 1,2
• A typical 1-hour-long hookah smoking session involves inhaling
100–200 times the volume of smoke inhaled from a single
cigarette, exposing the lungs to more smoke over a longer
duration. 4
• Hookah smokers are at risk for similar chronic diseases as found in
cigarette smokers,
including oral
cancer, lung cancer,
stomach cancer,
cancer of the
esophagus, reduced
lung function, and
decreased fertility. 5
Hookah smoking
is NOT a safe
alternative
to smoking
cigarettes. 1

Hookah Smoke and Cancer
Health effects
• Hookah tobacco and smoke contain numerous toxic substances
known to cause lung, bladder, and oral cancers. 1,4
- The charcoal used to heat tobacco in the hookah increases
the health risks by producing high levels of carbon
monoxide, nicotine, arsenic, cobalt, nickel and cancer-causing
chemicals, even though it has passed through the water. 1,4
• 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 a hookah session typically lasts for a longer
period of time. 6
Other Health Effects of Hookah Smoke
• Hookah tobacco and smoke contain numerous toxic substances
known to cause clogged arteries and heart disease. 1,4
• Infectious diseases, such as tuberculosis, mononucleosis, and
influenza, may be transmitted by sharing a hookah. 2
• Babies born to women who smoked one or more water pipes a
day during pregnancy have lower birth weights than babies born
to nonsmokers and are at an increased risk for respiratory
diseases such as asthma. 5
Hookahs and Secondhand Smoke
• Just like cigarettes, secondhand smoke from hookah poses a
serious risk for nonsmokers, particularly because it contains
smoke not only from the tobacco but also from the charcoal used
in the hookah. 1,4
Using a hookah to smoke tobacco poses a serious potential
health hazard to smokers and others exposed to the smoke
emitted. 1,4

Reference: Centers for Disease Control and Prevention. Smoking and Tobacco Use at www.cdc.gov 1. American Lung Association.
An Emerging Deadly Trend: Waterpipe Tobacco Use . 2. Akl E., et al.. The Effects of Waterpipe Tobacco Smoking on Health
Outcomes: A Systematic Review . International Journal of Epidemiology 2010;39:834–857 3. Centers for Disease Control and
Prevention. Tobacco Use Among Students Aged 13–15 Years—Baghdad, Iraq, 2008 . Morbidity and Mortality Weekly Report
2009;58(12):305–8 4. World Health Organization. Tobacco Regulation Advisory Note. Water Pipe Tobacco Smoking: Health Effects,
Research Needs and Recommended Actions by Regulators, Tobacco Free Initiative, 2005 5. Nuwayhid, I, et al. Narghile (Hubble-
Bubble) Smoking, Low Birth Weight and Other Pregnancy Outcomes . American Journal of Epidemiology 1998;148:375–83. 6.
El-Hakim I., Uthman M. Squamous Cell Carcinoma and Keratoacanthoma of the Lower Lips associated with “Goza” and “Shisha”
Smoking. International Journal of Dermatology 1999;38:108-10.
Individuals needing accommodation under ADA,
please contact Erica Allen, (813) 974-4936 (FL Relay 711).
www.usf.edu/wellness/Hookah