Health Risk of Hookah Smoking vs Cigarette Smoking


Health Risk of Hookah Smoking vs Cigarette Smoking – Hookah is a form of smoking tobacco evolved in 16th century introduced by physician Hakim Abul-Fath Gilani. They designed it with concept that when smoke passes through water underneath it will purify the smoke and do less harm to the health.

Later, with this unproven hypothesis hookah got popular. Now-a-days still many people give the same opinion as that of 16th century. Despite the misconception prevalent in youth, various literature have shown the significant health risk associated with hookah smoking.

Now-a-days hookah smoking is gaining popularity all over the world, mostly among teenagers and young adults. Most of the restaurants, bars, pubs, clubs and cafe focus mainly on selling hookah. Many College going students find hookah smoking as one of the most cheerful and chill moment in their college life. One survey in 2018 revealed that nearly 1 in 13 of high school going students in United States have smoked hookah during their high school days.

Why people are attracted to hookah

New additive flavors with popular marketing strategies make hookah smoking more familiar and popular among youths. Due to pleasant and soothing smell of added flavor,hookah smoker are increasing putting their health into high risk. Many people find hookah smoking as sociable activity as a new taboo to our community.

People are aware about health risks associated with cigarette smoking but most of us have no idea regarding risks associated with hookah smoking. Study in Saudi Arabia will help us to explain why young population is attracted toward smoking hookah every day. The data shows that 50% of students think smoking hookah as very less harmful compared to cigarettes and 61% of students believe that substance in hookah is purified by water filtration beneath so it has less side effect compared to cigarette smoking.

Many people start cigarette smoking after they smoke hookah. So,now it is high time that we create awareness among young generation regarding associated health risk and ill effect of hookah smoking.

What are the constituent in Hookah which is causing health risk?

As hookah smoker puffs through pipe, heated charcoal burns and temperature rises from 200-300˚C, then added flavor underneath starts to burn forming smoke. This smoke contains various organic and inorganic compounds which increases the health risks. The major harmful compounds are polycyclic aromatic hydrocarbons (PAH), volatile aldehydes, carbon monoxide, nitric oxide (NO), nicotine etc.

Polycyclic aromatic hydrocarbon (PAH) is present in flavor; also it is added from combustion of coal which is considered as potent carcinogenic compound. One study suggested that smoking hookah for long duration will lead to significant exposure to polycyclic aromatic hydrocarbon (PAH) which increases the risk of various malignancies.

Another major component in hookah smoke is volatile aldehydes which are also found in cigarettes. These include formaldehyde, acetaldehyde, acrolein etc. which is found to be associated with various respiratory issues. Comparing the cigarette and hookah, evidence suggest that hookah smoke contain significantly higher amount of such volatile aldehyde, which is directly associated with increased risk of aldehyde associated respiratory disease.

Carbon monoxide (CO) is another major constituent whose level significantly increases in blood after hookah smoking. Level of CO is directly proportional to source of heat and material of hookah. It is found that level of CO is decreased by 10 fold with electronic source compared to charcoal burn flavor.

Comparing CO concentration in blood among non-smoker, cigarette smoker and hookah smoker, hookah smoker is found to be highest i.e. more 10% followed by cigarette smoker i.e. 6.5% and non-smoker, 1.6%. CO is potent carcinogen;increased level of CO concentration in blood causes various ill effects such as loss of consciousness, shortness of breath and headache when concentration is about 20-30%. Several cases of acute CO poisoning caused by hookah smoking are reported where they found the level of CO bonded with hemoglobin higher than 20%.


The other component which is putting health at risk is Nicotine. Still, many people believe that nicotine is absent in hookah. Increased nicotine level increases the risk of cardiovascular disease.

There are limited researches on hookah smoking as compared to that of cigarette smoking. Medical fraternity too has limited knowledge regarding risks associated with hookah smoking. Research done among medical students in Malaysia showed that significant portion of medical students have wrong concept that hookah does not contain nicotine and CO and they also have no idea on hookah causing respiratory, cardiovascular and dental comorbidities.

A study suggests that 20% of medical student smoke hookah in various part of world such as UK, US, Pakistan. Number of hookah smokers, especially teenagers and young adolescents are increasing day by day all over the world.

As hookah smoking is usually done in group, there are chances of transmission of communicable diseases due to use of common pipe. So spread of infection is another issue related to hookah smoking.

Now let’s check the fact, health risk of hookah smoking vs cigarette smoking

Beginners start smoking hookah by believing that it is less harmful than cigarette smoking and doesn’t have addiction. But current literature suggests that that hookah smoking has more or less similar health issues as that of cigarette smoking.

Hookah smoker absorbs more amount of smoke which ultimately absorbs more toxic substance compared to cigarette smoker. Researches have shown that an hour-long hookah smoking session involves almost 200 puffs, while smoking an average cigarette involves about20 puffs. The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), where as it is 500–600 ml with cigarette.

One can also find herbal hookah flavor in market, although studies on comparison between tobacco-based hookah and “herbal” hookah concluded that smoke from both preparations contain CO and other toxic agents known to increase the risks for smoking-related cancers, heart disease, and lung disease.

Recently there are various new models of electronic hookah in market which have electric power to light the smoke instead of coal; flavor is in liquid form with various tastes some containing nicotine with few being marketed as nicotine free.Labels and advertisements for these products often claim that users can enjoy the same taste without the harmful effects of tobacco but, there are very less information available regarding the side effect of such electronic hookah.

Center for Disease Control (CDC) stated that long term effect of smoking hookah may be at risk for developing the same diseases as cigarette smokers. These include

  • Oral cancer
  • Lung cancer
  • Stomach cancer
  • Cancer of the esophagus
  • Reduced lung function
  • Decreased fertility


Now hookah smoking is already established as postmodern taboo among youths. They find themselves cool smoking hookah in restaurant and bar and sharing photos in the social sites. It is time to erase the misconception of filtered smoke and motivate youth not to smoke hookah. After all with all these information here, it is clear to all smoking hookah, how similar is the effect on health as that of smoking cigarette. So quit smoking and live healthier.

Amrit Jaishi








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