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Smoking the Hookah

Jan. 1, 2008
Harmless High or Harmful Habit?
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Harmless High or Harmful Habit?

by Kelli Swanson Jaecks, MA, RDH

It all started innocently enough. My daughter, 18, wanted to purchase a hookah after traveling to South Africa and Brazil. I thought it would be an exotic and fun thing to do, a new activity to keep my daughter’s friends hanging out at our home rather than somewhere else. It seemed a benign new trend, much safer than cigarette smoking. Until then, my only exposure to the hookah was the Caterpillar in Alice in Wonderland, sitting on the mushroom smoking his water pipe. However, I was never quite sure just what he was smoking in it! After some initial questions about what one might smoke in the hookah, we went down to the local “bad habits” shop and purchased a product called shisha. Thus began many nights where my daughter and her friends would sit around the table, pass the pipe, relax, and laugh together.

Smoking the hookah is an ancient social ritual, originating in either Turkey or India, depending on which Web site you search. This smoking tradition began long before American cigarette companies began promoting their wares on the worldwide market. Throughout the Middle East there are numerous cafes where guests can sit or lie on long cushions and enjoy spending time destressing and talking with friends. Hookahs are exotic and beautiful pieces of artwork, often featuring unique metal or glass scrollwork and multicolored hoses and bowls.

New Trend

Hookah smoking is a relatively new social phenomenon among older teens and college-age adults in America. Hookah bars are popping up in many college towns across the nation, presenting a place for people to hang out and relax with friends, minus the bump-n-grind music and alcohol. Many users see hookah smoking as an almost virtuous, clean alternative to the relatively dirty habit of smoking. Hookah bars make it easy to imbibe, as the hookah apparatus, flavored shisha, and charcoal are all provided for a relatively small fee.

What Is the Hookah?

The hookah, or water pipe, usually consists of four parts: base, bowl, pipe, and hose. They come in varying sizes and colors and can have either a single or multiple hose hook-up.

  • Base: This is the smoke chamber, which is partially filled with water.
  • Bowl: The bowl holds both the shisha and the heating source, usually charcoal.
  • Pipe: An internal pipe dips into the water, connecting the bowl and base.
  • Hose: A tube connects to the pipe and the air inside the base, which allows the user to inhale the smoke.
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To smoke a hookah, the user inhales through the mouthpiece that is connected to the tubing. This creates a pressure difference that forces the air past the charcoal or heating source and heats up the shisha, which creates smoke. The smoke is then cooled as it passes through the water chamber. Thus, the hookah operates with indirect heat and water filtration.

What Is Shisha?

Shisha is a combination of tobacco, a sweetener, and fruit. Fresh tobacco leaves are either ground up and mixed with dried fruit pulp or soaked in fruit shavings to infuse the taste. Molasses, sugar, or honeys are used to sweeten the mixture. Shisha comes in many aromatic flavors including apple, apricot, mint, cherry, grape, lime, and mango. The taste is sweet and smooth, creating a pleasing sensation in the mouth and throat while smoking.

Harmless High or Harmful Habit?

Hookah use is associated with relaxation and a peaceful social setting. One is not in a hurry when smoking the hookah, as part of the ritual is passing the pipe to others, taking turns, and enjoying the camaraderie. Many believe that the tobacco is less toxic and less nicotine is consumed because it passes through water before being inhaled. Unlike cigarette smoking, using the hookah does not stain your teeth or leave you smelling like an ashtray.

An anonymous quote from states, “Smoking shisha is nothing like smoking a cigarette. Cigarettes are for nervous people, competitive people, people on the run. When you smoke shisha, you have time to think. It teaches you patience and tolerance, and gives you an appreciation of good company. Shisha smokers have a much more balanced approach to life than cigarette smokers.”

While this hookah smoking attitude sounds beneficial and rewarding (who doesn’t want to be balanced, patient, and tolerant?), there is another side to this phenomenon. The biggest myth surrounding the hookah is that it is safer than smoking cigarettes. It is true that filtering the tobacco through water removes some of the dangerous toxins. However, according to a World Health Organization Advisory, even after passing through water, the tobacco smoke still contains high levels of carcinogens, including carbon monoxide. The smoke itself transports considerable levels of nicotine — nearly three times that of smoking cigarettes, increasing the risk of addiction. Typically, a hookah session lasts 30 minutes to an hour. This amount of time exposes the user to 100 to 200 times the smoke volume inhaled by a single cigarette.

The ritual of sharing the mouthpiece while smoking increases the risk of passing infectious diseases such as the herpes virus and oral bacteria or respiratory infections. Additionally, the tobacco composition of shisha products is not standardized, so one cannot be clear on the nicotine content being consumed. When looking at hookah smoking in relation to periodontal disease, there is a five-fold increase in relative risk as compared to nonsmokers. No tobacco is risk-free; therefore, hookah smokers are still in danger of addiction, oral and throat and lung cancers, and systemic complications usually associated with tobacco use.

After researching the risks involved in smoking the hookah, I realize this is not another benign new trend, but a potentially dangerous activity. This form of tobacco inhaling is proving to be more harmful than cigarette smoking and carries similar health risks. Unfortunately, it is a relaxing, communal social activity, shrouded by myths of safety. For young adults already in that developmental place of believing no harm will befall them, the message of risk goes largely unheard.

Today, my daughter’s hookahs are part of her bedroom decor, and only occasionally put into use. Sometimes having more knowledge means changing habits and behaviors. Drat! Life was simpler when my daughter and I were both blindly unaware of the dangers of the beautiful hookah!

About the Author

Kelli Swanson Jaecks, RDH, MA holds a Master’s degree from Oregon State University in Communication and Adult Education, where she taught Leadership and Public Speaking. Kelli is an active leader in the ADHA, serving at the local, state and national levels. She provides healthcare education through her company, Verbal Impact, LLC. She can be contacted though her website at


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Pros of Hookah Smoking

  • No staining of the teeth
  • No smelling like a cigarette
  • Social fun with no hangover
  • Dangerous tar is filtered out through water
  • Aids in relaxation and stress relief

Cons of Hookah Smoking

  • Increased exposure to smoke (volume)
  • Risks of infectious disease due to pipe sharing
  • Composition of shisha not standardized
  • Nicotine and carcinogens are inhaled
  • Increased risk of periodontal disease