HookahA hookah is a waterpipe that is used to smoke tobacco, mostly containing flavors. The popularity of hookah (also known as “waterpipe” or “shisha”) in the United States has increased over the past decade. There are misconceptions about hookah. For example, may hookah smokers think the practice is less harmful than cigarette smoking.1


In 2013, 42.1 percent of high school students in Florida said that they believed that hookah smoking was less harmful compared to cigarette smoking.2 But the fact is hookah smoking carries many of the same health risks as cigarettes.3 Hookah smokers may be at higher risk for oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility.4,5 Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.3,5

Because of the way a hookah is used, smokers may even absorb more of the toxic substances also found in cigarette smoke than cigarette smokers do.3 The amount of smoke inhaled during a typical hookah session is more than 100 times greater than the amount inhaled when smoking a cigarette.5 The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.3,5 Even after it has passed through water, the smoke from a hookah has high levels of these toxic agents.5

Experimentation with hookah among Florida’s young people has increased in recent years. Between 2012 and 2016, there was a 42.2 percent increase in high school students who reported having ever tried hookah, from 16.6 percent to 23.6 percent.6


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1 Aljarrah K, Ababneh Z, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacco Induced Diseases, 2009, 5:16.

2 Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2014.

3 American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. [PDF–222 KB] Washington: American Lung Association, 2007 [accessed 2016 Nov 21].

4 Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review. International Journal of Epidemiology 2010;39:834–57 [accessed 2016 Nov 21].

5 Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. American Journal of Health Behavior 2010;34(3):275–85 [accessed 2016 Nov 21].

6 Florida Youth Tobacco Survey (FYTS), Florida Department of Health, Bureau of Epidemiology, 2016.