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Hookah smoking has become a popular social activity for many college and university students and is commonly seen as a cheaper and safer alternative to cigarettes. The truth is, hookah smoking has some of the same serious health effects as smoking cigarettes including lung cancer, respiratory illness, periodontal disease, cardiovascular disease and nicotine dependence! 1,2

Hookah is smoked in a waterpipe and is typically a mixture of tobacco, molasses, honey and/or fruit flavourings. Many young adults are unaware that hookah smoking is just as, or even more dangerous than smoking cigarettes.

Whether you are using tobacco, flavoured tobacco or marijuana, here’s the 411 on hookah…

Why is it a BIG deal?

Nicotine,3 carcinogens and other toxins including carbon monoxide and tar remain present in hookah smoke.4,5 Add to that the fact that higher levels of arsenic (rat poison), chromium (dye and paints) and lead (batteries) are found in hookah smoke compared to smoke from a cigarette (gross!).6

Sure some of the nicotine and tar is absorbed from the smoke as it passes through the water, but hookah users often inhale deeper and take more puffs to get the desired ‘buzz’. Deeper, more frequent inhalation means that a typical 20-80 minute hookah session is equivalent to smoking 100 cigarettes, exposes you to up to 200 times the volume of smoke compared to a single cigarette and can triple your nicotine exposure!7

Hookah smoke may taste sweeter and feel less irritating to your throat, but it’s still doing damage. The fruit flavourings are often added to hookah tobacco to appeal to young people and to mask the toxins. So even an occasional hookah session can lead to increased blood pressure and an increased heart rate, putting your health at risk.1,2

As if that isn’t enough; the wood, cinder, charcoal and other commonly used heat sources used to burn the tobacco give off high levels of carbon monoxide, metals and cancer-causing chemicals when burned (so why risk it?).7

Hookah is not a harmless smoking alternative.

Want help quitting smoking?

Talk to your doctor, nurse or pharmacist, or visit the Leave The Pack Behind Team on your campus.



1 Akl, E. A., Gaddam, S., Gunukula, S. K., Honeine, R., Jaoude, P. A. & Irani, J. (2010). The effects of waterpipe tobacco smoking on health outcomes: A systematic review.International Journal of Epidemiology, 39, 834-857.

2 Cobb, C., Ward, K. D., Maziak, W., Shihadeh, A. & Eissenberg, T. (2010). Waterpipe tobacco smoking: An emerging health crisis in the United States. American Journal of Health Behavior, 34(3), 275-285.

3 Shihadeh, A. A. (2003). Investigation of mainstream smoke aerosol of the argileh water pipe. Food & Chemical Toxicology, 41(1), 143.

4 Shihadeh, A., & Saleh, R. (2005). Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food & Chemical Toxicology, 43(5), 655-661.

5 El-Nachef, W., & Hammond, S. (2008). Exhaled carbon monoxide with waterpipe use in US students. JAMA: Journal of the American Medical Association, 299(1), 36-38.

6 Maziak, W., Ward, K. D., & Eissenberg, T. (2007). Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews, 4. Art. No.: CD005549.

7 World Health Organization. WHO Advisory Note: Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. WHO 2005

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