The hookah, also known as the shisha, narghileh, or water pipe, dates back centuries in the Middle East, North Africa, and South Asia, but its popularity has only recently begun to take hold in the west. Young adults especially are taking to the habit, and many are under the misconception that it’s safe.

Nearly a third of young adults believe that smoking hookah is less dangerous than smoking cigarettes. But the belief isn’t limited to them — nearly 19 percent of those between the ages of 25 and 34 agree.

Social acceptance and a coolness factor could be to blame — cigarettes are frowned upon and there is no such thing as a cigarette bar, but you’ve probably seen or been to a number of hookah lounges.

But the idea that they are safer than cigarettes, or safe at all, is seriously flawed.

Hookahs Are Dangerous

Compared with a single cigarette, smoking hookah for “one session” delivers 25 times the tar, 125 times the smoke, 2.5 times the nicotine, and 10 times the carbon monoxide, according to research from the University of Pittsburgh School of Medicine.

And hookahs aren’t only dangerous for the people partaking. Even more recent research has confirmed that secondhand hookah smoke is damaging as well. Employees at hookah bars are exposed to “elevated concentrations of indoor air pollutants,” which may cause “adverse health effects,” concluded the authors.

It’s important to note, however, that comparing cigarettes to hookahs is not an apple-to-apple comparison. Cigarette smokers generally smoke at least several cigarettes throughout the day, whereas someone who likes to smoke hookah, may only do so on the weekends or a few times a week.

Still, the effects can be damaging.

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An hour-long hookah “session” involves roughly 200 puffs, according to the Centers for Disease Control and Prevention, and one such session delivers 90,000 milliliters of smoke. Compare that to the average cigarette, which lasts about 20 puffs and delivers up to 600 milliliters of smoke.

It isn’t clear just how much hookah smoking you’d have to do to be at the same risk level as a cigarette smoker, largely because there are so many variables — for example, the number of cigarettes a smoker lights up every day varies widely, and toxin exposure depends on inhalation depth.

But it isn’t a stretch to suggest that occasional hookah smoking could lead to cigarette smoking, as cigarettes are more convenient, more easily accessible, and relatively cheaper. A study involving 1,671 Arab-American teenagers in the Midwest found that smoking hookah during early teen years was a strong predictor for future cigarette use.

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Long-Term Risks of Smoking

Whether you’re smoking a cigarette or a hookah, the risks are similar. The water of a hookah pipe does not filter the toxins out. Like cigarette smoking, over time, you could be putting yourself at a greater risk of:

Many universities have begun raising awareness of these dangers in an effort to correct the many misconceptions surrounding hookahs, and students can help with this endeavor.

There is a pretty good chance that the young adults huddled around a hookah lack clarity on what exactly they’re doing to their bodies. They’re old enough to make their own decisions, but ensuring that they’re educated to make an informed decision about hookah smoking is the responsibility of everyone.

The Takeaway

When it comes down to comparing hookahs and cigarettes, it all depends on how much you smoke, and how deeply you inhale. But while hookah smoke comes in many aromatic flavors, the evidence shows that one smoke session delivers more tar, nicotine, and carbon monoxide than a handful of cigarettes.