Oct 24, 2011: What is a hookah?

A hookah is an apparatus that was developed somewhere between India and Persia sometime in the 16th century.  It was developed as a way to heat tobacco and vaporize its’ constituents, filter the constituents through water, and then inhale the vapors.  It was thought that the water would purify the vapors from harmful substances and cool down the vapors.

As can be seen from the diagram, charcoal is burnt, above a screen.   The tobacco in the bowl is never burnt.  Vapors (from tobacco) and smoke from the charcoal then pass down through a long stem (body) into a water bowl.  One or more hoses or pipes are connected to the airspace above the water jar and smoke/vapors are inhaled.

Of course, many different substances can be placed in the bowl.  Opium, cannabis, tobacco, and other substances have all been tried.  A typical combination is flavored tobaccos, with or without a fruit, molasses and other flavoring essences.

People of all cultures are concerned about the growing popularity and introduction into restaurants and coffee shops.  One public health official mentioned that the hookah bypasses the smoking ban in some states and localities.  Since the tobacco is not burnt, users state that there is no smoking.  Some states are revising their statutes to ban tobacco use in hookahs.  Regardless, there is a burning of charcoal, and therefore smoke is created.

There has been little data collected on the health effects of “smoking” with a hookah.  Studies are conflicting. Tar content has not been determined and certainly would vary depending on the tobacco mixture being used.  Nicotine levels in heavy hookah smokers reach values as high as those in cigarette smokers.  Carbon monoxide (CO) levels are exceptionally high due to the combustion of charcoal and inhalation of its smoke.   Ambient CO levels of 10 to 60 ppm have been reported.  Newer, quick-lighting charcoals are also coated with substances to make them light quicker (nitrates, sulfur, etc.), and the extent of exposure and potential adverse health consequences from inhaling smoke from these charcoals is unknown.


This question prepared by: John G. Benitez, MD, MPH   Medical Toxicologist


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Donna Seger, MD

Medical Director

Tennessee Poison Center

Website: www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222