Graphic by Cara Ocampo

Clearing up the Haze: Hookah's Effects on Health

by Victoria Chang

20-year-old Cassie is laying back on the exam chair having her teeth examined by her general dentist, itching to find out if the boy she is interested in has texted her back yet. Her phone is resting on her lap, beneath her clasped hands.

Her dentist suddenly interrupts her thoughts, asking, “Cassie, do you smoke?” She immediately laughs and replies, “No.” His eyebrows furrow and he stares down at her with a hint of skepticism in his eyes. She stares back at him. But I really don’t smoke! Wait…I have smoked hookah a few times. All my friends do it. But, that’s not smoking. That’s not the same at all. The water filters out all the bad stuff and it’s completely safe. It doesn’t count and it’s not harmful...right?


Hookahs are water pipes, varying in shape and size, which are used to smoke specially made tobacco that burns in a small bowl. The resulting smoke travels through a water chamber, enters a rubber tube and eventually reaches the mouthpiece. The water pipe was first invented by a 16th century physician in India, who claimed that the tobacco smoke’s passing through water would eliminate the harmful effects of tobacco use.

Hookah smoking originated in the Middle East over 500 years ago. Today, over 100 million people engage in hookah smoking worldwide. In the United States, the target group for most hookah bars and cafes is between the ages of 18-24. From this selection, it is estimated that about one in five college students has tried hookah, with a majority of them under the assumption that it is harmless. However, it turns out that this assumption may likely be false.

Research has proven that using water to filter out harmful ingredients does not work and it, in fact, fails to protect a smoker from the dangerous side effects of smoking hookah. The water serves only to cool the smoke, enabling the user to inhale a greater amount of smoke over a longer period of time. As a result, the risk of oral, throat and lung cancers may actually be even greater in those who smoke hookah compared to those who smoke cigarettes. The highly concentrated tobacco juices irritate the oral cavity, causing the tissue around the teeth and in the gums to become inflamed and susceptible to infection.

Additionally, not only is hookah made up of the same ingredients found in cigarettes, such as carbon monoxide and tar, but it also contains two to four percent nicotine compared to one to three percent in cigarettes. Hookah smokers are also at a five times greater risk of developing periodontal disease than nonsmokers, a risk even greater than cigarette smokers who have a 3.8 times higher chance than nonsmokers.

An hour-long hookah smoking session involves approximately 200 puffs, while smoking a single cigarette involves about only 20 puffs. Translated into measurable volume, the resulting amount of smoke inhaled for a hookah session is about 90,000 mL versus 500-600 mL when smoking a cigarette. As evidenced, smoking hookah for an hour can expose one to an amount of tar and nicotine comparable to an entire pack of cigarettes, thus greatly increasing the risk of addiction and disease. Researchers have further found that just one evening of smoking hookah can cause the user’s nicotine levels in the urine to jump 70 fold and significantly raise the carbon monoxide levels in their bloodstream.

In terms of oral health, the effects of hookah smoking are grossly negative. A side effect of smoking in general is halitosis, or bad breath. Smoking hookah also causes dry mouth by decreasing the production of saliva, which functions to keep one’s mouth healthy and less prone to cavities. As smoking is also associated with oral squamous cell carcinoma, oral leukoplakia, periodontal diseases, tooth loss, tooth decay, gingival recession and smoker’s leukoplakia, this places hookah users at a significantly higher risk for developing these diseases. Additionally, the toxic agents found in hookah smoke are also associated with heart disease, reduced lung function and decreased fertility. During a group hookah smoking session, the mouthpiece is shared between the users as well, which increases the risk of passing around infectious diseases such as respiratory infections, tuberculosis, herpes virus, influenza, hepatitis A and hepatitis B.

From all this research, there is significant evidence that poor Cassie may not be well aware of the adverse side effects of smoking hookah. However, she is not alone. Many young people are oblivious to the dangers associated with hookah smoking, especially because it is so readily available.

Hookah smoking is growing rapidly in popularity worldwide for this very reason, since many users (like Cassie) believe that hookah is either less harmful than cigarette smoking or not harmful at all. As cigarette use declines among today’s young adult population, hookah smoking is becoming increasingly common, being viewed as a clean alternative. Older teens and college-age adults are surrounded by easily accessible hookah bars, cafes and tobacco stores. The hookah bars especially present a social environment for young adults to hang out and relax with friends. A common hookah apparatus will often be used for a whole group, bringing everyone into the social setting together. As an interesting point, hookah also comes in different flavors, ranging from chocolate to mint, giving off a smooth, savory taste in the mouth and throat. The option of smoking hookah at home is likewise present, as it is cheap to purchase the hookah apparatus and water pipe, for as low as $9.99. There are even new forms of hookah smoking in the form of battery-powered products, making the potentially dangerous hobby effortlessly attainable for today’s young adult population.

In terms of establishments that offer hookah smoking, these locations are fairly unregulated, making them very accessible environments for the youth to engage in the activity. Additionally, many statewide smoke-free regulations that are currently in place do not address hookah smoking or impose any regulations. If more people were aware of the health risks and harmful short and long-term effects, perhaps the growth in today’s hookah smoking market would decline and eventually cease.

So how is the University of Pittsburgh playing a role in discouraging young adults from smoking? Recently, the President of the Student Health Advisory Board, Ethan Baker, and the Student Health Services Director, Marian Vanek, started a petition to ban tobacco use on campus. Currently, the university prohibits smoking and chewing tobacco inside all university owned and leased facilities/vehicles as well as within 15 feet of the main entrances of buildings. However, this rule is not strictly enforced or followed by students and staff of the university. For example, numerous students can often be found smoking on Towers Patio or gathered around a hookah apparatus.

The goal of this petition is to collect 10,000 signatures and make the university completely smoke-free, by enforcing a form of penalty. The plan is currently being discussed between the Director of Student Health and the Student Health Advisory Board, and the petition is gaining signatures from various organizations, from bigger groups such as the Student Government Board to smaller ones such as Students as Healers. Perhaps with a complete university smoking ban in place, there will be a positive impact on the health and lives of current and future Panthers to come.