Saturday, January 22, 2011

Is Hookah Harmful?

The following is an extract of an article of the same name by Darrell Hulisz, PharmD which was posted on Medscape Pharmacists on 09/03/2010

Numerous publications have documented the harmful effects of hookah.[3-9] For example, a single session of waterpipe smoking (which may last about an hour) may deliver as much tar as an entire pack of cigarettes.[3] As with cigarette smoking, the user inhales nicotine, carbon monoxide, benzene, toluene, arsenic, lead, formaldehyde, and other carcinogens.[3,4] Concern has been raised over a lack of warning labels of waterpipe tobacco products and accessories.[3,4]

Scholarly reviews have found similar adverse health consequences with waterpipe and cigarette smoking.[9] Pregnant women who use waterpipes are more likely than abstainers to give birth to babies with low birthweights, low Apgar scores, and respiratory distress syndrome. Studies have shown that hookah smoking increases the chances of periodontal disease, and may be associated with adverse cardiovascular effects, such as tachycardia and increased blood pressure.[9]

The World Health Organization[10] and the American Lung Association[11] have released advisory statements indicating that many of the long-term adverse consequences of hookah smoking, including increased risk for cancer, mimic those of cigarette smoking.


  1. Dugas E, Tremblay M, Low NC, et al. Water-pipe smoking among North American youths. Pediatrics. 2010;125:1184-1189. Abstract
  2. Aljarrah K, Ababneh ZQ, Al-Delaimy WK. Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tob Induc Dis. 2009;5:16.
  3. Nakkash R, Khalil J. Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories. Tob Control. 2010;19:235-239. Abstract
  4. Chaouachi K. Hookah (shisha, narghile) smoking and environmental tobacco smoke (ETS). A critical review of the relevant literature and the public health consequences. Int J Environ Res Public Health. 2009;6:798-843. Abstract
  5. Maziak W. The waterpipe: time for action. Addiction. 2008;103:1763-1767. Abstract
  6. Barnett TE, Curbow BA, Weitz JR, et al. Water pipe tobacco smoking among middle and high school students. Am J Public Health. 2009;99:2014-2019.
  7. Watad W, Sukhera J, Shushan S, et al. Water pipe smoking: effects, attitudes and directions. J Smoking Cessat. 2009;4:18-25.
  8. Noonan D, Kulbok PA. New tobacco trends: waterpipe (hookah) smoking and implications for healthcare providers. J Am Acad Nurse Pract. 2009;21:258-260. Abstract
  9. The hazards of hookah. Harv Ment Health Lett. 2008;24:1-3.
  10. World Health Organization. Tobacco regulation advisory note: Waterpipe tobacco smoking: health effects, research needs, and recommended action by regulators. 2005. Available at: Accessed July 8, 2010.
  11. American Lung Association. An emerging deadly trend: waterpipe tobacco use. Tobacco policy trend alert. 2007. Available at: Accessed July 8, 2010
  12. Picture credit

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