Cancer Wellness

The truth about hookah and your health

man smoking hookah
Written by Alexis Dobranowski

I’ve noticed some posters inside Toronto-area bars and restaurant washrooms lately with an image of a hookah pipe and the words “Smoking is smoking.”

A hookah is a waterpipe that is used to smoke flavoured tobacoo or non-tobacco products. This year, the province’s Smoke-Free Ontario Act extended to ban hookah smoking in licenced bars and restaurants.

I’ve heard before that smoking hookah is fine for your health and not at all like smoking cigarettes.

To set the record straight and find out how hookah smoking can affect our health, I spoke to Bonnie Bristow, a Sunnybrook radiation therapist and leader on the Smoking Cessation Team.

“Hookah smoke is just as dangerous as cigarette smoke,” Bonnie said. “In a one-hour hookah session, the user is exposed to 100 to 200 times the volume of smoke inhaled from a single cigarette.”

This smoke contains cancer-causing substances just like cigarette smoke, she said. And hookah smoke contains higher levels of arsenic, lead, and nickel than a single cigarette and 72 times more tar. “A one-hour hookah session can expose the smoker to the same amount of tar and nicotine as one pack of cigarettes.”

Hookah uses flavoured tobacco that contains nicotine, which is the addictive substance. Even herbal-based shisha, which doesn’t include tobacco, produces second-hand smoke that is still harmful.

Hookah smoking has been significantly associated with low birth weight, periodontal disease, significant drop in oxygen consumption cancer, respiratory illness and cardiac disease.

A common misconception, Bonnie said, is that the water in the pipe filters the tobacco and makes it safe to smoke.

“It was invented in the 16th century in India by a physician who thought smoke would be filtered through the water and not be harmful,” she explained. “Today we now know that the water cools the smoke but does not filter out the toxins. Water-filtered smoke can damage the heart and lungs. Hookah use is related to a higher level of benzene, a chemical that has been linked to leukemia.”

There is more social acceptance surrounding the hookah, particularly in some parts of the world where teens and even children sometimes smoke at home with their parents, Bonnie said. However, most countries in the Middle East have now banned indoor hookah smoking.

While more than 80 per cent of the people who smokes cigarettes say would like to quit, less than 30 per cent of those who smoke hookah would like to quit. Bonnie said the belief that hookah is safe and not addictive might lead to that number.

“But the nicotine contained is more than in a cigarette causing higher and faster dependence,” she said.

For those who’d like to quit, counselling and motivational interviewing to increase the desire to quit can be helpful.

“Nicotine replacement therapy and other smoking cessation medications can be helpful,” she said. “There are ongoing trials to determine the best method for this. Also, removing yourself from the triggers such as social settings with hookahs in them can help too.”

“People need to realize the false advertising of the safety of hookah compared with cigarette smoking,” Bonnie said. “Both are bad for you.”

About the author

Alexis Dobranowski

Alexis Dobranowski is a Communications Advisor at Sunnybrook.