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American Heart Association

Hooked on hookah? Warning issued that inhaling its toxic chemicals may harm the heart

The American Heart Association says there is a misconception that hookah smoking is less harmful than cigarettes.

SMOKING TOBACCO IN hookahs results in inhaling toxic chemicals, often at levels exceeding cigarette smoke, that may harm the heart and blood vessels, the American Heart Association has warned.

Waterpipes – which go by multiple names such as hookah, shisha, goza and narghile – usually consist of a head or bowl that holds tobacco, a body, water base and hose that ends with a mouthpiece. 

Hookah tobacco is usually a combination of dried fruit, flavoured tobacco and substances to keep the tobacco moist. Burning charcoal is placed on top of the tobacco-filled bowl. 

Smoking sessions usually last for up to 30 minutes or more, during which users can inhale litres of smoke. 

“Although direct comparisons between hookahs and cigarettes have some limitations, a single session of hookah use typically results in greater exposure to carbon monoxide than a single cigarette. Even short-term exposure to carbon monoxide in hookahs is toxic and can interfere with exercise capacity,” the AHA said in a scientific statement, published in its journal, Circulation.

Aruni Bhatnagar, PhD, chair of the writing group for the statement from the AHA said there is a misconception that hookah smoking is less harmful than cigarettes because the tobacco is filtered through water, a claim he says has no scientific evidence. 

However, there is evidence to suggest that hookah smoking is addictive and can lead to the use of other tobacco products such as cigarettes.

“Hookah smoke contains harmful substances and the American Heart Association strongly recommends avoiding the use of tobacco in any form,” Bhatnagar said.

He added that there is growing evidence that hookah tobacco smoking acutely impacts heart rate and blood pressure while chronic use is associated with increased coronary artery disease risk.


In the US, recent surveys have shown that people 18-24 years of age accounted for 55% of hookah smokers nationwide.

The American Heart Foundation has noted that the spread of hookah smoking among young people is promoted by sweetened and flavoured hookah tobacco. Unlike cigarette tobacco, hookah tobacco, often colourfully packaged, can be sold in candy and fruit flavours, which appeal to younger audiences. 

Globally, hookah usage is spreading among younger people. Data from a survey of seven Middle Eastern countries showed that the rates of hookah smoking ranged from 9% to 15%. 

Hookah is available in a number of cafes and lounges around Ireland, however, little research has been carried out on its popularity here. 

Because most people smoke hookah in lounges and cafes it is perceived as a social activity and less habit-forming, AHA research found. 

The AHA is concerned that there is a misconception among young hookah users that this method of tobacco use is harmless.

In contrast, many youths are more aware of the risks associated with cigarette smoking and avoid that method of tobacco use because of those risks. Research is needed to effectively communicate the negative health impact of hookah smoking.

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