A hookah is a water pipe used to smoke flavored tobacco, known as shisha. It works by heating tobacco with charcoal, drawing the smoke down through a water-filled base to cool it, and then delivering it through a flexible hose to the smoker. Hookahs have been used for centuries across the Middle East and South Asia, and they’ve become increasingly popular in lounges and cafés worldwide, particularly among young adults.
How a Hookah Is Built
A standard hookah has five main parts that work together. The bowl sits at the top and holds the shisha tobacco. Below it, the stem is a metal or glass shaft that connects everything: the bowl, the base, and the hose port. The base is a large glass container filled with water. A flexible hose, usually made of silicone or vinyl, connects to the stem and ends in a mouthpiece. Most hookahs also have a small purge valve that lets you blow stale smoke out of the base.
Hookahs range from tall, ornate traditional models that stand two feet high to small portable versions with plastic bases. The design hasn’t changed much in principle over the centuries. The water base is the defining feature that separates a hookah from other smoking devices.
What’s Inside Shisha Tobacco
The tobacco smoked in a hookah isn’t the same dry, shredded tobacco found in cigarettes. Shisha is a wet, sticky mixture that’s typically 15% to 25% tobacco by weight. The rest is molasses, glycerin, and flavoring. Common flavors include apple, mint, grape, and watermelon, which is a big part of why hookah appeals to younger smokers who might otherwise avoid tobacco products.
When heated, shisha produces a thick, aromatic cloud that’s primarily water vapor, glycerol, and propylene glycol, along with nicotine and whatever byproducts come from the heating process. The tobacco is heated to around 190°C (374°F), which is lower than the burning temperature of a cigarette but still high enough to release nicotine and other compounds.
How the Smoking Process Works
Setting up a hookah takes a few minutes. You pack shisha loosely into the bowl, cover it with perforated foil or a metal screen, and place lit charcoal on top. The charcoal heats the tobacco from above rather than burning it directly, which is why hookah smoke feels smoother and tastes sweeter than cigarette smoke.
When you inhale through the hose, you create suction that pulls hot air down through the tobacco, generating smoke. That smoke travels down the stem and bubbles up through the water in the base. The water cools the smoke and filters out some particulate matter before it reaches the hose and your lungs. A typical session lasts 45 to 60 minutes, which is far longer than smoking a single cigarette.
Health Risks Are Higher Than Most People Think
The water filtration gives many people the impression that hookah is safer than cigarettes. It isn’t. An average hour-long session exposes you to as much smoke as 100 cigarettes. The water cools the smoke and removes some particles, but it doesn’t filter out most of the harmful chemicals.
Carbon monoxide exposure is one of the biggest concerns. A 60-minute hookah session delivers at least 145 milligrams of carbon monoxide, roughly eight times what a single cigarette produces. Five minutes of hookah smoking alone generates four times the carbon monoxide of an entire cigarette. The ratio of carbon monoxide to nicotine in hookah smoke is about 50 to 1, compared to 16 to 1 in cigarettes. That means you’re absorbing disproportionately large amounts of carbon monoxide just to get a modest nicotine hit.
Hookah smoke also contains tar, heavy metals, and the same cancer-causing chemicals found in cigarette smoke. The smooth, flavored quality of the smoke makes it easier to inhale deeply and for long periods, which increases exposure further.
Sharing a Hookah Carries Infection Risks
Hookah is almost always a social activity, and passing the hose around creates a direct route for transmitting infections. Studies of hookah equipment in cafés have found a wide range of bacteria on mouthpieces and inside the pipes, including Staphylococcus aureus, E. coli, Pseudomonas, Streptococcus, and Klebsiella. Some of these were antibiotic-resistant strains.
The risks go beyond bacteria. Researchers have isolated tuberculosis-causing bacteria and Aspergillus fungal spores from water pipes. Hookah sharing has been linked to transmission of Helicobacter pylori (the bacterium behind most stomach ulcers) and hepatitis C. During outbreaks of respiratory viruses like MERS and COVID-19, shared hookah pipes were flagged as a transmission risk. Disposable plastic mouthpiece tips, which many lounges offer, reduce but don’t eliminate the problem since contamination also lives in the hose and water base.
Electronic Hookahs
Electronic hookahs work differently from traditional ones. Instead of charcoal heating tobacco, a battery-powered heating coil vaporizes a flavored e-liquid when you inhale. The experience mimics hookah in terms of flavor and cloud production, but the chemical profile of the vapor is different.
The most notable difference is carbon monoxide. Traditional hookah raises exhaled carbon monoxide levels by an average of nearly 37 parts per million after a session. E-hookah produces essentially no change. That said, e-hookahs still deliver nicotine and other aerosolized chemicals, and long-term health effects are not yet fully understood.
Who Uses Hookah
Hookah smoking is most common in the Middle East, South Asia, parts of Europe, and the United States. In Middle Eastern countries, usage rates among young people range from 2% to over 50% depending on the country and population studied. In the U.S., prevalence among young adults varies widely, with some university studies finding that nearly half of students had tried hookah. About 8% of U.S. high school students reported hookah use in 2018.
Males smoke hookah at higher rates than females across nearly all studies. Usage tends to increase with age through the teen and young adult years, and it’s more common among higher-income groups. The social, café-based nature of hookah smoking, combined with sweet flavors and the perception that it’s less harmful than cigarettes, drives much of its popularity among younger demographics.