Smoking Hookah: Harmless or Toxic?

I frequently get asked if smoking hookah is harmless or just as detrimental as smoking cigarettes.  Hookahs have become increasingly popular in the United States and worldwide because of their social implications.  It usually involves sitting together with a group of friends, sharing one mouthpiece, and finding the best hookah bar or hookah party.  Unlike cigarettes, the tobacco used in hookahs comes in various flavors such a strawberry, mango, cappuccino, etc.  This flavor appeal has made it popular and given the impression that it is entirely harmless.  Its easy to see that cigarettes are harmful, but how can something that taste like watermelon be a bad thing?

So here are the facts, directly from the CDC (Centers for Disease Control) website.  They site various studies on their fact sheet (CDC Hookah Fact Sheet) and can be summarized as follows:

• Hookah smokers may absorb higher doses of the toxins found in cigarette smoke.
• A 1-hour long hookah smoking session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.
• Charcoal used to heat the tobacco in a hookah produces high levels of carbon monoxide, metals, and cancer-causing chemicals.
• Hookah smoking can cause the same medical conditions and cancers as cigarette smoke.
• Second-hand smoke from hookahs contains smoke from the hookah and charcoal, posing an even higher risk for nonsmokers.

Before I read up about hookah smoking, I also figured that it couldn't be as harmful as cigarette smoking because hookah is smoked much less frequently than cigarettes.  However, doing the math suggests otherwise.  If smoking hookah for an hour involves inhaling 150 times the smoke from a cigarette and you only smoke it once a month, that is still equivalent to about a 150 cigarettes per month.  Thats about 3 cigarettes per day.  Then I think about the smoke from the charcoal that is used to heat the tobacco.  Would anybody sit and inhale the charcoal smoke from their barbecue for an hour?  Would you also share the same straw as 8 other people in one sitting?  I highly doubt it.  

It looks like Washington has taken note of the facts laid out by the CDC because hookahs are now receiving the same treatment as cigarettes.  There are many proposals to ban hookah bars and limit its use in public establishments.  We know one thing, and that is that hookahs will never become as popular as cigarette smoking.  Afterall, its not often that you see a person driving and smoking their hookah.  Driving while eating a bowl of cereal?  That's for another day.