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JAMA Pediatrics Patient Page |

Risks of Hookah Smoking FREE

Megan A. Moreno, MD, MSEd, MPH
JAMA Pediatr. 2015;169(2):196. doi:10.1001/jamapediatrics.2014.2110.
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Tobacco use is the leading preventable cause of death and illness worldwide. During the past 45 years, rates of cigarette smoking have decreased in the United States owing to greater understanding of the health risks of smoking, indoor smoking bans, media and advertising restrictions, and increased public awareness. However, the use of alternative forms of tobacco, such as hookah, is rising, threatening these successful efforts.

Hookah is also known as shisha, narghile, hubble-bubble, argileh, goza, and water pipe. It involves the smoking of substances through a water pipe so that the smoke passes through water and is cooled before being inhaled. New forms of electronic hookah smoking are also available. Smoking a hookah is a tradition that dates back at least 400 years to origins in northern Africa and southwest Asia. Smoking a hookah was mostly a tradition observed in Middle Eastern countries. It is now growing in popularity worldwide and is common in Western countries. Hookah is also becoming popular among youth. An estimated 15% to 41% of US college students smoke hookah, 18% of high school seniors have used it in the past year, and nearly half of middle and high school students report being aware of hookah.

Hookah is used to smoke tobacco that is often flavored or sweetened. Hashish, or hash, a form of cannabis that is in a solid or resinous form, and marijuana can also be smoked in hookah. Hookah may be appealing to youth because of the flavored tobacco, the experience of smoking in a group fashion with peers, and the frequent use of hookah alongside alcohol.


Some teens view hookah as a safer alternative to cigarette smoking. However, there are many risks to hookah smoking.

  1. Sharing of hookah pipes can result in the transmission of serious infections including tuberculosis and hepatitis.

  2. In a single 60-minute hookah smoking session, smokers inhale approximately 100 times the volume of smoke compared with smoke inhaled from a single cigarette.

  3. Hookah smokers are also exposed to greater levels of carbon monoxide and carcinogens.

  4. Hookah may lead to higher risks of starting to smoke cigarettes. A study in JAMA Pediatrics found that smoking a water pipe was linked to increased likelihood of smoking cigarettes.


  1. Talk to your children early and often about the risks of using tobacco or nicotine in all forms.

  2. Know the laws in your state about the legal age to use hookah in a public place and counsel your adolescent accordingly.

  3. Yearly physical examinations with your pediatrician are an opportunity to review this information.

  4. If you are concerned that your child is using any of these tobacco or nicotine products, see your pediatrician to discuss how best to evaluate and approach treatment.

  5. Educate your adolescent that there is no evidence that using hookah can help them break a smoking habit and may in fact increase the risk for nicotine addiction.

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For More Information

Centers for Disease Control and Prevention: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/


The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Resource: Centers for Disease Control and Prevention




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