Why waterpipe smoking raises concerns about addiction and other health problems.

The nicknames sound exotic and even whimsical: hookah, shisha, boory, goza, nargile, arghile, hubble bubble. All are terms for the waterpipe, a centuries-old method of smoking that originated in Africa or Asia, but which has become popular in Europe and North America. The trend is raising concerns about its long-term health effects, including the potential for addiction.

Experts estimate that 100 million people worldwide smoke tobacco from waterpipes on a daily basis. Although young people rarely used waterpipes in the 1990s, that has changed. The Global Youth Tobacco Survey, which collected data on more than 90,000 adolescents ages 13 to 15 living in 20 countries in the Eastern Mediterranean region (where hookah smoking is part of the culture), found that 3% of girls and 7% of boys smoked cigarettes, while 10% of girls and 16% of boys used tobacco by other means, mainly the waterpipe.

Preliminary studies in the United States indicate that both high school and college students are using waterpipes. One study in a Midwestern suburb found that 27% of high school students ages 14 to 18 had tried waterpipe smoking at least once. An Internet survey at Johns Hopkins University found that 15% of freshmen had tried waterpipe smoking at least once in the previous month. And a survey of undergraduates at Virginia Commonwealth University found that 48% of those who responded had tried waterpipe smoking at least once; 20% were active users at the time of the survey.

Waterpipe smoking is widely perceived to be less harmful and addictive than smoking cigarettes or other forms of tobacco. Yet many public health officials believe this form of smoking may be just as addictive and perhaps even more harmful than cigarette smoking, in large part because of the way people smoke while using a waterpipe. Concerned about the increase in waterpipe smoking, the World Health Organization (WHO) in 2005 issued a public advisory about its possible health hazards. Since then, additional research has emerged to clarify the risks.

In brief
  • Scientists at the World Health Organization and other experts warn against the unrecognized hazards of waterpipe smoking.

  • Nicotine exposure from waterpipe smoking is lower than in cigarette smoking, but still may be significant enough to cause addiction.

  • Waterpipe smoking raises the risk of other tobacco-related health problems.