Harvard Mental Health Letter

The hazards of hookah

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.

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