Dear Dr Peg,

Some friends introduced me to hookah smoking a few months ago, and we've been getting together to smoke a couple of times a week. It's fun to hang out, and the smoke smells nice. I know cigarette smoking is dangerous, so I've never done it, but hookah smoking is safe, right? Doesn't the water filter out all the bad stuff from the smoke? And isn't hookah tobacco healthier than the tobacco in cigarettes?

-Hooked on hookah

Dear Hooked,

I'm sorry to disappoint you, but you are wrong on all counts. As usual, I'll start with the basics.

What is a hookah? A hookah is a water pipe. Other names for hookah include nargile, sheesha, okka, kalyan and hubbly-bubbly. It is a device for smoking a flavored tobacco mixture.

The mixture is placed in a small bowl at the top of the device. From the bowl, a hollow pipe leads straight down into a chamber called the base, which is partly filled with water. The pipe extends below the surface of the water. From the side of the base, above the water line, a hose leads to a mouthpiece.

To smoke a hookah, you light a piece of charcoal, place it on top of the tobacco mixture, put the mouthpiece in your mouth, and suck hard. The smoke goes down the pipe, bubbles up through the water into the air at the top of the base chamber, up the hose and into your lungs. Hookahs can be quite ornate and beautiful, and can cost hundreds of dollars.

Hookahs have been around for centuries, probably originating in the Middle East or India, where it is a common social custom for men to gather, smoking and chatting for hours.

In the United States the hookah has become very popular in recent years, especially with young people of both sexes. Hookah smoking is promoted as an aesthetic social activity, touting the sweet smell of the tobacco and the bubbling sound of the water as pleasant, relaxing influences. A typical hookah session lasts two or three hours and involves several friends smoking from the same pipe.

Commercial hookah bars have sprung up all over the country. There are at least five here in Albuquerque, where you can go just to smoke.

What does one smoke in a hookah? Typically, the mixture is one-third tobacco and two-thirds flavoring. The flavorings may include molasses, dried fruit, honey and other ingredients. The resulting aroma has been likened to a baking apple pie by one hookah-selling website. Sounds pretty benign, doesn't it?

It isn't. Like many fads, it has been hyped with false claims in order to increase its popularity and profits.

What are the dangers of hookah? Tobacco is tobacco, no matter how you get it, and tobacco smoke is hazardous. In fact, hookah smokers get more smoke than cigarette smokers, and here's why. Cigarette smoke is uncomfortably hot if you inhale it deeply. Hookah smoke has been cooled by its passage through the water. In addition, you have to inhale hard to pull the smoke through the hookah. The result is cooler smoke going farther into your lungs. Add to that the duration of a typical hookah session, and the result is huge volumes of smoke being deposited into your lungs.

A study done by the World Health Organization showed that one hookah session of a mere few hours can deliver as much smoke into your lungs as 100 cigarettes. Five packs! It's a rare cigarette smoker who gets that much in one day.

Tobacco smoke contains nicotine, a highly addictive substance that is not filtered out by the water in a hookah. In addition to nicotine, you are pulling other dangerous substances through that hose. Tar is not water-soluble, so it comes through the pipe -- the same amount in one session as in a whole pack of cigarettes. Tar causes cancer.

Other carcinogens (cancer-causing agents) also make it through, like heavy metals and carbon monoxide. In fact, because of the charcoal which is burned on top of the tobacco mixture, hookah smoke has a higher level of heavy metals and carbon monoxide than cigarette smoke. Hookah smokers risk cancer of the lung, lip, tongue and bladder.

As you doubtless know by now, tobacco smoke affects the cardiovascular system, causing increased blood pressure and heart rate, and increasing the risk of heart attack and stroke. Smoke of any kind is also a lung irritant, which can trigger asthma and allergies. And, of course, the bad effects of any kind of second-hand smoke are well-studied.

In addition to the tobacco, there are also the smoke flavorings to consider. Unfortunately, nobody has yet studied the effects of inhaling dried apricots, but I would bet they aren't all good.

Finally, think about sharing the mouthpiece. It's like kissing everyone in the group. Hookah pipes can spread herpes, flu, strep throat, a cold, even tuberculosis. And wiping it on your sleeve doesn't sterilize it.

I'm a big believer in social gatherings and relaxation time. By all means, gather away, and relax like crazy. But if you are concerned with the health of your young lungs, think about gathering around a cup of coffee, or relaxing with exercise and a bath instead of a water pipe. And if you are already addicted to any form of tobacco, I strongly urge you to quit. Student Health and Counseling has people and programs to help you. Call 277-3136.

Dr. Peggy Spencer is a physician at Student Health and Counseling and UNM Center for Life. She is also co-author of the book "50 Ways to Leave Your 40s." Email your questions to her at All questions will be considered, and questioners will remain anonymous.