The Core Ingredients: Shisha and Charcoal
Shisha, or ma'assel in Arabic, is the most common substance smoked in a hookah. It is a moist, often sticky, blend of tobacco, sweeteners like molasses or honey, and flavorings. This mixture is placed in the hookah's bowl and heated by burning charcoal, which sits on top of perforated foil. The charcoal is a critical component, and its combustion is a source of toxic chemicals like carbon monoxide, heavy metals, and other carcinogens. The smoke produced is cooled as it travels through the water chamber and is then inhaled by the user through a hose.
Flavored Tobacco (Shisha)
Flavored tobacco is the most prevalent form of shisha, enjoyed in many cultures as a social tradition. The flavors mask the harshness of the smoke, making it particularly appealing to younger users. Common flavors include fruity options like apple and watermelon, as well as exotic choices like mint, licorice, and cappuccino. This flavored tobacco contains nicotine, a highly addictive substance, and exposes users to tar and heavy metals.
Herbal Shisha
For those who wish to avoid nicotine, herbal shisha is an option. It is typically made from a blend of herbs, tea leaves, or dried fruits mixed with molasses, but without tobacco. While marketed as a safer alternative, herbal shisha is not without risks. The smoke from herbal preparations still contains carbon monoxide and other toxic agents when heated by charcoal. It is a misperception that avoiding tobacco makes the practice harmless.
Other Substances
Beyond traditional and herbal shisha, hookahs have also been used to smoke other substances. Studies have noted the use of cannabis, hashish, and even opium, though these uses vary by region and legality. However, the health risks of using these substances in a hookah are significant and should not be underestimated.
Health Risks: Dispelling Misconceptions
Many people mistakenly believe that hookah smoking is a safer alternative to cigarettes because the smoke passes through water. The water does cool the smoke, making it less irritating, but this does not effectively filter out the toxins. As a result, hookah smoke contains many of the same harmful chemicals as cigarette smoke, including nicotine, tar, and carbon monoxide. Due to the typical duration of a hookah session (often 45 minutes to an hour), users may inhale a much larger volume of smoke compared to a single cigarette, leading to greater exposure to these toxic substances.
Comparison Table: Hookah vs. Cigarettes
| Feature | Hookah Smoking | Cigarette Smoking |
|---|---|---|
| Nicotine Content | A single session can deliver nicotine levels equivalent to several cigarettes. | A single cigarette delivers 1 mg of nicotine absorbed. |
| Smoke Volume | A single session can result in inhaling 100-200 times more smoke. | Inhales 500–600 ml of smoke per cigarette. |
| Carbon Monoxide | Up to 9 times more carbon monoxide in a single session. | Standard levels per cigarette. |
| Heat Source | Burning charcoal, which produces its own set of toxins. | Burning tobacco and paper. |
| Secondhand Smoke | Contains harmful chemicals from both the shisha and charcoal. | Also contains harmful chemicals. |
The Problem of Carbon Monoxide
The burning charcoal used in hookahs is a significant source of carbon monoxide (CO), a colorless, odorless, and poisonous gas. The inhalation of CO can reduce the amount of oxygen-carrying red blood cells in the bloodstream, leading to symptoms such as headache, nausea, and dizziness, a condition sometimes referred to as "hookah sickness". In poorly ventilated spaces, the risk of carbon monoxide poisoning is even higher. This is a particular concern in indoor hookah lounges where many devices may be used simultaneously.
Other Dangers of Hookah Use
Besides the toxins in the smoke, there are other health risks associated with hookah use. These include the potential for spreading infectious diseases, such as oral herpes, tuberculosis, or hepatitis, when sharing mouthpieces. While personal, disposable mouthpieces are available, they do not completely eliminate the risk. Furthermore, research has linked hookah use to various cancers, heart disease, and lung conditions, similar to the risks associated with cigarette smoking.
Conclusion: Making an Informed Choice
Understanding what is smoked in hookah is the first step toward making an informed decision about its use. Whether it's traditional tobacco shisha or an herbal alternative, the process involves burning materials that release a host of toxic chemicals, including addictive nicotine and poisonous carbon monoxide. The cooling effect of the water offers a false sense of security, and the longer duration of smoking sessions increases overall exposure to harmful substances. Acknowledging the health risks is crucial for anyone considering hookah use.
For more information on the dangers of tobacco products, visit the CDC's Smoking and Tobacco Use website.
