Last week World No Tobacco Day was celebrated and all eyes were focused on tobacco consumption. traditional tobacco and the increase in the use of electronic cigarettes. But There is another way of consuming nicotine and other substances that normally go unnoticed, but that pose a real risk to the health, especially the younger ones: the hookahs.


Because as the Dr. Ana Sánchez Prieto president of the smoking prevention committee of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC):

“The rapid popularization of consumption of hookahs, especially among the young population, has been, among other reasonscaused by the incorrect perception that they pose less damage to health than conventional tobacco”and nothing could be further from reality.

Almost 40% of adolescents smoke hookahs

The concern of otorhinolaryngologists is justified since according to the data managed by the SEORL-CCC:


  • 40% of the teenagers Spaniards between 14 and 18 years old have smoked hookah (also called hooka, shisha, water pipe or narguile) in the last month.

  • And what is more worrying, 9.5% of 12 and 13 year old students acknowledge having used water pipes at some point in their lives (7% in the last year).

And as Dr. Sánchez Prieto adds:

“This increase in popularity in certain social contexts is caused by the availability of flavors, their appearance on the internet and social networks and the lack of regulation in this regard. Its acceptance has increased among young people due to mistaken idea of ​​absence of harmfulness and the belief that it has less addictive power”,

One hour of hookah smoking is equivalent to 200 times the volume of smoke from a cigarette.

To dismantle this belief of the harmlessness of hookahs, specialists provide several data.

  • The first of them is that The smoke inhaled during a one-hour smoking session is about 200 times the volume of a single cigarette.

  • Besides, In a single session we can achieve between 2 and 10 times the amount of nicotine, carbon monoxide and tar than with a cigarette.

But there is more.


  • when you smoke hookah also exceeds the amount of heavy metals, polycyclic aromatic hydrocarbons and semivolatile furans compared to cigarettes, warns a study published in Tobacco induced diseases.

Because we must not forget that, as this specialist explains:

  1. “In pipes, the tobacco is heated by a charcoal.

  2. When the user draws from the mouthpiece, the resulting smoke bubbles through the water.

  3. This makes many users believe that the water filters out the toxic agents in tobacco.

  4. This combination with water results in a Wetter, smoother smoke that is less irritating initially compared to a conventional cigarette.

  5. This, added to the fact that the inhalation resistance in the hookah is lower, encourages making a deeper and longer inhalation when smoking with shisha.

  6. Besides, allows sessions to be longer “since humidity reduces initial irritation.”

Head and neck cancer risk factor

The specialists provide one more piece of information that supports the toxicity of hookahs and that is that Some studies even go so far as to suggest that consuming these devices could be more powerful than smoking conventional cigarettes.

  • Has been shown affectation of the oral cavity and lung function. “In the oral cavity, cellular alterations have been described that indicate premalignant and malignant lesions in both languagesuch as the oropharynx and floor of the mouth”comments the Dr. Jon Alexander Sistiagapresident of the Oncology and Head and Neck Surgery commission.

We must not forget that Tobacco causes 85% of laryngeal tumors. One in five cases of cancer in Europe is attributable to this toxic substance, warns a study published in the European Journal of Cancer, which means 750,000 tumors caused by tobacco. Of all of them, Half affect the lung and 15% are located in the head and neck area. affecting mainly the lip, oral cavity, pharynx and larynx.

Lack of regulation of hookahs

Being clear that its effects are very harmful, it is curious that hookahs do not have a specific regulation that regulates their consumption. In our country, its use is governed by the current tobacco regulation law of 2010. In this way, Their use in closed premises is prohibited as long as they are loaded with tobacco products..

The problem is that the regulation says nothing about whether the hookah is not loaded with tobacco.

  • “They can be used with herbs or with flavored tobacco that contains the same substances as tobacco, including a greater amount of CO. This causes a decrease in O2 uptake that causes respiratory and heart diseases”, comments Dr. Sánchez Prieto.

Given this lack of control, the WHO has asked all countries to tighten measures to open premises where smoke a water pipe as well as increasing taxes; boost protection against smoke exposure and include health warnings such as those on tobacco packages.

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