The waterpipes are thought by some to be a safer alternative to smoking cigarettes, but the evidence does not necessarily agree. The hookah is a device dating back to sixteenth century Persia and India. When tobacco is heated, the smoke released contains not only tobacco smoke but also the combustion products released when charcoal or other combustion aids are burned. As the smoker inhales through the tube, it passes through a water container and enters the smoker's body. In addition to tobacco, hookahs are often flavoured with spices or other flavours that are particularly appealing to young people and non-smokers. The waterpipe set-up is also well-designed or painted with stylish pictures, intended to downplay its health hazards.

The Hong Kong Council on Smoking and Health has earlier commissioned the School of Public Health of the University of Hong Kong to conduct a survey on young people's use and awareness of hookah. It was found that young people in general underestimated the harm of hookah.

The survey revealed that the majority (94.5%) of respondents had heard of hookah. 30.4% and 13.4% have used and currently use hookah respectively.

Among those respondents who had never used hookah, more than a quarter of them intended to use it (27.4%).

On a scale of 0 (lowest) to 10 (highest), cigarettes (9.05) were considered more harmful than hookahs (7.65) by all respondents; cigarettes (8.56) were considered more addictive than hookahs (6.84).

The data shows that young people underestimate the health effects of hookah.

Smoking a single hookah is 125 times worse than smoking a cigarette

The smoke from hookahs contains carcinogens associated with the burning of tobacco, such as formaldehyde, benzene and even heavy metals. Although many people believe that the water in the vessel filters out these harmful substances, studies have shown that smokers and hookah users have similar levels of toxins in their blood and urine.

According to a US study, each hookah inhaled is 125 times more likely to be inhaled than a normal cigarette, meaning inhaling hookah is 25 times more tar, 2.5 times more nicotine and 10 times more carbon monoxide than smoking a cigarette. Therefore, it is a big misconception that hookah smoking is healthier than general cigarettes.

Waterpipes have a variety of flavours and are similar to food (e.g. fruit flavours) and take longer and more frequently to inhale than smoking cigarettes. Waterpipe users tend to inhale more toxic compounds than regular cigarette smokers.

Harmful effects of hookah

The hookah smoke attacks the lining of the lungs, damaging alveoli, damaging lung cells and inflaming tissue, and weakening the lungs' ability to fight infection. Damage to the lungs makes it easier for viruses to invade the lung tissue, causing other more serious symptoms and increasing the risk of death. The following are the diseases that can be caused by the use of hookah:

- Weakened lung function

- Fertility loss

- Heart disease

- Cardiovascular disease

- Chronic obstructive pulmonary disease

- Oral cancer

- Lung cancer

- Stomach Cancer

- Oesophageal cancer