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The British Health Foundation claims that:

The average shisha-smoking session lasts an hour and research has shown that in this time you can inhale the same amount of smoke as from more than 100 cigarettes.

There is also one article on Daily Mail that claims the same thing. Also huffingtonpost claims they are equivalent in terms of:

the amount of smoke inhaled — and therefore in the damage they can cause to a person’s health, including increased risk for heart disease, cancers, stroke, blood clots and death, to name a few

But I didn't find any research online to prove this claim. Is there any science behind this or is it just some authoritative claim?


Definition of shisha:

A hookah (from Hindustani: हुक़्क़ा (Devanagari) حقّہ (Nastaleeq), IPA: [ˌɦʊqqaː]; also see other names) is a single- or multi-stemmed instrument for vaporizing and smoking flavored tobacco (called Mu‘assel), or sometimes cannabis, whose vapor or smoke is passed through a water basin—often glass-based—before inhalation

  • you can probably tell by measuring the amount of nicotine you feel from 1 hour of shisha smoking, if you use tobacco. and you can tell by the amount of coagulants and congestion you feel the day after. – com.prehensible Oct 8 '17 at 20:38
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    I'm not a smoker -- how many regular cigarettes might someone smoke in an hour? – Daniel R Hicks Oct 9 '17 at 3:37
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    The headline and the question does not match. The headline asks for the harm done, the question compares the amount of smoke. – MichaelK Oct 10 '17 at 8:52
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Is 1 hour of shisha as harmful as smoking 100 cigarettes?

There are studies supporting the idea that this is probably close to the right order of magnitude.


The US Centers for Disease Control and Prevention claim

The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500–600 ml inhaled when smoking a cigarette.

based on Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. American Journal of Health Behavior 2010;34(3):275–85

90,000 / 550 is 163 cigarettes.

The CDC document mentions several health risks arising from the way that the Shisha heats the tobacco and states that the smoke contains high levels of toxins after passing through the water. However I didn't see any quantitative comparison in the CDC document of toxicity of the smoke compared to cigarettes.

However the referenced study contains this statement

these data suggest that, relative to a single cigarette (about 500 ml of smoke, see Table 1), a single waterpipe use episode (about 90,000 ml of smoke, see Table 1) is associated with 1.7 times the nicotine, 8.4 times the CO, and 36.0 times the tar. Although extrapolating this type of smoke content analysis to actual cigarette or waterpipe smokers has important limitations (see 23,49), these data suggest that waterpipe tobacco smoking is likely associated with substantial toxicant exposure.

This suggests the harm might, at worst, be equivalent to smoking 36 cigarettes - if tar is the major cause of harm and if harm is linearly proportional to exposure.


Volumes of smoke

Cobb et al says:

As seen in Table 1, data collected from actual waterpipe tobacco smokers in natural settings show that a waterpipe use episode typically involves almost 200 puffs, with an average puff volume exceeding 500 ml.22,24 Thus, compared to a cigarette, which involves inhalation of approximately 500–600 ml of smoke (ie, 10–13 puffs of about 50 ml, on average

They cite

  1. Breland AB, Kleykamp BA, Eissenberg T. Clinical laboratory evaluation of potential reduced exposure products for smokers. Nicotine Tob Res. 2006;8(6):727–738. [PubMed]

  2. Djordjevic MV, Stellman SD, Zang E. Doses of nicotine and lung carcinogens delivered to cigarette smokers. J Natl Cancer Inst. 2000;92(2):106–111. [PubMed]

There is an FTC machine smoking protocol (for e.g. measuring toxins delivered to a smoker from smoking a cigarette). This specifies 35ml 2-second puffs once a minute until 23mm butt length remains.


Djordjevic et al performed measurements with pressure transducers on 133 smokers and found puffs of around 46ml at around 20 second intervals.


A 2009 study: Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. concluded:

Mean total puff volume was 48.6 L for waterpipe use as compared to 1.0 L for cigarette smoking (p<0.001).


These numbers seem broadly consistent with a total volume of 500ml of smoke inhaled per cigarette.

  • Hmmm, am I the only one suspecting that 500ml being waaay too low? 500ml is a single, very short breath. I would guess 5l or even more would be a correct number. – sweber Oct 10 '17 at 2:54
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    @sweber. 500ml is the tidal volume for a young healthy adult. Typical cigarette smokers apparently take smaller puffs of cigarette smoke - according to studies cited by the article quoted above - see extended answer covering this point. – RedGrittyBrick Oct 10 '17 at 8:56
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    @LangLangC: That represents a small percentage of what passes into the lungs. The water is not there to filter anything out, it is there to cool and humidify the smoke. – RedGrittyBrick Oct 10 '17 at 15:19

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