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Hookah steam stones: smoking vapour expands from electronic cigarettes to waterpipes
  1. Youn Ok Lee,
  2. Arnab Mukherjea,
  3. Rachel Grana
  1. Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  1. Correspondence to Dr Youn Ok Lee, Postdoctoral Scholar, Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390, USA; younok.lee{at}

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A hookah is a waterpipe (also known as narghile or shisha) used to smoke flavoured tobacco. It is estimated that the hookah is used daily by more than 100 million people globally.1 Further, hookah smoking appears to be increasing both worldwide and in the USA.2–5

A limited number of studies suggest that health risks associated with hookah smoking are similar to those of cigarette smoking.6 ,7 A single session of hookah smoking can last 30–60 min, with over 100 inhalations.8 ,9 Despite data demonstrating potential health risks, smokers perceive hookah use as less harmful than cigarettes10 because of its sweet smell and taste, and the belief that water ‘filters’ the smoke, reducing toxicant exposure5 ,11 ,12 and is, therefore, less addictive than cigarettes.5 Moreover, existing legal protections for non-smokers do not apply to hookah since most public venues for waterpipe use are exempt from clean …

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  • Funding This work was supported by the National Cancer Institute grant number CA-113710 and the State of California's Tobacco-Related Disease Research Program (TRDRP) award number 19FT-0175.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.