Sir, hookahs are smoked widely in the Arab world. Many people think that hookahs are less dangerous than cigarettes as the tobacco is filtered through water, but while a cigarette lasts for a few minutes, a hookah lasts for hours. The person smoking the hookah may inhale a hundred times in a session lasting 30-60 minutes. The rising popularity of the hookah is partly due to the unfounded assumptions of safety and misleading commercial marketing. In cities across the UK, especially London, hookah bars have become popular among young immigrant Asian communities and among others as well. The hookah is complemented by shisha, a special blend of tobacco and molasses, and the bars serve hookahs with flavours like apple, peach, mango, mint and strawberry.1 Such flavours might explain the hookah's popularity among women.

The hookah makes use of a large quantity of pure shredded tobacco, making smoking a hookah for 30-60 minutes equivalent to smoking a packet of cigarettes. The tobacco burns at a lower temperature in water pipes which makes it easier to inhale and the smoke penetrates deeper into the respiratory tract, thus causing more damage than a cigarette. The water does not filter the toxins as many people think, so those who smoke hookahs are exposed to larger amounts of nicotine, carbon monoxide and certain other toxins.1 The tar produced when the tobacco is burnt contains carcinogens, does not dissolve and together with other tobacco particles affects the lungs directly. The smoke produced while smoking the hookah also gets deposited in the lungs. The amount of cellular chromosomal damage is the same1 whether a hookah or a cigarette is smoked and so is the prevalence of cancer. Since the hookah habit is becoming widely prevalent in eastern countries2 and now spreading to the west, proper health education is needed in helping people kick this habit. It should be borne in mind that smoking kills with or without gurgling water.