All over New York City, the smoking few huddle outside of restaurants because smoking indoors has, since 2003, been banned in most public New York City establishments.

However, Hookah bars—gathering places where people go to smoke flavored tobacco from a waterpipe—offer the chance to keep smokers’ fingers warm by openly advertising a menu of hookah flavors, to be smoked indoors.

The smoking ban in New York City  was implemented to protect the health of the public, intended to discourage smoking in general, and protect non-smokers from the detrimental effects of second-hand smoke. Does this mean that Hookah smoke is not bad for your health, and that second-hand smoke from the hookah pipe is not harmful to the health of those around the smoker?

It would seem that this is the message being sent by both the bars and the city.

The reality though is that hookah smoke is detrimental both to the health of the smoker and those around him. As far as what constitutes “bad for your health”, it’s the tar and carbon monoxide in both cigarettes and hookah smoke that can cause cancer and cardiovascular disease, not the nicotine

With regard to this tar and carbon monoxide, studies show that waterpipe smoke contains 802 mg of tar compared to 22.3 mg for cigarettes, and 145 mg carbon monoxide, compared to 17.3 mg for cigarettes. Thus, a single waterpipe use episode (lasting 30-45 minutes) will put only slightly more nicotine in a smoker’s system than a single cigarette, but about 36 times the tar and 8 times the carbon monoxide.

Furthermore, commonly used heat sources that are applied to burn the tobacco, such as wood cinders or charcoal, are likely to increase the health risks because when such fuels are combusted they produce their own toxicants, including high levels of carbon monoxide, metals and cancer-causing chemicals.

For those simply hanging out at a hookah bar and not participating, it is important to be aware that second-hand smoke from waterpipes is a mixture of tobacco smoke in addition to smoke from the fuel. Therefore, it poses a serious risk for non-smokers.

Beyond the health risks of smoking from the waterpipe, sharing a waterpipe mouthpiece poses a serious risk in itself. According to the World Health Organization, the mouthpiece can be a source for transmission of communicable diseases, including tuberculosis, hepatitis, and herpes.

Additionally, the American Cancer Society warns that hookah users can become infected with aspergillus (a fungus that can cause serious lung infections) or helicobacter (which can cause stomach ulcers). These organisms may be spread by sharing the pipe or through the way the tobacco is prepared.

Take home message: Smoking from a hookah waterpipe is NOT a healthier option to smoking cigarettes or cigars, but rather poses great health risks in light of the prolonged inhalation of cancer-causing compounds with each use episode. Beyond that, the smoker is also at risk of acquiring some pretty nasty communicable diseases by sharing the mouthpiece with others. Your best bet is to stay away from smoking and from others who smoke. Your lungs will thank you for it.