Water pipe or hookah smoking is becoming increasingly popular outside of the Middle East, especially among the younger generation, and is often touted as a harmless way to smoke tobacco. A hookah, also commonly known as “shisha,” “narghile,” or “hubble bubble,” is a water pipe used for smoking a preparation of tobacco, glycerol, and other additives and flavors using charcoal separated by thin aluminum foil to heat the mixture. Air is drawn in over the charcoal and then passes through the tobacco mixture through the water pipe and then into a water bowl before the vapors cool and are released as a dense aerosol, which is inhaled by the user. Hookah smoking, compared with cigarette smoking, produces a greater content of tobacco smoke, tar, carbon monoxide, polyaromatic hydrocarbons, and carbonylic compounds. The tobacco-free versions of hookahs contain less nicotine but produce a similar exposure to toxins and particulates when compared with tobacco-containing hookahs.