Many think the hookahs are a safer alternative to cigarettes, but smoking from a hookah is much more powerful.
It's alarming news to Dr. Tom Dailey.
"This is cigarette smoking on steroids," he says.
Dailey, a pulmonologist and board member of Breathe California, says it's a double whammy coupling the toxins from the tar and nicotine in the tobacco with the chemicals from the charcoal.
He says the idea that the smoke is filtered when it passes through the cooled water is bunk.
"It's an astounding exposure to a greater concentration of toxins by people holding their breath and inhaling deeper," he explains.
Dr. Dailey says spending just one hour in a hookah lounge is the same as smoking 200 cigarettes.
Aside from the cancers, heart and lung diseases associated with smoking, there's a germ factor to sharing the pipe, too.
"There's virus transmission...there's transmission of other infectious diseases," Dr. Dailey warns.