Fanning the coals
Clearing the stem.
18+Reference resource. Nicotine is addictive. Tobacco use harms your health.
Clearing the stem.
The phrase "electronic hookah" does not describe a device. It is sold on products that differ in the one thing that matters most — what actually gets heated inside. That determines what you inhale, and which research applies to the device at all.
Not the shape, not the presence of a base, and not the word on the box, but the answer to one question: what does the heater heat? There are exactly three answers — tobacco, an impregnated mineral granulate, or a flavoured liquid. And one further question: does combustion happen anywhere in the device?
On that basis, everything called an electronic hookah falls into five recognisable groups.
The most conservative design: a metal "puck" with a heating element, placed on top of the foil exactly where charcoal would sit. Everything else — bowl, foil, tobacco, base, hose — stays a hookah.
These devices have actually been tested. The Center for Tobacco Products at the US Food and Drug Administration tested a commercial 40 mm heater (Ren, Headstream, China); another study used a model from the same maker, "Type RY0811, 28 mm diameter, Ren Headstream, China". The manufacturer's stated supply for the first was 13 V DC at 3.5 A; the authors measured 14 V DC with 2.7 Ω resistance.
What is known about how they run: the commercial unit reaches maximum temperature in 2 minutes against roughly 15 for charcoal, then oscillates between 350 °C and 450 °C, averaging 386.3 °C against 405–450 °C for charcoal. Over a 57-minute session it consumes 20.56 % of the tobacco against 31.35 % for charcoal. The authors' verdict: "The commercial electric heater did not reach consumption levels seen in the charcoal heating system."
One detail shows how borderline this category is: in Brinkman and colleagues' study, the same kind of electric heater was used not as a replacement for charcoal but as a way to light it — the charcoal sat on it for 2 minutes before being moved to the foil.
On emissions: the American University of Beirut group compared three commercial electrical heating elements against charcoal and found "an 80% reduction in total PAH and a 90% reduction in CO emissions", but at the same time "a several-fold increase in the potent respiratory toxicant acrolein". Their conclusion: "marketing EHEs as reduced harm products may be misleading."
Here the heating element is built into the bowl itself, and neither foil nor charcoal is needed. The 2026 study used "a commercial ceramic electric head (Hookah-Shisha Heater, Ren Headstream, China)" with an "adjustable temperature dial (heat setting range = 0–9)". The tobacco inside is ordinary hookah tobacco.
The thermal profile of this design is different, and that matters. Measurements by Brinkman and colleagues (Tobacco Control, 2020): "Temperature of the electric head ranged from 300°C to 380°C, depending on the power supply setting", and "maximum tobacco temperature obtained when using electric heating (~300°C) was almost twice that obtained when using charcoal heating (~150°C)". The tobacco gets hotter than under charcoal, not cooler.
The consequences show up in both machine and human experiments: 2.4 times more tobacco consumed, 1.4 times more mainstream nicotine, more semivolatile furans. And the 2026 home study found physical evidence of overheating: "we found visual evidence of charred WPT from electric sessions, suggesting excessively heated WPT." The authors frame it as a regulatory task: "Inadequate control of electric heaters can lead to WPT overheating and degradation."
The researchers themselves stress that groups 1 and 2 must not be lumped together: "a categorical statement about the harm of electric heating cannot reasonably be made", because a heater designed to sit on top of the foil, from the same manufacturer, gave markedly lower nicotine yields than charcoal.
Here there is no tobacco at all. The filler is a porous mineral granulate soaked in a glycerol liquid with flavourings; a laboratory review of the category (Bakker-'t Hart et al., 2023) describes such stones as sold both with and without nicotine, and notes that the composition is not disclosed on the packaging. More on this class of fillers is in "Hookah Without Tobacco: Tea, Fruit and Mineral Blends".
The only located study of the electronic variant comes from the Bavarian Health and Food Safety Authority (Schober et al., 2017). Three volunteers smoked an electronic hookah with nicotine-free Shiazo stones for two hours in a well-ventilated room, with parallel air measurements and urinary biomonitoring.
The authors name the assumption they set out to test: "Since there is no combustion of tobacco, it is often assumed that the produced vapor is not harmful to health." What they found: "concentrations of formaldehyde, acetaldehyde, glycerine, and propylene glycol rose significantly in the indoor environment. The content of putative carcinogenic PAH in indoor air increased by 42% to 174 ng/m3. Particle number concentrations ranged from 39,968 to 65,610 particles/cm3 (median), with peaks at diameters from 25 to 31 nm. 3-HPMA, the mercapturic acid metabolite of the pyrolysis product acrolein, was strongly elevated in urine samples of the smokers. All fluids contained high amounts of contact allergens."
The conclusion comes in two steps, and both matter: "Compared to conventional waterpipes, the release of pollutants is lower. Nevertheless, smoking with Shiazo waterpipes is a source of health risks for both users and bystanders."
A caveat on data quality is mandatory: three participants, one product, one laboratory. This is the only study of the category, not a settled result.
Formally this is no longer a hookah but a vape assembled in a hookah body. The definition from Rezk-Hanna and colleagues (Chest, 2022): "e-Hookahs are a new category of vaping devices in which e-bowls are combined with and placed on traditional water pipes, allowing the aerosol to pass through a water-filled base before being inhaled."
This is the only group for which the verified sources give both a device name and a power figure: the experiment used a "Starbuzz Wireless E-head, Starbuzz Tobacco, Inc." with liquid from the same maker — a 50-50 blend of propylene glycol and vegetable glycerin at 6 mg/mL nicotine. On power: "Because the e-hookah bowl has various power settings, based on participants' preferences and reported use, the device power was set at 50 W." So 50 watts was the experimental setting, not the device's only mode. No model year is given in the source.
The comparison against a conventional hookah in 17 regular smokers produced unexpected results. Carbon monoxide from the vaporiser was effectively nil: "exhaled CO levels were higher after smoking than after vaping (+36.81 ± 6.70 parts per million vs −0.38 ± 0.22 parts per million; P < .001)." But nicotine was the same: "plasma nicotine concentrations were comparable (+6.14 ± 1.03 ng/mL vs +5.24 ± 0.96 ng/mL; P = .478)."
On vascular measures the vaporiser did worse, not better: the rise in pulse wave velocity was larger (+0.74 vs +0.57 m/s), the augmentation index rose significantly only for vaping (+5.58 %, P = .004), and "these vascular changes were accompanied by elevation of the proinflammatory biomarkers high-sensitivity C-reactive protein, fibrinogen, and tumor necrosis factor α after vaping (all P < .05). No changes in biomarkers of inflammation and oxidants were observed after smoking." The authors conclude: "Although advertised to be 'safe,' flavored e-hookah vaping exerts injurious effects on the vasculature."
A separate study by the same group (2024) isolated nicotine's contribution: with nicotine, heart rate rose by 8 ± 3 beats/min, mean arterial pressure by 7 ± 2 mmHg, and flow-mediated dilation fell by 1.57 ± 0.19 %; without nicotine there was no significant impairment of endothelial function. This is the only located instance where a nicotine-free variant matched sham on a specific measure — but it is one acute measure in 18 people, and it does not generalise.
The group furthest from a hookah, and the most widespread. The literature describes it precisely: "A shisha-pen is an electronic cigarette variant that is advertised to mimic the taste of a water pipe, or shisha" (Kienhuis et al., Tobacco Induced Diseases, 2015). No water, no bowl, no tobacco: just a vaporiser and a liquid.
The Dutch RIVM analysed the vapour of a nicotine-free shisha pen: "The main components in shisha-pen vapor are propylene glycol and glycerol (54%/46%)." A calculation for a single 50–70 mL puff gave 430–603 mg/m³ of propylene glycol and 348–495 mg/m³ of glycerol, above the airway-irritation points of departure from published studies (309 mg/m³ in a human study for propylene glycol, 165 mg/m³ in a rat study for glycerol).
An honest caveat: this assessment drew a published methodological objection, and the authors replied in a separate paper in the same journal (Bos, Kienhuis, Talhout, 2016). The calculation was contested and cannot be treated as beyond dispute.
As for scale, a survey of four high schools (Krishnan-Sarin et al., 2019) found that among adolescents who had ever tried an electronic device, 60.6 % had tried "vape/hookah pens", and 46.8 % had used nicotine in them — nearly half.
It has been measured as a phenomenon in its own right. In focus groups with 77 adolescents and young adults (Wagoner et al., Nicotine & Tobacco Research, 2016), the same devices attracted the terms "e-cigarette", "e-hookah", "hookah pens", "tanks" and "vapes", and "although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification." Perception split along social lines rather than composition: "E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine."
Qualitative work by Sakuma and colleagues (2020) adds that "the term hookah recalled both the traditional and electronic pen-type products", and that "survey items used in surveillance systems … may not match definitions used by high-risk populations" — meaning even official statistics may not be counting what they think they are counting.
The practical takeaway is simple: whether any figure about harm or safety applies depends on which of the five groups a given device belongs to. Data on heating tobacco says nothing about a liquid vaporiser, and vice versa.
Three questions settle it:
The one thing that does not work as a signal: the word "hookah" on the packaging. All five groups have it.
The systematic review written for regulators by the Dutch National Institute for Public Health (Kienhuis, Talhout, Tobacco Induced Diseases, 2020) lists the heating sources as "charcoal, steam stones, electric heating" and, in its summary table, places electrical heating in the "toxicity" column — together with charcoal, not apart from it. Their recommendation covers all groups at once: "we advise to include all waterpipe products, tobacco and non-tobacco, with or without nicotine, in tobacco product regulations and smoking bans."
They are candid about the evidence base: "The systematic review retrieved five research papers on the attractiveness and toxicity attributed to heating sources" — five papers for the whole subject.
The Russian definition turns out to be broader than the technical distinctions. Federal Law No. 15-FZ of 23 February 2013 defines a hookah in Article 2 as a device for generating smoke from the smouldering or heating of tobacco or of products containing no tobacco leaf. That covers both electric heating and tobacco-free fillers.
Article 2 separately classifies tobacco-free heating mixtures as nicotine-containing products, and clause 4.2 describes them as a type of nicotine-containing or nicotine-free article. It follows that the absence of tobacco and the absence of nicotine do not by themselves change the legal perimeter. The same rules apply: hookah use is prohibited in food-service premises (Article 12), advertising and promotion of sale and consumption are prohibited (Article 16), and sale to and consumption by minors are prohibited (Article 20).
How many kinds of electronic hookah are there?
By what gets heated, five recognisable groups: a heater in place of charcoal, an electric head, steam stones with electric heating, a liquid vaporiser on a hookah base, and a disposable "hookah pen".
Which of them are actually hookahs?
The first two heat real hookah tobacco and remain hookahs in terms of smoke composition. The third is a hookah in construction but without tobacco. The fourth is a vape in a hookah body. The fifth is an e-cigarette related to hookah by name only.
How does an electric head differ from a heater on the foil?
In thermal profile. In the head, tobacco reached about 300 °C — nearly twice the temperature under charcoal; the on-foil heater in another study ran cooler than charcoal and delivered less nicotine. The researchers explicitly warn against generalising between designs.
Is there really nothing harmful in steam stones?
The only study of electronic stones recorded rises in formaldehyde, acetaldehyde and carcinogenic PAH in indoor air by 42 % to 174 ng/m³, high particle concentrations, and a sharply elevated acrolein metabolite in urine. The verdict: emissions are lower than a conventional hookah, but it is still "a source of health risks".
Is a "hookah pen" a hookah?
No. The literature describes it as a variant of the e-cigarette advertised to mimic the taste of a water pipe. In the high-school survey, 46.8 % of adolescents used nicotine in such devices.
Why does the distinction matter?
Because figures do not transfer between groups. With a liquid vaporiser, carbon monoxide is essentially nil, but plasma nicotine matched a conventional hookah — and inflammation markers rose only for the vaporiser.
Related material on the site: on electric heating itself — "Electronic Hookah: What Changes in the Smoke When the Charcoal Is Removed"; on the choice between the two — "Is It Worth Switching to an Electronic Hookah"; on tobacco-free fillers — "Hookah Without Tobacco: Tea, Fruit and Mineral Blends"; on charcoal — "Types of Hookah Charcoal"; on bowls — "Types of Hookah Bowls".