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The device works by burning charcoal that will then burn a tobacco mixture, as well as heat up the water. The smoke the charcoal generates helps move the tobacco through the water and hose and up to the mouthpiece.

Using a hookah exposes a person to tobacco smoke, which contains harmful components, such as carbon monoxide. The water in the hookah does not filter out these components. Even if a person does not smoke directly from the hookah, they can still inhale secondhand smoke if they are nearby.