Urinary levels of nicotine metabolites were measured in nonsmokers and smokers of tobacco either as cigarettes or as the Middle-Eastern water pipes (narguila). Levels of urinary cotinine were similar for the smokers of cigarettes (median 30 cigarettes per day) and narguila (median 2 pipes per day, or around 40 grams of tobacco). Use of water pipes may remove a small amount of nicotine, but smokers appear to titrate dose to effect. It is unlikely that narguila smoking confers any less risk.