Woman smoking Shisha or hookah

Shisha. Hookah. Is it safe?

Across many cities you may have noticed people smoking through big water-pipes and wafts of smoke floating in the air. The tobacco comes in different flavours and is seen as a social past time, but is it safe and should you be concerned if you do Shisha?…

Shisha, also known as Hookah, is a water-pipe used to smoke flavoured tobacco. It comes in many different shapes and sizes and they all work in a similar fashion. The flavoured tobacco is burnt on charcoal creating smoke and when the user sucks in air through the shisha pipe, the tobacco smoke is pulled through a water chamber. The smoke is cooled before being inhaled in this chamber. A range of tobacco flavours are available from fruity to chocolate ones.

A short history of Shisha

Shisha has been used to smoke tobacco for centuries. There is debate regarding about its origins however it is thought to have originated in India in the 15th century where it was used by members of high society as a sign of their wealth. The use of shisha quickly spread and has been used for centuries across the Middle East and North Africa.

More recently shisha lounges and bars have grown in popularity especially among younger people, and shisha bars have been springing up across towns and cities in the UK. A study from 2012 reported that the number of the bars and lounges in the UK has increased by 210% between 2007 and 2012.

Is Shisha dangerous?

There’s a common misconception that Shisha is safer than smoking cigarettes. As the charcoal burns to heat the tobacco, this exposes the smoker to carbon monoxide and shisha smoke has around 6 times more Carbon Monoxide, and 46 times more tar than cigarette smoke.

The smoke also contains many of the same dangerous chemicals found in cigarettes including arsenic, nickel and lead. A common misconception is that Shisha smoke does not contain nicotine. Many people think that when the smoke passes over the water to cool the nicotine from the smoke it is removed.

People using shisha will inhale the same amount of smoke in one puff as they would if they were to smoke an entire cigarette, which means that 20 puffs of shisha would equate to smoking a pack of 20 cigarettes!

What are the risks of Shisha?

Shisha smoking exposes users to the risk of developing many of the same diseases that smokers are at risk of. Higher Carbon Monoxide levels means there is less Oxygen available in the body, and the risk of developing lung, bladder and oral cancer are increased as the smoke contains a variety of cancer causing chemicals.

Tobacco can irritate the mouth in some people, and increase the risk or oral cancer. Shisha smoking is also associated with gum disease, respiratory problems and low birth weight of infants born to pregnant mothers smoking shisha. Shisha is often smoked in group settings with a shared mouthpiece which increases the risk of transmission of infectious diseases.

Second hand smoke inhalation will occur if you are around people smoking shisha. The smoke will contain toxins from the tobacco as well as the smoke itself.

What about tobacco free alternatives?

Even if you smoke tobacco free shisha, you are still at risk of exposure to carbon monoxide and other cancer causing toxins from the charcoal.

What does this mean for me?

Shisha smoking is a long standing tradition in  many cultures across the world, however it does still carry health risks which are often not recognised. Shisha smoke, even if nicotine free, exposes you to a number of toxic chemicals which can be harmful.

If you are addicted to nicotine and you want help to stop smoking you can visit TheDoctorService and search for our smoking cessation service.

Get more information

If you are interested in finding out more, here are some great resources to check out:

The British Heart Foundation and their advice

The NHS’s advice on Shisha

Edited by Dr Kiran Sodha & The Doctor Service at TheDoctorService.co.uk


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Shihadeh A, Salman R, Eissenberg T. Does Switching to a Tobacco-Free Waterpipe Product Reduce Toxicant Intake? A Crossover Study Comparing CO, NO, PAH, Volatile Aldehydes, Tar and Nicotine Yields. Food and Chemical Toxicology 2012;50(5):1494–8 [accessed 2015 Sep 14].

Akl, Elie A., et al. “The effects of waterpipe tobacco smoking on health outcomes: a systematic review.” International journal of epidemiology3 (2010): 834-857.

Jawad, Mohammed, Husain Khaki, and Fiona Hamilton. “Shisha guidance for GPs: eliciting the hidden history.” (2012): 66-67.

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