For centuries, tobacco lovers throughout Asia and Africa have gathered in social settings to puff from and pass around a large waterpipe known as a shisha.(See Reference 1, page 1). Smoking of shisha, also known as “hookah”, “goza”, or “narghile”, has grown in popularity among new groups such as young people in the U.S.and other parts of the word. (See Reference 1, page 4). This popularity appears to be due in large part to the prevailing but unfounded view that shisha smoking is a safe alternative to cigarette smoking. (See Reference 1, page 1). However, existing data strongly suggests that shisha smoking is associated with many of the same health risks as smoking cigarettes and may in fact, present unique health risks. (See Reference 1, page 4).

Smoke Inhalation (See Reference 1, page 3)

Shisha smoking exposes the smoker to more smoke over a longer period of time than does cigarette smoking. According to a World Health Organization report, cigarette smokers generally inhale 8-12 puffs over 5-7 minutes whereas a shisha session lasts 20-80 minutes and involves 50-200 puffs. Therefore, in one shisha session, a smoker can inhale the same amount of smoke that would be inhaled by smoking 100 cigarettes.

Health Effects

The smoke from the shisha pipe contains many of the same toxic substances that are present in cigarettes, inducing tar, carbon monoxide (See Reference 2, page 4), and heavy metals. (See Reference 1, page 5). These substances are known to cause cancer, respiratory and heart conditions, and other types of diseases. (See Reference 1, page 4). A shisha session can involve inhalation of up to 6.5 times the carbon monoxide and 46.4 times the tar as smoking a single cigarette (See Reference 2, page 4).

In addition to risks caused by shisha smoke, smoke from the charcoal has unique toxic substances and poses its own health risks (See Reference 1, page 5). Because shisha smoking is often a social experience with users sharing a mouthpiece, the risk of communicable diseases such hepatitis and tuberculosis is increased. (See Reference 1, page 5).

Nicotine (See Reference 1, page 3)

Like cigarettes smoke, shisha smoke contains the drug nicotine. While the water absorbs some of the nicotine, shisha smokers can be exposed to enough nicotine to cause addiction and more frequent use is associated with a greater likelihood of addiction. Tobacco intake is heavily influenced by nicotine intake and it is possible that the decreased amount of nicotine in shisha results in shisha smokers inhaling more smoke and getting more exposure to toxic chemicals than if none of the nicotine was absorbed by the water.

Harm to Others (See Reference 3, page 331)

In addition to having negative health impact on the smoker, shisha smoking can cause harm to others 2. Second hand smoke from shisha contains tobacco smoke as well as smoke from the coals and exposes non-smokers to the same toxic compounds that smokers are exposed to. In homes where shisha are used, children could be at increased risk because they spend the majority of time at home. Smoking shisha during pregnancy has been shown to be associated with low birth weight, lower health assessment scores, and increased respiratory problems in newborns.