Waterpipe (Hookah)

A waterpipe (also known as hubble-bubble, goza, narghile or hookah in North America)^{1 2 3} is a device used to smoke specially made tobacco and non-tobacco herbal products called Shisha.¹

Waterpipes can vary in shapes and sizes but usually have 4 parts:^{1 2 3 9}

1. Head: where Shisha is heated by charcoal.
2. Body: the part that smoke travels through.
3. Water bowl: a water filled chamber that cools the smoke from shisha before being inhaled; it does not filter chemicals.
4. Hose(s) attached to mouthpieces: smoke from the water bowl travels through the hose to mouthpiece where it is inhaled.

Facts about Waterpipe and Shisha

• It is perceived as less harmful by youth and young adults.

  Waterpipe smoking has been around for centuries and is a custom in many countries around the world,^{1 6 8} however, it is becoming popular among youth and young adults in North America.^{1 5 6} This is most likely due to the flavours that are added to shisha to make it smell and taste good, as well as the belief that is less harmful than cigarettes.^{2 6} According to the Ontario Student Drug Use and Health Survey, 8% of students in grades 7-12 in Ontario reported using a waterpipe (hookah) at least once in the past year. However, use increases with age with 5.3% in grade 9 vs. 14.4% in grade 12.⁷

• It can be addictive. 
  

  Shisha can contain tobacco and non-tobacco blends. Even if the blend is non-tobacco, flavoured liquid nicotine (called e-liquid or e-solution) can be added. This means that like cigarettes, waterpipe can be addictive. Research shows that waterpipe smoking contributes to starting and maintaining nicotine addiction.^{1 2 3 4 8}

• It can spread disease.

  Part of the appeal for youth is that the waterpipe is usually smoked in groups or social gatherings. Yet, quite often the same mouthpiece is shared and not cleaned properly which puts individuals at risk of diseases like hepatitis, herpes, meningitis, tuberculosis and the flu.^{1 2 3 4 6 9}
  

• It produces second-hand smoke. 

  Like tobacco, waterpipes produce second-hand smoke.⁸ Both tobacco and herbal shisha can produce toxic chemicals such as carbon monoxide, ultrafine particles, heavy metals and aldedhydes.¹,⁵,⁸ When compared to cigarettes, hookah smoke actually contains higher levels of carbon monoxide and polycyclic hydrocarbons.⁸ However, not only does the shisha give off chemicals, but so does the burning charcoal. The charcoal used to heat the shisha also produces very high levels of carbon monoxide, heavy metals and cancer causing chemicals.⁵

• It has the same health risks as cigarettes.

  Even though there may be differences in how waterpipe and cigarettes are used (waterpipe has longer sessions and deeper inhalation), studies show that waterpipe smoke contains many chemicals associated with cancer, heart disease, respiratory illness, low-birth weight, and gum disease.^{1 2 3 5 8 9}

Additional Information

For more information, contact the Middlesex-London Health Unit's Smoke-Free Information Line;

• 519-663-5317 ext. 2673
• smokefreeinfo@mlhu.on.ca