Shisha smoking has ancient Middle Eastern and Asian origins as a relaxing and stress relieving pastime. It was invented in the 16th century by a physician named Hakim Abul-Fath Gilani.

Very Popular in the UK

However, as the popularity of the ‘hookah’, as it’s also known, there has always been a burning debate on how harmful Shisha smoking can be. Are some overlooking the harmful effects due to the pleasure they get from smoking Shisha? Asian Sunday investigates.

Harmful Toxins

Shisha smoking is of course another way of using tobacco, but with either molasses sugar or fruit thrown in via a bowl and hose or tube. The tube runs to a mouthpiece from which the smoker inhales the smoke, as substances are in effect, burnt into their lungs.

Shisha tobacco contains cigarette tobacco, also carrying nicotine, tar, carbon monoxide and heavy metals, like arsenic and lead. This all means shisha smokers are at risk of the same kinds of diseases as cigarette smokers. Pregnant women can also be heavily at risk.

Dr Mike Knapton, associate medical director at the British Heart Foundation, explains: “Contrary to popular belief, shisha is not safer than smoking cigarettes. Don’t be duped by the sweet smell and wholesome sounding fruity flavours, if you use shisha you are a smoker and that means you’re putting your health at risk.

“It’s linked to the same serious and life-threatening diseases as cigarettes and there are added risks because you often smoke it for far longer than you would a cigarette and you’re also exposed to toxins from the wood or charcoal used to burn the tobacco. Fortunately No Smoking Day is a great opportunity for anyone who smokes, in whatever form, to try and quit”.

Conflicting Evidence

Research undertaken at the Royal University of Saudi Arabia several years ago revealed shisha smoke is 30 times less concentrated in chemicals than cigarette smoke. This goes against warnings to the contrary from The World Health Organisation. They say: “One shisha session of a single hour can be the equivalent of smoking up to 200 cigarettes.

Dr Mohammed Jawad from Imperial College London has done quite a bit of extensive research on the effects of the practice. He said:“Many people think shisha is less harmful than cigarettes, because of its fruity taste or because the smoke passes through, and is somehow filtered by the water. Not only is this perception incorrect, but it’s opposite to what our research has found.

“It’s important that the community is aware of the harmful risks of shisha tobacco use so informed decisions can be made.”

A review on shisha smoking carried out by The Royal College of Physicians highlighted the fact it is associated with three main detrimental health effects, cardiovascular damage, infection and cancer formation. A medical team in Pakistan however, found that shisha smoke can be much less carcinogenic and radioactive than cigarette smoke.

Bradford Metropolitan Borough Council have promoted the fact smoking shisha or using substances like paan, gutkhu, betel (areca nut) and naswar, can increase your risk of developing a range of cancers including mouth cancer.

A Pleasurable Pastime

So, with all these health risks, why are the number of people smoking shisha increasing? There’s little doubt shisha cafés provide a place for people to come together and find pleasure. They can be introduced to smoking by friends, at a party, or simply try shisha for the experience.

Revealing Research

With this in mind The British Medical Journal produced the findings of a study involving English speaking young people aged 18 to 30 years who had lived in Leeds for more than a year. All were required to have smoked Shisha at least once a week in a one-month period.

A Question of Smokers

The youngsters revealed several fascinating things including, the fact shisha does play a huge role in social interaction. That peer pressure and wanting to be part of a group sees them participate even if they really don’t want to.

Peer Pressure

One 18-year old female participant said: “I have friends who smoke shisha in shisha cafés and I go with them too. When I reach these cafés, I have to take shisha as well because all my friends are taking shisha.”

Relaxation Mode

Another young female explained: “You can imagine the kind of sound that come from bubbling water in the shisha machine, very relaxing, the sweet smell coming out while smoking. A very sweet smell indeed. I enjoy that all the time.”

Following The Professionals

Many believe Shisha cafés are implicitly sanctioned when used by respected professionals like doctors for example. A 25-year-old male told interviewers: “I have friends who are doctors and lecturers who smoke shisha with me. If a doctor can smoke shisha, who am I not to take shisha? These are respected people and we have to believe in what they do.”

Another 20-year-old male made clear: “Doctors always tell us not to smoke but they smoke, they tell us not to take alcohol but they take it. Some of them even take shisha too. I know all these risks are there but I will keep taking my shisha as doctors and other professionals do.”

The Right to Take Part

“I smoke because I have a right to do anything I want,” said a 24-year-old male. “I propose that excessive rights especially those that make people vulnerable should be reduced so as to have a healthy society. Otherwise, it becomes hard to convince people not to take shisha.”

The Bottom Line

Most, but not all, shisha smokers acknowledge shisha cafés are harmful. Many participants clearly stated shisha smoking has many negative consequences to their physical health. One 20-year-old participant said: “A few months ago, I started experiencing sleepless nights and increased heart rate when I am climbing a steep slope. This started months after start of shisha use.”

From legislation to restrict Shisha smoking to offering non tobacco alternatives, cigarette cessation programmes to greater protection around mouth-pieces, peer based interventions to greater support for youngsters, the interviewees certainly produced a good cross section of viewpoints.

Health Facts On Shisha

  • Regular shisha smokers can become addicted and dependent.
  • The bubbling water will not filter out toxins that can cause respiratory and cardiovascular diseases.
  • Second hand smoke can cause long term problems for anyone nearby.
  • You can get oral herpes simply by sharing a mouthpiece.
  • Tobacco-free or herbal shisha is not a safe alternative.

Important Notes

It’s worth remembering shisha cafés are required to comply with the smoke-free regulations operational since July 2007. They were introduced to protect the public and people at work from the harmful effects of second-hand smoke. Your local council as opposed to the police are in charge of enforcing the Smoke Free law. All areas open to the public including workplaces are considered smoke free zones where they are enclosed or substantially enclosed.


This is an area with permanent walls and doors without any gaps. Windows and doors aren’t classed as gaps. An enclosed structure may be permanent i.e. a building or even a marquee (temporary).

Substantially Enclosed:

This would be a structure (with a roof/ceiling) with an opening in the walls where the opening would make up less than half of the area of the total wall space. Again, doors and windows are not classed as gaps.

If in any doubt about whether their building or structure is enclosed, substantially enclosed or open enough to allow smoking in the wisest course of action for businesses would be to contact the local council for advice and clarification.

Shisha café use could be reduced through efforts aimed at the individual and the community. This could also strike a balance between the pursuit of pleasure and long term health. As a result of the Leeds study many experts believe future work should focus on intervention development to prevent the negative individual and public health consequences of shisha use, without sacrificing the importance of social interactions.