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What is ‘shisha’ and is it safer than smoking?

“What is ‘shisha’? My family is originally from Iran and my uncle says that it’s ‘tar free’. He says that it’s safer than smoking. Is that true?”

Shisha is a tobacco mixture that is smoked using a ‘hookah’ or water pipe. It is typically flavoured, with more traditional shisha usually containing molasses or some other form of sweetener, as well as flavourings such as fruits like apple or lemon. In recent times, other flavours such as chocolate, vanilla and cappuccino have been added to the mix. Water pipe tobacco smoking is a centuries old cultural tradition typically associated with the Middle East and is part of everyday social life in a range of countries from Syria, Egypt and Turkey, through to India, Pakistan and Nepal. Hookahs are typically shared by several users in a smoking session with one or more hoses being used.

Water pipe tobacco smoking is known by many names across a range of cultures (e.g., goza, narghile and hubble bubble), and involves heating the tobacco mix, having the resulting smoke pass over or through water and into a pipe for the smoker to inhale.

As with vaping, the use of hookahs and ‘shisha smoking’ is often promoted as a ‘safer’ alternative to cigarette smoking. Like e-cigarette products, the use of sweet flavourings reinforce the belief that this is a harmless activity. This is not the case, however, with water pipe smoking carrying many of the same health risks as cigarette smoking, including cancer, heart disease and respiratory disease.

Even though many shisha products claim to be ‘tar free’ it’s important to remember that burning creates tar. While the shisha itself may not contain tar, when the product is heated tar is produced and is present in the smoke. When this is inhaled, it can potentially cause mouth and lung cancers, as well lead to possible heart disease, just like cigarette smoke. In fact, the World Health Organization (WHO) found that in a typical shisha smoking session taking approximately 45 minutes to 1 hour, the smoker can inhale up to 200 times the volume of smoke inhaled with a single cigarette.

In recent times, shisha or hookah bars have become increasingly popular in Australian cities as places to socialize, with various flavours of shisha available for smoking. Smoking in these venues leads to inhaling even more smoke, for longer periods than typical cigarette smokers. Secondhand smoke in these environments can be particularly dangerous, not only containing tobacco smoke, but smoke from the heat source used in the hookah (usually charcoal). It’s also important to note that sharing a water pipe mouthpiece poses a serious risk of transmission of a range of communicable diseases such as hepatitis. Even though shisha bars now often provide disposable mouth tips for hygiene and do their best to increase ventilation to reduce the amount of secondhand smoke they continue to be risky environments, particularly for non-smokers.

Although shisha smoking may be regarded as a relatively harmless social activity amongst certain cultural groups, it is not a safe alternative to cigarette smoking and poses a serious health hazard to both the smokers and others exposed to the secondhand smoke that is produced.

First published: April 2024

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