Case study

DFID Research: The dangers of waterpipe smoking

Research shows that smoking tobacco in hookah pipes can be as harmful as smoking cigarettes.

Hookah pipes
Hookah pipes. Picture. Gilles 1313/FLICKR

Research for International Tobacco Control (RITC) working with a multidisciplinary team at the American University of Beirut in Lebanon, led by IDRC and supported by DFID has generated groundbreaking results on the consequences of waterpipe smoking.

Researchers have developed an artificial smoking machine that generates smoke samples, allowing them to analyse the content of waterpipe smoke. Results from these studies indicated that contrary to popular belief, waterpipe smoke contains many of the toxins that make cigarette smoke dangerous, and some are present in much greater quantities. The rising popularity of waterpipes for the consumption of shisha - a mixture of tobacco, molasses and fruit flavours, appears partly due to unfounded assumptions that waterpipes are a safer way to smoke, and misleading marketing used to exploit misconceptions. The waterpipe, often known as a ‘hookah’, has been used for centuries in North Africa, the Middle East and Central and South Asia. It has recently become increasingly popular in the West, particularly among college students and young adults, with special bars opening up in some cities to exploit the new market.

Comparing the content of smoke and measuring smoking behaviours among cafe-goers has shown that using a waterpipe usually exposes a person to more smoke over a longer period of time than do cigarettes. A person can inhale more than 100 times more smoke in a hookah session than in a single cigarette. Research also suggests that those exposed to secondhand hookah smoke appear to be at risk of the same diseases as those exposed to cigarettes.

A significant outcome of the research is the major role it has played in stimulating the World Health Organization (WHO) to issue a Scientific Advisory Note on Waterpipe Tobacco Smoking, to publicise the dangers. WHO has warned that hookah smoke could also increase the risk of adverse effects during pregnancy. WHO has drawn on the RITC research in developing its anti-smoking policy; suggesting that governments of all countries should declare public indoor places smoke-free by passing laws and actively enforcing them.

Published 2 February 2009