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The Truth About Shisha Smoking


Shisha may not offer the same taste, or smell, of regular cigarettes but don't let that fool you. Shisha (or waterpipe) smoking may end up being more harmful for your health than most people realise. Way, way more harmful.

Misconception About Shisha
While cigarettes are universally considered harmful, shisha doesn't usually appear on our radar as a potential health hazard. Says Dr K Vijaya, Director, Youth Health Division, Health Promotion Board, "Many consider shisha smoking to be an occasional social activity and hence, not harmful. The tobacco used for shisha smoking is often flavoured which masks its danger and increases the appeal of shisha smoking to youth and young adults."

This social nature of shisha smoking may even lead to addiction, she says. "In a study conducted by Maziak W et al (2004), authors noted that as shisha smokers receive comparable or higher doses of nicotine compared to cigarette smokers due to the social nature of the activity, addiction can set in. However, there has been no published study on when this addiction comes about and whether shisha tobacco is more addictive than cigarettes," explains Dr Vijaya.

The main culprit for causing addiction is nicotine, which is found in shisha tobacco as well as regular cigarettes. This substance is as addictive as drugs like heroin and cocaine, according to Dr Vijaya, and shisha smokers have been shown to receive similar or even higher doses of nicotine. She says, "Shisha smokers reportedly suffer from many, if not all, of the indications of nicotine dependence. These include craving for nicotine fix, anxiety, restlessness, difficulty concentrating, headaches, and irritability."

More Dangerous Than Cigarettes
With sweet scented flavours like apple, grape or peppermint, shisha smoke certainly doesn't smell or taste like your typical harsh cigarettes. But beneath that innocent fragrance, the smoke it produces is just as harmful -- containing tar, carbon monoxide and nicotine just like cigarette smoke.

Dr Vijaya explains further, "Cigarette smoke contains over 4000 chemicals of which 400 are poisonous and at least 69 are cancer-causing. Besides measuring concentrations of three of the constituents of cigarette smoke - tar, carbon monoxide and nicotine - there are no ISO standards to measure the concentration of the rest of the constituents of cigarette smoke. Similarly, studies have revealed that smoke released into the atmosphere when shisha tobacco is burnt contains tar, carbon monoxide (from incomplete combustion of the shisha tobacco as well as the charcoals used to burn the tobacco), nicotine, heavy metals and cancer-causing chemicals. However, concentrations of the ‘heavy metals’ and ‘cancer-causing chemicals’ are not known."

In the table below, the shocking truth about the chemical composition of shisha smoke is revealed. 

Table 1: Chemicals found in shisha smoke versus cigarette smoke

Tar, mg 802

Range: 1-27

Average: 11.2

Nicotine, mg 2.96

Range: 0.1 – 2

Average: 0.77

Carbon Monoxide (CO), mg 143

Range: 1-22

Average: 12.5


Source: Shahadeh, A., Saleh, R., (2005) ‘Polycyclic aromatic hydrocarbons, carbon monoxide, ‘tar’ and nicotine in mainstream smoke aerosol of the narghile water pipe. Food & Chemical Toxicology, 43:655-661

What Shisha Can Do To You
Dr Vijaya lists the various health risks posed by shisha smoking:

a. Cancer Threat
The charcoal used to heat tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals. Even after it has passed through water, the smoke produced by a hookah contains high levels of toxic compounds, including carbon monoxide, heavy metals, and cancer-causing chemicals. Hookah tobacco and smoke contain numerous toxic substances known to cause lung, bladder, and oral cancers.

Irritation to the mouth from exposure to tobacco juices increases the risk of developing oral cancers. The irritation by tobacco juice products is likely to be greater among hookah smokers than among pipe or cigar smokers because hookah smoking is typically practiced (with or without inhalation) more often and for longer periods of time. 

b. Heart disease
Hookah tobacco and smoke contain numerous toxic substances known to cause clogged arteries and heart disease.

c. Flu
Sharing of smoking pipes increases risk of tuberculosis and flu.

d. Second-hand smoke
Second-hand smoke from hookahs poses a serious risk for non-smokers, particularly because it contains smoke not only from the tobacco but also from the heat source (e.g., charcoal) used in the hookah.

Giving Up
If you do feel moved to give up shisha smoking, HPB has some help at hand. Says Dr Vijaya, "Our Certified Smoking Cessation Consultants and Quit Counsellors manning QuitLine have been trained to assist to shisha smokers who seek assistance to quit." 
You can call the QuitLine at 1800 438 2000 or find out more about their Quit Centres.

Learn more about the dangers of shisha at


(Comments may take up to 15minutes to appear)
BANNED Cigarettes & Shisha in Singapore !!! I am a smoker but I support this ban totally ...

I am not completely in favor of banning cigar and hookah. I agree that shisha is a form of tobacco and it is harmful for health but there are many hookah flavors which are herbal and has no side effects on body. So, there should not be ban on such hookahs but ban other cigar products.

This article provides false information. When done properly, Shisha tobacco is not burnt, but only heated to the point that the nicotine is vaporized. Therefore, it does not release tar, and other chemicals associated with burning tobacco.

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