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Middlesex-London Health Unit

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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.

What is Shisha?

Shisha is a blend of moist tobacco OR herbs, preservatives and flavourings held together with molasses or honey.2 Shisha is available in many flavours such as apple, plum, coconut, mango, banana, licorice, lemon, orange, tutti fruity etc.2 5 9

It is hard to know the exact amounts of the ingredients contained in a shisha package for several reasons:2 3 There is no standard labeling. Exact ingredients are often not labeled clearly, sometimes it indicates that there are ‘herbs’ but doesn’t say what those herbs are, and it doesn’t always state the amount of nicotine. Some packages have labeling in a foreign language. Even if packages do have labeling, some retailers will take shisha out of the original package and place in tupperware containers that have no labeling. Also, some waterpipe cafes prepare their own shisha mixtures.


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;

Date of creation: February 15, 2013
Last modified on: January 28, 2019


1American Lung Association. (2007). An Emerging Deadly Trend: Waterpipe Tobacco Use. American Lung Association: Washington, D.C. Retrieved from
2Non-Smokers' Rights Association and Smoking and Health Action Foundation. (2007). Waterpipe Smoking in Canada: New Trend, Old Tradition. Retrieved from
3The Ontario Tobacco Research Unit. (2011). Waterpipe Smoking: A Growing Health Concern. OTRU: Toronto, ON. Retrieved from
4Non-Smokers' Rights Association and Smoking and Health Action Foundation. (2008). Second-hand smoke and hookah pipes. Retrieved from
5Centers for Disease Control and Prevention. (2011). Smoking & Tobacco Use: Hookahs. Retrieved from
6Government of Alberta. (2012). Waterpipe Smoking in Alberta: A Report by the office of the Chief Medical Officer of Health. Government of Alberta: Alberta, Canada. Retrieved from
7Boak, A., Hamilton, H. A., Adlaf, E. M., & Mann, R. E. (2013). Drug use among Ontario students, 1977-2013: Detailed OHDUHS findings. (CAMH Research Document Series No. 36). Toronto, ON: Centre for Addiction and Mental Health. Retrieved from
8World Health Organization. (2015). Waterpipe tobacco smoking: health effects, research needs, and recommended actions for regulators (2nd Ed). Geneva, Switzerland: WHO Document Production Services.
9American Lung Association. Hookah Smoking: A growing threat to public health. Retrieved from