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Middlesex-London Health Unit

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Smoke is Smoke

All smoke is harmful, whether it comes from commercial tobacco, cannabis (marijuana) or from a hookah pipe (waterpipe). Smoke is smoke.

While it is well known that there is no safe level of commercial tobacco smoke, many are not aware of the health risks associated with exposure to smoke from cannabis or a hookah pipe. Just like tobacco, both produce first- and second-hand smoke.



Commercial tobacco is the leading cause of preventable death and illness in Canada and costs the province of Ontario $7.73 billion annually.7 The Tobacco Industry is always looking to create new tobacco products to entice youth to start using tobacco. Some of these products are regulated and permitted in Canada, while others are not. All tobacco products and tobacco exposure are harmful and can have negative health effects.

A Hookah or waterpipe is a device used to smoke specially made tobacco and non-tobacco herbal products called shisha.1 Both tobacco and herbal shisha can produce toxic chemicals such as carbon monoxide, ultrafine particles and aldedhydes.1,2,3 However, not only does the shisha give off chemicals, but so does the burning charcoal. The charcoal used to heat the shisha produces very high levels of carbon monoxide, heavy metals and cancer causing chemicals.2,3


Smoke from cannabis (marijuana) has been shown to have many of the same toxic chemicals as tobacco such as fine particles, heavy metals and carbon monoxide.4 Cannabis smoke also contains THC (delta-9-tetrahydrocannabinol), the chemical responsible for the “high” experienced by users. Breathing in second-hand cannabis smoke could negatively affect the health of those exposed.5,6


Instead of creating smoke, an e-cigarette (or vapour product) creates a vapour once activated. While e-cigarettes may be safer than regular cigarettes, less harmful doesn’t mean safe. Learn more about e-cigarettes (vapour products) to make an informed decision.

Traditional/Sacred Tobacco

For many First Nations communities, tobacco is a gift given by the Creator, which is respected and honoured. Visit the Indigenous Tobacco Program through Cancer Care Ontario to learn more.

Limit Exposure

Limiting exposure to all sources of smoke (commercial tobacco, herbal shisha and cannabis) is the best way to protect yourself and others from the harmful effects.

  • Avoid places where you might be exposed to any kind of second-hand smoke.
  • Make your home and car smoke-free.
  • Avoid smoking tobacco, herbal shisha or cannabis around of children, pregnant women, older adults and those with health conditions such as asthma, lung and heart disease.
  • If you smoke any substance, think about quitting.
Date of creation: September 25, 2017
Last modified on: February 21, 2020


1American Lung Association. (2007). An Emerging Deadly Trend: Waterpipe Tobacco Use. American Lung Association: Washington, D.C. Retrieved from
2Centers for Disease Control and Prevention. (2011). Smoking & Tobacco Use: Hookahs. Retrieved from
3World Health Organization. (2015). Waterpipe tobacco smoking: health effects, research needs, and recommended actions for regulators. (2nd Ed). Geneva, Switzerland: WHO Document Production Services.
4Smoking and Health Action Foundation. (2016). Secondhand Marijuana Smoke: Health effects of exposure. Retrieved from
5Centers for Disease Control and Prevention. (2017) Marijuana and Public Health. Retrieved from
6State of Colorado. (2017). Smoking and secondhand smoke. Retrieved from
7Smoke-Free Ontario Scientific Advisory Committee. (2010). Evidence to Guide Action: Comprehensive Tobacco Control in Ontario. Retrieved from