WaterpipeBy Dr Colin Mendelsohn, Tobacco Treatment Specialist, Sydney www.colinmendelsohn.net.au

Waterpipe smoking is becoming increasingly common among young people in some parts of Australia. However there are many misconceptions about waterpipe use.

In the waterpipe (hookah, shisha, narghileh), air is drawn through heated charcoal, then through perforated aluminum foil and moist tobacco (‘Maassel’) in the head of the device. The resulting smoke bubbles through the water in the bowl and is inhaled by the smoker through a mouthpiece.

Young people are attracted by the taste of the flavoured, sweetened tobacco smoke, the novelty factor and the social experience of sharing with others.

Myth 1. The water filters out toxins from the smoke

Wrong. The water cools the smoke making it smoother to inhale, but does not reduce the intake of toxic chemicals. Even after passing through the water, the smoke contains high levels of toxic compounds from tobacco as well as additional toxic ingredients from the combustion of charcoal used to heat the tobacco. These include carbon monoxide, heavy metals and cancer-causing agents. Some chemicals such as carbon monoxide and certain cancer-causing agents such as hydrocarbons are at much higher levels than from cigarette smoke. (1,2)

Myth 2. Waterpipe smoking is safe

Wrong. Waterpipe smoking may be at least harmful if not more harmful than cigarettes. (2,3) Waterpipe smokers take deeper and longer puffs over a long period of time, exposing themselves to more toxic chemicals. In a typical 1-hour session a waterpipe smoker may inhale as much smoke as a cigarette smoker may inhale from 100 cigarettes or more. (3)

Waterpipe smokers are at risk of the same kinds of diseases as are caused by cigarette smoking. (2,3) A review of the research so far found that it is associated at least with lung cancer, respiratory illness, low birth-weight and periodontal disease. (4) It is very likely that many other diseases will be identified with further research.

Secondhand exposure to waterpipe smoke is also a serious risk to non-smokers, especially pregnant women. (3) Sharing a waterpipe mouthpiece also poses a risk of transmitting infectious diseases. (3)

Myth 3. Waterpipe smoking is not addictive

Wrong. Waterpipe smoking delivers at least as much nicotine as cigarettes and can hook young people on nicotine just like smoking. (2) Young people are particularly sensitive to nicotine and can become addicted very quickly, even after a single session in some cases. Addicted users experience urges to smoke and withdrawal symptoms (restlessness, anxiety, depression) after a break from smoking and most regular users have difficulty quitting. (5)

Waterpipe smokers are also at higher risk of transitioning to regular cigarette smoking, compared to those who have not used waterpipes. (5)

Image from Unsplash


1) Shishani K. Hookah Use. Going Down in Smoke. J Add Nursing 2012

2) Eissenberg T. Waterpipe Tobacco and Cigarette Smoking- Direct Comparison of Toxicant Exposure. Am J Prev Med 2009

3) World Health Organisation. Waterpipe Tobacco Smoking. Health effects, research needs and recommended actions. 2005

4) Akl. EA. Effects of waterpipe tobacco smoking on health. Nic Tob Res 2011

5) Maziak W. The Waterpipe. A New Way of Hooking Youth on Tobacco. Am J Addict 2014