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Hookah and waterpipe smoking

​​Hookah, or waterpipe smoking (also called nargile or shisha), was traditionally used in India, South Africa, Persia, and Ethiopia. In Alberta, hookah is available in hookah bars and some restaurants.

You may have heard that hookah is safe. But research shows it’s not a safe option to smoking and may harm your health. Messages and ads about hookah products often say they are herbal and don’t have tobacco. But this is misleading.

About hookah

Traditional hookah is a mix of tobacco and a sweet-tasting liquid called glycerin. There may also be honey added to it. Hookah can have different amounts of nicotine. Hookah doesn’t always have tobacco, but testing shows even products that say they are tobacco-free may have tobacco and nicotine.

Nicotine is a very addictive drug. Once you use a product with nicotine, it can be hard to stop without having unpleasant symptoms.

Over the last 20 years, hookah has become more popular and can be bought in stores. It may also have flavouring added to make it more appealing. 

Some hookah products say that they are “washed.” But this doesn’t mean that they have less nicotine or that they’re safer to use than other hookah products.

Health risks

Anytime a hookah product is burned with or without tobacco, it creates smoke that releases harmful and toxic chemicals. It's safest for you and your family to avoid using and breathing in this smoke.

Smoke from hookah has been linked to the same diseases as smoking cigarettes, such as cancer, heart disease, and lung disease. 

Using hookah during pregnancy can put the baby at risk for sudden infant death syndrome (SIDS), low birthweight, and breathing issues. It can also put the baby at risk for changes in how their brain grows, which may affect learning and behaviour later in life.

A lot of people think that hookah is safer than using other tobacco products because there’s water in the base of the pipe. But research tells us the water doesn’t act as a filter.

The World Health Organization found that a hookah user may inhale as much smoke in a 1-hour session as someone who smokes 100 or more cigarettes.

Infectious diseases

Studies show that infectious viruses (such as COVID-19) can stay in the air and on surfaces for a long time. Using a waterpipe can put you at a higher risk of contact with these disease-causing viruses.

Infectious diseases like herpes can spread when you share the same mouthpiece with others. The moisture in the waterpipe is a great place for germs to grow. It’s also hard to properly clean and sanitize the mouthpiece and other parts of a waterpipe.

Cancer-causing chemicals

Waterpipe smoking is linked to lung cancer and death from cancer. Burning hookah, including hookah without tobacco, still creates cancer-causing chemicals. The levels of these cancer-causing chemicals in hookah smoke are the same as or even higher than tobacco products.

These chemicals are in the smoke that you breathe in from the waterpi​pe. They’re also in the second-hand smoke that you breathe out. So even being around hookah smoke—for example, if you work in hookah bars—​puts you at risk for health problems from second-hand smoke.

Note: References to “tobacco” on this page do not include “traditional tobacco” used by First Nations and Métis groups for ceremonial purposes.

Current as of: February 8, 2024

Author: Tobacco, Vaping and Cannabis Program, Alberta Health Services