Described as a global epidemic, the popularity of waterpipe smoking has been steadily increasing since the 1990s. With mouth-watering flavours, exotic appeal and widespread misperception about its health effects, waterpipe smoking is emerging as a chic new trend among young adults worldwide, including Canada. This is a concern, given that the cigarette smoking rate among 20-24 year olds is significantly higher than the national average (22% vs 17%) and has started to flatline in recent years.

A typical waterpipe has 4 main components: a head, body, water bowl and one or more hoses. Shisha (which may or may not contain tobacco) is placed in the head of the pipe and covered with perforated tinfoil. A piece of charcoal is placed on top. Shisha has a high moisture content and thus is not capable of self-sustained combustion, instead requiring the heat of the burning charcoal on top to produce smoke. When the smoker sucks on the hose, a vacuum is created which pulls the smoke down from the head of the waterpipe through the hollow body, where it bubbles up through the water bowl and is cooled before being inhaled.

Shisha has a high sugar content which, when mixed with flavourings like candy, fruit or alcohol, makes the smoke extremely aromatic. Due to a lower combustion temperature and the fact that it passes through water before being inhaled, hookah smoke is both cooler and moister than cigarette smoke. The result is a smoke that both smells and tastes good and has a smoothness that is easily tolerated—masking the tobacco taste and softening the smoking experience for beginners.

There is a widespread perception that smoking tobacco in a waterpipe is less harmful and less addictive than cigarette smoking—because hookah smoke travels through water, the harmful constituents are believed to be filtered out before being inhaled. The cooling and moisturizing effect of the water makes the smoke less irritating, confirming the belief that waterpipe is a relatively benign method of smoking. These misperceptions both encourage people to try smoking a waterpipe and reduce concerns about limiting use or quitting smoking altogether. In addition, given that a sizeable minority of smokers believe that nicotine itself causes most of the cancer associated with smoking, it is reasonable to hypothesize that nicotine-free “herbal” shisha is viewed by some as a “healthier” smoking option.

Studies looking into the toxicants of waterpipe smoke have reported that it likely contains many of the chemicals that are associated with the elevated incidences of cancer, cardiovascular disease and addiction of cigarette smokers. The Ontario Tobacco Research Unit (OTRU) has examined the evidence and concludes that waterpipe tobacco smoke is at least as toxic as cigarette smoke.

Provincial and territorial smoke-free legislation and local bylaws pertain only to tobacco, with the exception of Quebec and a couple of dozen municipalities in BC, AB and NS. For all other jurisdictions, the smoking of other weeds or substances is not included. It is increasingly common at hookah establishments for proprietors to remove tobacco shisha from its original packaging and store it in unlabelled plastic containers. Claiming the shisha is “herbal” and does not contain any tobacco, proprietors are circumventing smoke-free laws and allowing customers to smoke indoors. Permitting smoking in public places and workplaces is confusing to the public and undermines enforcement efforts.

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