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Long popular in Africa, South East Asia and the Middle East, shisha or water pipes are increasingly popular in other regions – despite the risk for cancer that they pose to both smokers and those exposed to second-hand smoke.

Tobacco use is the single greatest cause of preventable death worldwide, claiming nearly six million lives each year. Many of these are cancer-related. Although tobacco use remains the greatest risk factor for cancer, consumption is still on the increase. The number of users now totals more than one billion.

While the health harms of cigarette smoking are well known, the dangers of using waterpipes, or shisha, are less familiar. Traditionally smoked in Africa, South East Asia and the Middle East, shisha pipes are increasing in popularity around the world. In Europe and the Americas, waterpipes are now available at some restaurants and bars, filled with flavoured and sweetened tobacco -- as such they are attractive and readily available to young people. Use is also increasing amongst women, for whom cigarette smoking is less acceptable in some cultures.

A common misperception is that smoking shisha is less harmful to health than cigarettes because water filters the smoke. In fact, during a one-hour shisha session a user can inhale the same amount of smoke as from one hundred cigarettes. Shisha also causes nicotine addiction, and exposure to second-hand smoke causes the same cancers and cardiovascular diseases as cigarette smoke.

In order to curb the use of shisha and the health harms it causes, it must be banned from all indoor public places within the comprehensive and well-enforced smokefree laws. Awareness–raising campaigns are needed to inform people of the dangers associated with shisha use. And waterpipes and waterpipe tobacco should display graphic health warnings.

Find out more about the health consequences of shisha smoking here.


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The Tobacco Control Department is based at The Union Europe Office, Edinburgh, registered charity no. SC039880
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