What a drag! Sheesha smoking is an oral tradition that should go up in smoke

By Nancy Collisson

 Sheesha, shysha, shisha.

No matter how you smell it, you know what it is: a fascinating conduit for convivial socialization that has been used for centuries particularly in Arab countries, Persia, and north India. And although there may be something seductive about the ritual involved in smoking from a sheesha (as I spell it) water-pipe — from its evocative hour-glass shape, gurgle of water, and obvious oral fixative — there is little that can be considered sensuous about the confirmed dangers to health that are associated with it.


From unsightly plaque and tooth decay, periodontal disease, lip and mouth cancer, decrease in lung function, heart ailments, decreased brain weight in infants born to sheesha-smoking or second-hand-smoke-inhaling mums, to the transmission of communicable diseases from shared saliva through its multi-person use at public venues, the sheesha sends some breathtaking smoke signals.

Amazingly however, despite the worldwide prevalence of information about the dangers of cigarette smoking, the practice of sheesha smoking, typically having been most widely practiced among the male population in Arab countries, is presently not only increasing among Arab women in those countries, but is also becoming popular in the West where members of these populations have settled, unpacked the pastime, and introduced its practice. Its newfound, multinational aficionados now partake in Manchester, Montreal, and Minneapolis.

Never snuffed out

Also commonly known as the narguilah, argila, hubbly bubbly or hookah, the glistening and sometimes bejeweled instrument is a novelty for the novice and an indispensable cultural icon for its devotees.

Intimate personal rituals are involved in preparing the instrument and integrating it in conversation. It may be shared, like an American Indian peace pipe, to establish a feeling of brotherhood. Puffs taken from it help punctuate commentary. As a tradition throughout the Middle East, the smoking of the sheesha has artfully enhanced story telling, and its practice there likely will never be snuffed out.

Reasons for ‘smoking the sheesha’ (as the practice is usually described, keeping in mind that a sheesha is the instrument that enables smoking), are twofold, and as intriguing as the unique health concerns associated with it. Determining which reason more greatly influences its users’ desire to continue or quit creates a challenge both for marketeers of sheesha-related products and for representatives of health organizations who encourage its demise.

First is the obvious that even the least analytical can conclude: folks suck on the sheesha because doing so makes them happy. Like infants at the breast, taking a deep one seems to help them take their minds off the worst of their troubles. They most enjoy partaking communally with friends or family members. Even to the most highly health conscientious among us — those who wouldn’t think of smoking anything from anything — there is something undeniably enviable in the look of hanging out with pods of people lounging along cushions in an after-dinner haze drawing happily on apple, honey or cherry-flavoured tobaccos from burbling water-pipes, blissfully unconcerned about the portentous potential of being fatally harmed by repeatedly inhaling tiny particles of nicotinized carbon monoxide from charcoal bits used to ignite tobacco placed into it. Given the seductive atmosphere, it’s easy to get sucked in.

Cigarettes v. Sheesha

The other reason folks take it up seems due to the widely clung-to delusion that inhaling through one of these big gizmos is safer than dragging on their relatively tiny cigarette counterparts because the instrument seems to filter more tar and nicotine. Many will say that the sheesha is ‘safe’ because as the inhaled smoke passes over a bowl of water and up through a long tube before reaching a mouthpiece and entering one ‘ s mouth it feels cooler than smoke inhaled of a cigarette. At pricier venues, tubes are inserted directly into the fleshy pink interiors of watermelons. (What could seem more fresh?) As their perceptual defense, sheesha smokers cling to false sense of confidence that the dangerous effects from smoking literally have been diluted.

But the fact is, because the average sheesha smoker tends to spend concentrated lengths of time smoking relatively large amounts of tobacco at one sitting, even if done only a few times per week, his or her nicotine intake is greater than that of the average cigarette smoker. As a result, sheesha users are equally if not more acutely vulnerable to smoking-related diseases.

Saudi/Swedish Study

Commenting on this misconception, Dr. Mostafa Baljoon, a Saudi Arabian dentist who concluded a study that incorporated analysis of sheesha smoking there, said ” Many people [in this region] think that smoking sheesha is less of a health hazard than cigarettes because there isn’t much research on sheesha. ” His study was prepared by the ethics committee of King Faisal Specialty Hospital & Research Center and King Abdul Aziz University Faculty of Dentistry, both in Jeddah, and was approved by the ethics committee of Karolinska Institutet at the Huddinge University Hospital of Stockholm.

The study invited participation of 325 Saudi Arabian male and female smokers from the ages of 21 to 70, to allow doctors to learn particularly more about oral health hazards associated with sheesha smoking. Thirty-eight percent of the participants smoked sheesha, and 21 percent of them smoked both sheesha and cigarettes.

1 Sheesha = 18-50 Cigarettes

According to Dr. Baljoon’s report, there has been a “remarkable revival” of sheesha smoking in recent years, noting that the habit has become as common among women as men. His concern about the health of both is drawn from results of his tests that show that smoking one sheesha is equivalent to smoking 18 cigarettes, nearly one pack. An even more startling determination was made in another study conducted by the Ministry of Health in Qatar. In that study, a Dr. H.A. Hajr concluded that the mass usually placed inside the bowl of a common water pipe is the equivalent, in terms of nicotine, to to the amount consumed by smoking 50 cigarettes.

The Saudi/Swedish study found that sheesha as well as cigarette smoking produces harmful effects on ventilatory capacity and increases the risk of developing what they call obstructive-airways disease, with sheesha smokers being at a greater risk. Furthermore, in terms of (generally popularly motivating) aesthetic impact, it was determined that sheesha smokers have higher statistical rates of dental plaque than cigarette smokers.

Dr. Baljoon also noted that a statistically significant level of infants born to sheesha-smoking mothers has low birth weight. Low birth weight generally translates into low brain weight, as the brain is where babies have their greatest weight. While 10 percent of cigarette smokers have low birth-weight babies, 7.5 percent of sheesha smokers have low birth-weight babies. (Four percent of the babies of non-smokers are considered low birth-weight.)

Swapping Spit / Communicable Diseases

While detailed studies on the risk of sheesha use in relation to communicable diseases remain limited — in fact none has been completed by the renowned Centers for Disease Control or World Health Organization — significant patterns have generated cause for concern and elicited commentary, at least, from WHO representatives.

In analyzing health hazards associated with smoking in general, the factor that sets sheesha smoking apart is that water-pipes accessible at sheesha joints throughout the world, are generally shared — like drinking glasses at bars. The difference is, sheesha pipes are impossible to clean, so they’re not. Even if the water bowl and mouthpiece were boiled in a vat of antibacterial gel between uses, water vapor and saliva droplets blown into the typically unwashable cloth-fiber tube would likely snuggle far enough inside the soft secure fibers of the tube — an ideal dark and damp habitat where bacteria and germs are happy to proliferate.


According to Alissar Rady, a medical officer at the World Health Organization, sheesha smoking is directly related to the spread of orally transmitted diseases, though the extent of the effect cannot be measured.

“Any disease that can be transmitted through contact with saliva is possible to contract when smoking narguilah, if cleanliness isn’t adhered to,” says Rady. “Colds, viruses like herpes, oral bacterial infections, and tuberculosis can all be passed through saliva.”

Because tuberculosis, like other orally transmitted diseases, can be spread through coughing and other means, there is no direct way to verify cases attributed to water-pipe smoking. However, according to Rady, the constant recycling of water-pipes at cafes raises concerns that water-pipe hoses that harbor bacteria create a means of transmitting contagion.

UAE Ban Plan

Health authorities in the United Arab Emirates and its exciting emirate of Dubai, in particular continually strive to enforce the legal smoking age of 21, as well as work to eliminate the spread of contagious diseases throughout the emirates.

If a link exists between communal use of smoking instruments and contagious diseases, then Dubai’s ban on smoking in enclosed public venues throughout Dubai, is a tiny first step toward eliminating that potential link.

Expatriates in the UAE who are found to have contracted communicable diseases are immediately deported. Since annual blood screenings are performed on all expatriates, such problems are expeditiously eliminated.

Hang up your hookah

The immense difficulty faced by governments throughout the world that attempt to eradicate communicable diseases such as TB could likely be helped by individuals who hang up their hookahs.

Unfortunately, throughout the Middle East, in particular, sheesha smoking for many is more than a passing fad. It is a cultural tradition featuring an iconic symbol of social solidarity and indulgence.

Despite its obvious or less obvious health risks, the instrument likely won’t be relegated a mere patio accessory anytime soon.

In recognizing the importance of keeping our germs to ourselves, at least, café owners who permit sheesha smoking could post signs that are similar to notes occasionally printed on party invitations: BYOB, or Bring your own beverages.

Their signs could read: BYOS!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s