Health Impacts

Studies have demonstrated that waterpipe Tobacco Smoking is very harmful!

Effects on The Cardiovascular System

Acute Cardiovascular Effects

  1. Increases Heart Rate (HR).
  2. Increases Blood Pressure (BP).
  3. Impaired Pulmonary Function (PF).
  4. Coronary Artery Disease (CAD).

Long-Term Cardiovascular Effects

  1. Ischemic Heart Disease or Heart Failure.

Effects on The Respiratory System

Acute Respiratory Effects

  1. Increased Respiratory Rate (RR).
  2. Carbon Monoxide Intoxication.

Signs and symptoms of carbon monoxide poisoning may include:

  1. Dull headache.
  2. Nausea or vomiting.
  3. Shortness of breath.
  4. Blurred vision.
  5. Loss of consciousness.
  6. Impaired Pulmonary Function (PF).
  7. Decreased Exercise Capacity.

Long-term Respiratory Effects

  1. Chronic Obstructive Pulmonary Disease (COPD).
  2. Chronic Bronchitis.
  3. Chronic Emphysema\.
  4. Asthma.

Association of WPS with Cancer

  1. Lung Cancer.
  2. Oesophageal Cancer.
  3. Gastric Cancer.
  4. Bladder Cancer.

Obstetrical and Perinatal Outcomes

  1. Low Birth Weight.
  2. Pulmonary Problems at Birth.

Periodontal and Oral Disease

  1. Periodontal disease.
  2. Larynx and Voice Changes.


  1. Lower bone density and increased fracture risk.

Infectious Disease


Other Health Outcomes

  1. Greater BMI and risk for obesity.
  2. Elevated Urine Microalbumin.
  3. Low Back Pain.
  4. Increased risk of Gastroesophageal Reflux.
  5. Hearing Loss.
  6. Hand Eczema.
  7. Acute Eosinophilic Pneumoni.
  8. Lower lip keratoacanthom and ulcerative colitis flare after discontinuing WPS.
  9. Lower overall health-related quality of life.

Related References

  1. Advisory note: waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators – 2nd edition
  2. Fact sheet: waterpipe tobacco smoking & health
  3. WHO’s work on tobacco product regulation
  4. Publications on tobacco product regulation
  5. Research paper: ‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served
  6. Smoking & Tobacco Use
  7. Herbal Shisha & Tobacco Free Hookah
  8. American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. [PDF–222 KB] Washington: American Lung Association, 2007 [accessed 2015 Sep 14]
  9. American Lung Association. [PDF–1.34 MB] Smokefree Communities Project, 2011 [accessed 2015 Sep 14]
  10. Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review. International Journal of Epidemiology 2010;39:834–57 [accessed 2015 Sep 14]
  11. Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States . American Journal of Health Behavior 2010;34(3):275–85 [accessed 2015 Sep 14]
  12. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General . Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012 [accessed 2015 Sep 14]
  13. U.S. Food and Drug Administration.
  14. Electronic Cigarettes (e-Cigarettes) . [last updated 2013 April 25; accessed 2015 Sep 14]
  15. El-Hakim Ibrahim E, Uthman Mirghani AE. Squamous Cell Carcinoma and Keratoacanthoma of the Lower Lips Associated with “Goza” and “Shisha” Smoking. International Journal of Dermatology 1999;38:108–10 [cited 2015 Sep 14]
  16. Nuwayhid, I, Yamout, B., Ghassan, and Kambria, M. Narghile (Hubble-Bubble) Smoking, Low Birth Weight and Other Pregnancy Outcomes . American Journal of Epidemiology 1998;148:375–83 [accessed 2015 Sep 14]
  17. Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indoor Air Quality in Virginia Waterpipe Cafés. Tobacco Control 2012 Mar 24 doi:10.1136/tobaccocontrol-2011-050350 [cited 2015 Sep 14]
  18. Shihadeh A, Salman R, Eissenberg T. Does Switching to a Tobacco-Free Waterpipe Product Reduce Toxicant Intake? A Crossover Study Comparing CO, NO, PAH, Volatile Aldehydes, Tar and Nicotine Yields . Food and Chemical Toxicology 2012;50(5):1494–8 [accessed 2015 Sep 14].
  19. Blank MD, Cobb CO, Kilgalen B, Austin J, Weaver MF, Shihadeh A, Eissenberg T. Acute Effects of Waterpipe Tobacco Smoking: A Double-Blind, Placebo-Control Study. Drug and Alcohol Dependence 2011;116(1–3):102–9 [cited 2015 Sep 14]