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What is waterpipe
  • Waterpipe is also known as hookah and shisha. It is a tobacco-smoking device that originated from the Middle East and getting popular in other regions.
  • The main components of waterpipe are tobacco bowl and water bowl. It is connected with single or multi-hose for inhaling tobacco smoke which heated by the lit charcoal.
  • It is common that flavourings are added to the harsh tobacco in waterpipe to attract youth and non-smokers to use.
  • Design of waterpipe devices are fancy and glamourous which intends to conceal the health risks of the products.
Health risks of waterpipe tobacco Smoking
  • Smoke of tobacco contains numerous toxicants including tar, carbon monoxide, heavy metals and carcinogens even it passed through water. The concentration of carbon monoxide and carcinogenic PAH is even higher than that in traditional cigarettes.
  • Due to the mode of smoking, including frequency of puffing, depth of inhalation, and length of the smoking session, waterpipe smokers may inhale more toxins than smoking cigarettes. Research found that one-hour waterpipe smoking session exposes the user to 100 to 200 times the volume of smoke inhaled from a single cigarette. It also results in a carbon monoxide level at least four to five times higher than the amount produced by one cigarette.
  • Waterpipe smokers are at risk of the same kind of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the oesophagus, heart disease, cardiovascular disease, chronic obstructive pulmonary disease, reduced lung function and decreased fertility.
  • The combustion of charcoal increases the health risks by producing high levels of carbon monoxide, heavy metals and hydrocarbons.
  • Waterpipe smoking delivers the addictive drug nicotine and causes dependence.
  • Secondhand smoke from waterpipe is also harmful to the health of other people.
Situation in Hong Kong
  • Waterpipe smoking with diversified flavours was offered by some restaurants in Hong Kong in recent years. Waterpipe smoking is positioned as a trendy social gathering among the youth and its adverse health effects are underestimated.
  • The School of Public Health of The University of Hong Kong was commissioned by COSH to conduct a survey to understand the perception of waterpipe tobacco Smoking among young adults. The survey found that majority (94.5%) of respondents reporting awareness of waterpipe tobacco Smoking. Around 30.4% and 13.4% of respondents had ever used waterpipe tobacco and were current waterpipe smokers respectively.
  • Over one-fourth (27.4%) of never-using respondents were susceptible to waterpipe smoking.
  • Ranging from 0 (lowest) to 10 (highest), majority of respondents perceived traditional cigarettes (9.05) were more harmful than waterpipe (7.65); and traditional cigarettes (8.56) were more addictive than waterpipe (6.84). This reflected that young adults underestimated the adverse effects of waterpipe smoking to one’s health.
Recommendation of WHO and legislation in Hong Kong
  • The World Health Organization (WHO) recommend a series of regulatory measures on waterpipe tobacco including (1) ban of use in public places; (2) ban of use of flavourings in waterpipe tobacco products; (3) regular increase of taxes on waterpipe and other tobacco products; and (4) ban or restriction on the sale and/or trade of waterpipe tobacco products.
  • According to the Smoking (Public Health) Ordinance, anyone who smokes waterpipe tobacco in statutory no smoking areas will also be prosecuted and be fined of fixed penalty of $1,500.
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