Don’t Let Tobacco Take your Breath Away: Health impact of Smoking Shisha on University Undergraduate Students.

All over the globe shisha smoking is fast growing among different age brackets. Shisha smoking is also known as water pipe, hookah and Narghile smoking. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. It has been reported that most shisha smokers are unaware of the deleterious health consequences of shisha smoking. Shisha smokers believed the toxins in the smoke are filtered out by the water in the pipe. Hence, it is less harmful and nonaddictive. This however is not the case as it contains same substances as cigarette smoke such as carbon monoxide (CO), tar, and nicotine. Shisha smoke contains a wide array of chemical substances, many of which are highly toxic and carcinogenic for humans. These include significantly higher quantity of heavy metals such as arsenic, nickel, cobalt, chromium, lead, and cadmium than that of cigarette smoke. Longer duration of shisha sessions results in greater nicotine exposure than cigarette smoking and also CO level in shisha smoke is higher than that of cigarette smoke. The inhaled amount of CO can be as much as ten times high.

Shisha smoking just like any other tobacco product is a preventable cause of death, killing more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030[1]. In Kampala shisha smoking is high among youths attending bars yet knowledge of the health effects associated with shisha smoking is limited. A greater proportion of youths, who attend bars always smoke in the company of friends and majority of them share shisha pipes. A study conducted by Lugemwa Anthony that was aimed at assessing the determinants of shisha smoking among youths in Uganda by using the social cognitive theory, taking the cases of Makerere University, Kyambogo University, Cavendish University Uganda and Kampala International Universities in Uganda from August 2017 to November 2017 found out that shisha smoking is more prevalent in University students with a total percentage of 29.5%[2]. The study also found out that most students knew the fact that shisha causes lung cancer. Close associates like siblings and friends who smoke shisha greatly impacted significantly on the smoking status. The study is showed that prevalence of shisha smoking is high and there is a lack of knowledge in relation to its impact on health among university students.

The banning of shisha use in Uganda came in 2015 with the President of Uganda Yoweri Kaguta Museveni assenting the Tobacco Control Act 2015[3] which demands for consumption of tobacco and its products, to control supply of tobacco and its products to the population, to protect the environment from effects of tobacco production and consumption and exposure to smoke, to promote health of persons and reduce tobacco related illnesses and death among others. Unfortunately, there has been widespread attention focused on the dangers of cigarette smoking and increasing efforts to discourage cigarette smoking, but comparatively less attention has been put to dangers of shisha use apart from the crack downs by Kampala Capital City Authority (KCCA) and Uganda Police on illegal drugs and chemicals, commonly known as shisha, smoked in bars and other social places also targeting retail shops and restaurants[4].

Till now very few studies have investigated attitudes and beliefs towards shisha use. Markets in even the developed countries promote the fallacy shisha is less hazardous than smoking and it is the main driving factor behind its current popularity.  A study conducted on Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic states that, 30% of university students believe in the fallacy about shisha being less deleterious than cigarette[5] This increases the health related risks around shisha smoking among undergraduate students.

Research shows three additional risks to health of shisha smoking over cigarette smoking. The first being since shisha is smoked over coal this adds to the already many harmful toxins the smoke possesses. Secondly, a shisha smoker inhales up to 200 times more smoke in a single session as compared to cigarette smokers. Thirdly it is linked to high rates of second hand smoking due to its high social acceptance. The famous misperception that the shisha is filtered due to the water in it seems to be one main belief justifying it being less injurious, however it is well known that making air bubbles pass through water doesn’t change their content and since the volatile carcinogen of tobacco smoke and other particles will stay within the air bubbles during their passage through water, it does not render shisha any less harmful, at least, than cigarette[6]

The key health impacts of shisha smoking among undergraduate students include.

  1. Acute dysfunction in autonomic regulation of the cardiac cycles, as reduction in heart rate variability which is associated with inhalation exposure induced oxidative stress and increasing heart rate and blood pressure.
  2. Single shisha smoking session increases oxidation injury while daily smoking induces persistent long-lasting oxidation injury.
  3. Smoking one or more shisha per day during pregnancy is associated with reduction of weight and also increasing the risk of delivering low birth babies.
  4. Shisha smoking can significantly increase hypertension and abdominal obesity.
  5. Shisha smoking can lead to staining of teeth, dental restorations and reduced ability of smell and taste.
  6. Shisha smoking increases the risk of developing pancreatic and prostate cancer.
  7. The practice of sharing a water pipe mouthpiece during smoking of shisha poses a high risk of transmission of communicable diseases including Tuberculosis and Hepatitis.

Due to rapidly increasing prevalence of shisha smoking, it has now become a global issue and potential global health threat. It is necessary to address issues related to social, health and dependence aspects of shisha smoking, with a focus on new ways of prevention, more focus needs to be done on medical education. The policies on the reduction of cigarette smoking need to be applied to shisha smoking and their products. It also is necessary to Develop evidence based counter advertising programs to create awareness regarding its hazards.


  1. Van der Merwe N, Banoobhai T, Gqweta A, Gwala A, Masiea T, Misra M, et al. Hookah pipe smoking among health sciences students. S Afr Med J. 2013; 103:847–9.
  2. Christine A. Knowledge, attitude and practices of shisha smoking among youths in Kampala. In: Unpublished master thesis; Makarere university Uganda; 2015.
  3. Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda Christine Aanyu, & Daniel Kadobera, Rebecca Racheal Apolot, Angela Nakanwagi Kisakye, Peter Nsubuga, William Bazeyo, John Bosco Ddamulira
  4. World Health Organization. The WHO Framework Convention on Tobacco Control: 10 years of implementation in the African region. World Health Organization, Geneva.2015. Google Scholar

[1] World Health Organization. Tobacco fact sheet

[2] Determinants of Shisha Smoking Among Youths in The Universities in Kampala, Uganda. Lugemwa Tony

[3] Ministry of Health Republic of Uganda. The tobacco control Act 2015. 2015. Retrieved from:

[4] KCCA launches campaign to fight illegal sell of shisha, drugs in pubs

[5] Maziak W, Ward K, Soweid RA, Eissenberg T: Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco control 2004, 13(4):327–333.

[6] Aljarrah K, Ababneh ZQ, Al-Delaimy WK: Perceptions of hookah smokingharmfulness: Predictors and characteristics among current hookah users. Tob Induc Dis 2009, 5(1):16

Published by bakshikhan

Bakshi Asuman has worked with youth projects since 2007 that focused on mentoring and working with young people with training experience of over 7 years in Sexual Reproductive Health and Rights and Behavior Change Communication for youth led and youth serving organizations. He is a Master Trainer in Evidence & Right based SRHR and HIV prevention Intervention for youth Behavior change, characteristics of effective interventions, measure effects on outcome level, stigma and discrimination and Sexual Reproductive Health and Rights for young people are used and Meaningful Youth Participation.

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