Shisha vs Cigarettes: What's the difference and which is more harmful?

Shisha, also known as hookah, waterpipe, narghile or hubble-bubble, has been smoked for centuries in parts of the Middle East, North Africa and Asia before becoming popular worldwide.

Unlike cigarettes, where tobacco is lit directly, shisha uses specially prepared tobacco mixed with molasses, glycerine and flavourings such as mint, apple or grape.

Burning charcoal heats the tobacco, producing smoke that passes through a chamber of water before travelling through a hose to the smoker.

That journey through water is where much of the confusion begins.

The smoke feels cooler and less irritating than cigarette smoke, but scientific studies have shown that nicotine, carbon monoxide, tar, heavy metals and dozens of other toxic substances remain present when the smoke reaches the lungs.

The session lasts much longer than a cigarette

One of the biggest differences between cigarettes and shisha isn't necessarily what's being smoked - it's how long it's smoked.

A cigarette is usually finished within five to ten minutes.

A shisha session, on the other hand, commonly lasts between 20 minutes and 80 minutes, with some lasting even longer.

During that time, smokers may take well over a hundred puffs, inhaling significantly larger volumes of smoke than they would from a single cigarette.

Because of this, health experts discourage direct comparisons such as "one shisha equals one cigarette."

The amount of smoke inhaled depends on how long the session lasts, how deeply the person inhales and how frequently they smoke.

Nicotine is still nicotine

One misconception surrounding shisha is that it isn't addictive because many people only smoke it socially.

In reality, traditional shisha tobacco contains nicotine - the same highly addictive substance found in cigarettes.

Nicotine stimulates the brain by releasing dopamine, creating feelings of pleasure and relaxation. Over time, repeated exposure can lead to dependence, making it increasingly difficult for users to stop.

Someone who only smokes shisha occasionally may have a lower overall nicotine exposure than a heavy cigarette smoker, but regular waterpipe use can still result in addiction.

Charcoal introduces additional health risk

Unlike cigarettes, shisha depends on burning charcoal to heat the tobacco rather than burning the tobacco directly.

That charcoal produces carbon monoxide, fine particles and other toxic compounds that mix with the tobacco smoke before being inhaled.

Carbon monoxide reduces the blood's ability to carry oxygen throughout the body.

High exposure can cause headaches, dizziness and nausea, while repeated exposure increases the strain placed on the heart and circulatory system.

This means shisha users are inhaling harmful substances from two separate sources: the tobacco itself and the burning charcoal.

Because the smoke is flavoured and feels smoother, it's easy to underestimate its long-term effects.

Research has consistently linked regular shisha smoking to many of the same diseases associated with cigarette smoking.

These include heart disease, stroke, chronic obstructive pulmonary disease (COPD), reduced lung function and several forms of cancer, particularly cancers affecting the lungs, mouth and throat.

Smoking also increases the risk of gum disease, tooth loss and complications during pregnancy, including premature birth and babies with low birth weight.

The exact level of risk varies depending on how frequently a person smokes and for how many years, but health experts agree that neither cigarettes nor shisha can be considered safe.

What about herbal shisha?

Many cafés now offer herbal or tobacco-free shisha, often marketed as a healthier alternative.

While these products eliminate tobacco and, in many cases, nicotine, they are still heated using charcoal.

That means users continue inhaling carbon monoxide, ultrafine particles and other chemicals produced during combustion.

Scientists are still studying the long-term effects of herbal shisha, but public health authorities caution that "tobacco-free" does not automatically mean "risk-free."

It's a risky social habit

Friends often share the same pipe, passing the hose around the table throughout the session.

Without proper hygiene or disposable mouthpieces, this practice may increase the risk of transmitting infections from one user to another.

At the same time, people sitting nearby are exposed to second-hand smoke, which contains many of the same toxic substances inhaled by the smoker.

The social nature of shisha may make it more enjoyable for many users, but it doesn't eliminate the health risks associated with smoke exposure.

The myth

If the scientific evidence is so extensive, why do so many people still believe shisha is safer?

Part of the answer lies in perception.

The fruity flavours mask the smell of tobacco. The smoke is cooler because it passes through water.

The experience is occasional and social rather than habitual and solitary.

Those differences create the impression that shisha is fundamentally different from cigarette smoking.

In reality, the body's organs respond to the chemicals inside the smoke - not to how pleasant that smoke tastes or smells.