Shisha smoking continues to be overlooked as a public health issue

Upcoming law changes alongside increased awareness and culturally competent support is needed, say experts

Shisha smoking continues to be overlooked as a public health issue in the UK, argue experts in The BMJ today.

This could change with the advent of the Tobacco and Vapes Bill, legislation currently making its way through Parliament, but only, they say, with more recognition and culture-specific campaigns and support in affected communities.

Shisha (also known as hookah, narghile, and hubble-bubble) is a waterpipe that is used to smoke a charcoal-heated tobacco mix. With almost 1,000 shisha cafes in the UK – and more in London than there are branches of McDonald’s – the practice is popular, especially among young people and some ethnic minority groups.

Yet, unlike cigarettes, shisha tobacco does not have the benefit of decades of regulation.

Its exclusion from flavour bans, for example, and a lack of licensing for businesses selling shisha tobacco is evidence of this “underregulation,” says Mohammed Jawad, a public health consultant and specialist in shisha tobacco smoking.

Hazel Cheeseman from Action on Smoking and Health says shisha is “every bit as bad for you as smoking cigarettes, and the flavours make it appear less harmful and make it more palatable … it’s an inequality not to apply the law equally.”

Leena Ali at the University of York also points out that shisha-specific research in the UK is about a decade old, and although shisha is popular among people from middle eastern backgrounds, these groups are not accurately represented in the data, which hinders accurate monitoring.

This lack of knowledge, research, and awareness of shisha affects policy. 

Jawad warns that shisha is not just another form of smoking and therefore covered by existing tobacco laws. Consumption patterns differ, with single sessions lasting up to an hour, delivering “quite a lot of toxins” compared to an occasional cigarette smoker, he explains. Unique design features, apparatus sharing, and prolonged exposure also change the risk profile.

The upcoming bill may make it easier to tackle the problem by creating consistency across all tobacco products, including regulating flavoured tobacco and licensing. However, Ali expresses concern about the bill’s lack of focus on shisha, questioning if funding will be allocated to it and whether the bill’s age of sale increases could drive shisha use into homes, potentially increasing its use.

And with the bill not set to come into force until 2027, experts also emphasise the need for work that can be done now, including culturally tailored health messaging. 

Jawad notes a lack of national anti-smoking campaigns mentioning shisha, which increases the likelihood of misinformation. He suggests funding community-led research, framing it as a “health equity issue, rather than a cultural attack, which is how it’s currently being perceived.” 

Local councils, like Bradford, are starting to conduct local research to target awareness efforts to specific communities where shisha prevalence is highest.

31/03/2026

Notes for editors
Feature: Shisha tobacco’s availability is rising. Why does UK smoking policy fail to tackle it? doi: 10.1136/bmj.r2198
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system:
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? No
Evidence type: Feature
Subject: Shisha tobacco