Shisha, betel leaf, paan and other tobacco

  • Tobacco comes in many different forms – all are addictive and cause cancer
  • There is no safe way to use tobacco
  • It’s never too late to stop, and support is available

On this page, we talk about shisha (also called waterpipe or hookah) and smokeless tobacco (such as betel leaf, paan and snus).


Are shisha and other types of smoking tobacco bad for you?

All forms of smoking tobacco are addictive and harmful for your health. This includes smoking cigarettes, cigars, pipes, bidis and shisha.


What is shisha?

Smoking shisha is also known as hookah, narghile, waterpipe, or hubble bubble.

It is most common in Southeast Asian, Middle Eastern, and North African communities. And it’s becoming more common in the UK, particularly with younger people. 

Coal or charcoal is used to heat up a form of tobacco, which is usually flavoured. This makes smoke which then passes through water or another liquid and into a tube or pipe. The user breathes in the smoke through a mouthpiece.

The water does not ‘filter out’ the toxic chemicals found in shisha smoke – smoking shisha is not safe.

Socialising and cultural celebrations are just some of the reasons people may smoke shisha. But be aware that even occasional shisha smoking is harmful.


Does shisha (hookah) increase risk of cancer?

Shisha smoke is toxic. It contains tobacco, and people who use it breathe in cancer-causing chemicals and addictive nicotine.

Smoking shisha could at least double your risk of lung cancer. It may also increase the risk of some other cancer types, like mouth and stomach cancers.


Is smoking shisha less harmful than smoking?

Shisha comes in many different flavours, including sweet flavours. This can make it seem less harmful than smoking, but this is not the case.

The amount of toxic substances that are taken in during a single shisha session can be as high as the amount taken in when smoking a cigarette. Cigarettes and shisha both contain the substances nicotine and tar, and have many of the same health risks.

People who use shisha can also be exposed to even higher levels of the poisonous gas carbon monoxide than people who smoke cigarettes. This is because shisha is burnt using charcoal.

Tobacco-free shisha is not a safe alternative. There are studies showing that tobacco-free shisha smoke contains carbon monoxide and many other harmful toxins that are found in normal shisha smoke.

Read more about the health risks of carbon monoxide, nicotine and tar on our What’s in a cigarette? page.


Is shisha addictive?

Yes, shisha is addictive as the smoke contains nicotine – a very addictive drug. This means people who smoke shisha regularly may find it harder to stop, as they could have a nicotine addiction. 

Even though it might not be easy, if you do smoke shisha, the best thing you can do for your health is to stop smoking completely.

Get tips and advice on stopping smoking for good.


Is second-hand shisha smoke harmful?

Second-hand smoke is when you breathe in someone else’s smoke.

Second-hand smoke from shisha pipes is harmful. It contains many of the same toxic chemicals as second-hand cigarette smoke.

Shisha is often smoked inside. And sitting in shisha cafes can expose you to harmful chemicals, even if you do not smoke.

Air pollution in shisha cafés and restaurants can go far above recommended safety limits.


Cigars, pipes and bidis also cause cancer

Cigars, pipes or bidis are as bad for you as smoking cigarettes.

They increase the risk of many different types of cancer. This includes lung, mouth and upper throat, oesophagus (food pipe), larynx (voice box) and stomach.


What is smokeless tobacco?

Smokeless tobacco is tobacco that’s not burned. It’s chewed (‘dry chewing tobacco’), sucked (‘moist oral tobacco’) or breathed in (‘nasal snuff’).


Does smokeless tobacco increase cancer risk?

Smokeless tobacco is harmful for your health. It is not a safe alternative to smoking cigarettes. Users can take in similar, or even higher levels of cancer-causing chemicals.

Smokeless tobacco causes mouth, oesophageal (food pipe) and pancreatic cancers.


Types of smokeless tobacco include:

Chewing, oral and spit tobacco

Chewing, oral and spit tobacco are loose forms of dried tobacco that people chew or put between their cheek and gum or teeth.

There is strong evidence that these types of tobacco cause cancer. 


Paan (also called betel quid or gutkah)

Paan is a mixture of betel nut (or areca nut), herbs and spices, and tobacco, all wrapped in betel leaf. It’s a form of chewing tobacco and causes cancer. Paan is common in South Asian communities.

Betel nut on its own also causes cancer. This means chewing betel quids can cause mouth cancer, even if no tobacco is added.


Snuff or dipping tobacco

Snuff is finely ground tobacco that often has flavourings added to it. Moist snuff can go in the mouth between the cheek and gums, or behind the upper or lower lip. Dry snuff is usually breathed in.

There is growing evidence that snuff is linked to increased cancer risk.



Snus is a type of moist snuff that comes from Sweden. It is illegal to buy or sell snus in the UK.

Snus contains lower levels of harmful chemicals. It is still unclear whether snus causes cancer.


Is smokeless tobacco addictive?

Yes, all tobacco products contain nicotine, which is very addictive.

Speak to your doctor if you’d like help to stop using tobacco. They can tell you about any free support in your area and help you to find a quitting tool that works best for you.

You can also read more about ways to stop using tobacco on our webpage.


Gupta, S., Cupta, R., Sinha, D., and Mehrotra, R. Relationship between type of smokeless tobacco and risk of cancer: A systematic review. Indian J. Med. Res. 148, 56–76 (2018).

International Agency for Research on Cancer. Personal Habit and Indoor Combustion: Tobacco Smoking. Vol  100 E, 377–504 (2012).

International Agency for Research on Cancer. Smokeless Tobacco and Some Tobacco-specific N -Nitrosamines. Vol 89 (2007).

National Institute of Health and Care Excellence (NICE). Smokeless tobacco: South Asian communities. September 2012.

Waziry, R., et al. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int. J. Epidemiol. 46, 32–43 (2017).


Last reviewed

Rate this page:

Currently rated: 3.3 out of 5 based on 19 votes
Thank you!
We've recently made some changes to the site, tell us what you think