Shisha, chewing tobacco, betel, paan and other tobacco

  • Tobacco comes in many different forms – it is addictive and causes cancer.
     
  • Smoking shisha is not safer than smoking cigarettes. Smoking shisha could double your risk of lung cancer.
     
  • Smokeless tobacco also causes cancer. There is no safe way to use tobacco. Support is available to help you stop for good.

Tobacco comes in many different forms. None are safe to use as tobacco causes cancer. On this page, we talk about types of smoking tobacco like shisha, cigars, pipes, and bidis. We also cover smokeless tobacco such as chewing tobacco, paan and snuff.

All types of tobacco are addictive. This is because all tobacco products contain nicotine – a very addictive chemical. People who use tobacco may have a nicotine addiction and find it hard to stop.

Even though it might not be easy, if you do use any form of tobacco, the best thing you can do for your health is to stop completely.

For support to stop using tobacco, speak to your doctor or pharmacist, or contact your free local stop smoking service. Getting specialist support gives you the best chance of quitting successfully.

Find out more about how to stop using tobacco.

 

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

Yes, all forms of smoking tobacco are addictive and harmful to your health. Smoking cigarettes causes at least 15 different types of cancer. Smoking shisha, cigars, pipes, or bidis also causes cancer. They contain many cancer-causing chemicals and can be as bad for you as smoking cigarettes.

You can find information on how smoking cigarettes causes cancer on our webpage.  

Smoking cigars, pipes or bidis causes many types of cancer. These include lung, mouth and upper throat, oesophageal (food pipe), larynx (voice box) and stomach cancers. They may also cause other types of cancer such as pancreatic, bladder and liver cancers. But we need more research to say for certain.

 

What is shisha (hookah)?

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

Coal or charcoal is used to burn a form of tobacco, which is usually flavoured. This makes smoke, which passes through water and up into a tube or hose - ‘the pipe’. The user breathes in the smoke through the pipe mouthpiece.

Smoking shisha is most common in Southeast Asian, Middle Eastern, and North African communities.  It has become more common in younger people in the UK over the last 20 years. 

Smoking shisha is harmful. Even if you smoke it occasionally, and so is second hand shisha smoke.

 

Does shisha increase cancer risk?

Yes, smoking shisha causes cancer.

Shisha smoke is toxic. It contains tobacco, nicotine, carbon monoxide and many cancer-causing chemicals, just like cigarette smoke does.  The sweet flavours of shisha may make it seem less harmful, but it isn’t.

Smoking shisha could at least double your risk of lung cancer compared to people who do not use shisha. It may also increase the risk of some other cancer types, like mouth, oesophageal and stomach cancers.

 

Shisha smoke passes through water, but this does not ‘filter out’ the toxic chemicals. These chemicals can cause cancer, cardiovascular disease and lung disease.

Tobacco-free shisha is not a safe way to smoke shisha.  This is because tobacco-free shisha smoke still contains carbon monoxide and many harmful chemicals that can cause cancer.

 

Is smoking shisha less harmful than smoking cigarettes?

No, smoking shisha is not less harmful than smoking cigarettes.

Smoking shisha has many of the same health risks as smoking cigarettes. This is because shisha smoke contains many cancer-causing chemicals, just like cigarette smoke.  

Research has shown that you can inhale the same amount of smoke in a 45-minute shisha session as if you smoked 100 cigarettes. This means high amounts of toxic substances are taken in, even during one session.

Using shisha can expose you to much higher levels of the poisonous gas carbon monoxide. This is because shisha is burnt using charcoal. There’s over 10 times more carbon monoxide in shisha smoke than the smoke from a cigarette.

Read more about the health risks of carbon monoxide, tar and other cancer-causing chemicals on our What’s in a cigarette? page.

 

Is second hand shisha smoke harmful?

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

Second hand shisha smoke comes from people breathing out smoke. It is also produced from the burning of the tobacco and charcoals. Second hand shisha smoke is toxic and contains many cancer-causing chemicals. It’s likely to have similar health risks to second hand cigarette smoke.

In the UK, it is illegal to smoke shisha in an indoor public space, just like cigarettes.

 

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What is smokeless tobacco?

Smokeless tobacco is tobacco that’s not burned.  It can be used orally (chewed or sucked) or nasally (breathed in through the nose).

There are many types of smokeless tobacco, including:

Chewing tobacco, oral and spit tobacco

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

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 it causes cancer. Paan use 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 (also called dipping tobacco)

Snuff is finely ground tobacco that often has flavourings added to it.

Snuff can go in the mouth, between the cheek and gums or behind the lip (oral snuff), or it can be breathed in through the nose (nasal snuff).

Oral snuff has been shown to increase the risk of mouth cancer. There is some evidence for a link between snuff and other cancer types too. There is a type of snuff from Sweden called snus. It is unclear if snus causes cancer, but it is illegal in the UK as it is considered harmful to health.

 

Does smokeless tobacco increase cancer risk?

Smokeless tobacco is harmful to your health and can cause cancer. It not a safe alternative to smoking tobacco.

People who use smokeless tobacco can take in cancer-causing chemicals at levels that are similar to, or higher than, cigarette smoke.

Smokeless tobacco causes mouth, oesophageal (food pipe) and pancreatic cancers. There is some evidence that smokeless tobacco causes other types of cancer as well. But we need more research to say for certain.

 

Get help to stop using tobacco

If you use tobacco in any form, the best thing you can do for your health is to stop completely. It’s never too late to stop.

We know that stopping can be hard, but you don’t have to do it alone.

You’re more likely to give up tobacco for good with specialist help from free local stop smoking services. Many of these services have trained advisors to help you give up all types of tobacco.

Find your free local stop smoking service.

You can also speak to your doctor or pharmacist if you’d like help, they can help you find a quitting method that works for you.

Get support and advice on stopping using tobacco for good.

 

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. https://www.nice.org.uk/guidance/ph39

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).

 

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