Daily shisha use: the tobacco control niche that’s not so niche any more

Between 1.8% and 3.6% of smokers use shisha daily across Australia, up from 1% just three years ago.

That’s the shocking result from the 2022-2023 National Drug Strategy Household Survey that was released Wednesday. It deals with a range of alcohol and other drug use, but I was interested in the data on tobacco use. In particular, what’s been happening with shisha use.

The 2022-3 survey results show a dramatic increase in the daily use of shisha in Australia over the COVID-19 period from 1% of smokers in 2019 to 2.7% only three years later.

A graph showing daily shisha use has increased form 0.8% of smokers in 2016 to 2.7% of smokers in 2022.

Keep in mind that this is daily use. 45 minutes of shisha use equates with more than 100 cigarettes, so this represents a marked increase in overall tobacco consumption for people in this group.

We can be fairly confident this increase is real and that the rate is between 1.8% and 3.6%. The 95% confidence intervals for the 2022-3 survey are 0.9% and the rate of standard error is 17.7% (RSE, generally <25% is considered reliable for most practical purposes).

This challenges assumptions made by many working in tobacco control and public health that shisha use is infrequent.

We also know that use isn’t distributed evenly. 2.7% of all smokers may seem like a small proportion, but this increase disproportionately affects Arabic speaking communities and populations, people living in cities and regional centres, and other migrant groups.

A young man with tongs kindles the coal while using a shisha.

This is also consistent with focus groups that Dr Lilian Chan and I conducted for the Shisha No Thanks project in 2022. People who used shisha told us that their use had intensified through the COVID lockdowns, but that this increase had continued afterwards and was increasingly complemented with e-cigarettes use.

We need to increase our focus on:

  • increasing awareness of the harms of water pipe use (this remains low)
  • providing avenues for quitting that are tailored to shisha users
  • making sure use at food venues complies with existing laws
  • enforcing and retail and import conditions more consistently.

Sources

AIHW. (2024). National Drug Strategy Household Survey 2022–2023. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey/contents/technical-notes

Evaluation of ‘Shisha No Thanks’ – a co-design social marketing campaign on the harms of waterpipe smoking

An important paper from our Shisha No Thanks! project, led by Lilian Chan, has been published:

This is one of the first published evaluations of a health promotion intervention targeting young people to address the growing global trend of waterpipe smoking. It makes a timely and important contribution that demonstrates that co-design social marketing campaigns can raise awareness of messages about the harms of water pipe smoking among young people of Arabic speaking background. 

It’s open access and free to access.

References

Chan, L., El-Haddad, N., Freeman, B., MacKenzie, R., Woodland, L., O’Hara, B. J., & Harris-Roxas, B. F. (2022). Evaluation of ‘Shisha No Thanks’ – a co-design social marketing campaign on the harms of waterpipe smoking. BMC Public Health, 22(1), 386. https://doi.org/10.1186/s12889-022-12792-y

The harms of shisha use: An issue that isn’t going away

The Cancer Institute NSW released their NSW Smoking and Health Survey, 2019 report last week. It highlights significant progress in tobacco control in NSW – with the exception roll-your-own cigarettes, e-cigarettes and shisha use.

The apparent reduction in shisha use in the 2017 survey may be partially explained by changes in the sampling approach. Another reason was that the question in 2017 made explicit reference to tobacco:

In 2017, however, the wording was waterpipe tobacco or shisha tobacco (i.e. the word tobacco was removed for 2019).

This highlights that people who use shisha may be unaware that it contains tobacco, an issue that we identified in our qualitative research on water pipe use . It also underlines the importance of ongoing campaigns to make people aware of the harms associated with water pipe use, such as the Shisha No Thanks program.

Shisha use is a significant and increasingly widespread tobacco control issue that can no longer be regarded as a niche concern . It needs to be explicitly addressed through all tobacco control activities.

References

Cancer Institute NSW. (2020). NSW Smoking and Health Survey 2019. Cancer Institute NSW. https://www.cancer.nsw.gov.au/how-we-help/reports-and-publications/nsw-smoking-and-health-survey-2019
Eissenberg, T. (2019). Now is the Time for Effective Regulation Regarding Tobacco Smoking Using a Waterpipe (Hookah). Journal of Adolescent Health, 64(6), 685–686. https://doi.org/10.1016/j.jadohealth.2019.03.011
Haddad, C., Lahoud, N., Akel, M., Sacre, H., Hajj, A., Hallit, S., & Salameh, P. (2020). Knowledge, attitudes, harm perception, and practice related to waterpipe smoking in Lebanon. Environmental Science and Pollution Research. https://doi.org/10.1007/s11356-020-08295-1
Kearns, R., Gardner, K., Silveira, M., Woodland, L., Hua, M., Katz, M., Takas, K., McDonald, J., & Harris-Roxas, B. (2018). Shaping interventions to address waterpipe smoking in Arabic-speaking communities in Sydney, Australia: A qualitative study. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-6270-3
Romani, M., Jawhar, S., Shalak, M., & Antoun, J. (2020). Waterpipe smoking cessation: knowledge, barriers, and practices of primary care physicians- a questionnaire-based cross-sectional study. BMC Family Practice, 21(1), 21. https://doi.org/10.1186/s12875-020-1095-4
Ward, K. D., Kumar, J., Khan, Z., & Jiang, Y. (2019). Characteristics of Waterpipe Health Warning Labels in the United States. American Journal of Health Behavior, 43(4), 858–865. https://doi.org/10.5993/AJHB.43.4.17