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.


Cancer Institute NSW. (2020). NSW Smoking and Health Survey 2019. Cancer Institute NSW.
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.
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.
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).
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.
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.