by Lucy Balona

Bursting the bubble

The hubbly bubbly puts users at risk of lung disease

Hubbly bubbly puts users at risk of lung disease
Bursting the bubble

“We watch with growing alarm as water pipes, also known as hookahs or hubbly bubblies, become increasingly popular among smokers and non-smokers alike, particularly among young people,” says Sue Janse van Rensburg, chief executive of the Cancer Association of South Africa (CANSA) as part of CANSA’s World No Tobacco Day (31 May) awareness campaign.

She continues: “There’s a misconception that the water pipe, which is a fashionable accessory at many social gatherings, is a harmless way of sharing a recreational drug that has no side effects. The truth is that water pipe smokers and second-hand smokers are at risk of the same kinds of diseases that are caused by cigarette smoking, including cancer, heart and respiratory diseases, as well as adverse effects during pregnancy.” 

It’s time for the truth

According to the World Health Organization (WHO), contrary to the popular belief that smoking a water pipe has little or no harmful health side effects and is better for you than smoking cigarettes, the smoke that emerges from a water pipe contains several toxins known to cause lung cancer, heart disease and other diseases. It delivers the addictive drug nicotine and, as is the case with other tobacco products, more frequent use is likely to result in the smokers becoming addicted to it. 

In addition, the fuel burned in the pipes – often charcoal – produces its own toxins including high levels of carbon monoxide and cancer-causing chemicals.

Says Janse van Rensburg: “This means that people exposed to the smoke produced by a water pipe, whether they are smoking the pipe or just in the vicinity, breathe in a double dose of toxins.”

More potential for harm

WHO has found that a water pipe smoking session, which typically lasts between 20 to 80 minutes, may expose the smoker to more smoke (and its harmful effects) over a longer period of time than when smoking a cigarette. Cigarette smokers typically take eight to 12 (40 to 75ml) puffs over about five to seven minutes and inhale 0.5 to 0.6 litres of smoke. In contrast, a water pipe smoker may take 50 to 200 puffs a session, which range from 0.15 to one litre of smoke each. The water pipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes.

It’s a tobacco product

The smoking of water pipes in public areas has been banned outright in several areas around the world, including Middle Eastern and Asian countries, where smoking the pipe is an ancient tradition and a popular modern social pastime and tourist attraction. Many other countries in North America and Europe are developing legislation to ban the water pipe because of the serious health risks it poses users as well as passive users exposed to second-hand smoke.

In South Africa, water pipes and their related tobacco products fall under the definition of ‘tobacco product’ in the Tobacco Products Control Amendment Act (2007). This means their use and sale have to comply with the regulations that apply to any tobacco product in the country. This includes the prohibition of the sale of hookahs and their products to anyone under the age of 18.



Q: Isn’t water pipe smoke better than cigarette smoke because it passes through water?

A: No, the water doesn’t clean the smoke. Water pipe and cigarette smoke both contain poisons including nicotine, tar, carbon monoxide, arsenic and lead, among many others. Arsenic is used as a rat poison, and carbon monoxide is a deadly gas also found in motor car exhaust. Lead is a neurotoxin that even in small amounts can damage the nervous system. 

Q: Do you get less nicotine from a water pipe than a cigarette?

A: The water does absorb some of the nicotine, but water pipe smokers can nonetheless be exposed to sufficient amounts to cause addiction. There is the potential for a water pipe smoker to take in as much nicotine by smoking one water pipe as you can by smoking 10 or more cigarettes.  

Q: Why are water pipes so appealing to young people?

A: The sweet flavour and pleasant smell make it easier to inhale the smoke without coughing. Also, smoking water pipes is a social, satisfyingly ritualistic activity for many, further encouraged by the prevailing myth that it's harmless and doesn't involve ‘proper drugs’.

Q: What are the long-term health effects of water pipe smoking?

A: The negative impacts associated with the water pipe are similar to cigarette smoke. Health effects include damaging your lungs, and making it painful or difficult to breathe. It can cause cancer of the mouth, lungs and bladder, or a heart attack. 

Q: If a pregnant woman smokes a water pipe, can she harm her baby?


A: Yes. The carbon monoxide and other poisons will pass from the mother’s blood to the unborn baby and can stunt its growth.

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