Hookah

An Egyptian hookah (shisha)

A hookah (Hindi: हुक़्क़ा, Urdu: حقّہ huqqah) is a single or multi-stemmed (often glass-bottomed) water pipe for smoking. Originally from India, the hookah has gained immense popularity, especially in the Middle East. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits, or tobacco

Terminology

Depending on locality, hookahs may be referred to by many names, often of Turkish origin. Narghilè but pronounced "Argilah" is the name most commonly used in Turkey, Azerbaijan and Syria. Narghile derives from the Persian word nārghile, meaning coconut, which in turn is from the Sanskrit word nārikela (नारिकेला), suggesting that early hookahs were hewn from coconut shells.

In Albania, Bosnia, Croatia the hookah is called "Lula" or "Lulava" in Romani, meaning "pipe," the word "shishe" refers to the actual bottle piece.

Shisha (Arabic: شيشة), from the Persian word shīshe (شیشه), meaning glass, is the common term for the hookah in Egypt and the Arab countries of the Persian Gulf (including Kuwait, Iraq, Bahrain, Qatar, Oman, UAE, and Saudi Arabia), and in Indonesia, Morocco, Pakistan, Tunisia, Somalia and Yemen.

In Iran, hookah is called غلیون "Ghelyoon". In Uzbekistan, hookah is called "Chillim". In India and Pakistan the name most similar to the English hookah is used: huqqa (हुक्का /حقہ).

The commonness of the Indian word "hookah" in English is a result of the British Raj, the British dominion of India (1858–1947), when large numbers of expatriate Britons first sampled the water-pipe. William Hickey, shortly after arriving in Kolkata, India, in 1775, wrote in his Memoirs:

The most highly-dressed and splendid hookah was prepared for me. I tried it, but did not like it. As after several trials I still found it disagreeable, I with much gravity requested to know whether it was indispensably necessary that I should become a smoker, which was answered with equal gravity, "Undoubtedly it is, for you might as well be out of the world as out of the fashion. Here everybody uses a hookah, and it is impossible to get on without" [... I] have frequently heard men declare they would much rather be deprived of their dinner than their hookah.

History

The Hookah was invented in India in the court of the Mughal emperor Akbar (1542 - 1605 CE) Following the European introduction of tobacco to India, Hakim Abul Fateh Gilani who was a physician in the court of Mughal raised concerns after smoking tobacco became popular among Indian noblemen, and subsequently envisaged a system which allowed smoke to be passed through water in order to be 'purified'. Gilani invented the Hookah after Asad Beg, then ambassador of Bijapur, encouraged Akbar to take up smoking. Following popularity among noblemen, this new device for smoking soon became a status symbol for the Indian aristocracy and gentry.

Culture

Middle East

Arab world

Bedouin smoking hookah, locally called argileh, in a coffeehouse in Deir ez-Zor, near the Euphrates River, 1920s.

In the Arab world, social smoking is done with a single or double hose, and sometimes even more numerous such as a triple or quadruple hose in the forms of parties or small get-togethers. When the smoker is finished, either the hose is placed back on the table signifying that it is available, or it is handed from one user to the next, folded back on itself so that the mouthpiece is not pointing at the recipient. Another tradition is that the recipient taps or slaps the previous smoker on the back of the hand while taking it, as a sign of respect or friendship.

In cafés and restaurants, however, it is rare for each smoker not to order an individual hookah, as the price is generally low, ranging from USD 3 to USD 25.

Most cafés (Arabic: مقهىً, transliteration: maqhah, translation: coffeeshop) in the Middle East offer hookahs. Cafés are widespread and are amongst the chief social gathering places in the Arab world (akin to public houses in Britain). Some expatriate Britons arriving in the Middle East adopt shisha cafés to make up for the lack of pubs in the region, especially where prohibition is in place.

Iran

Persian woman, in Qajari dress seen here smoking the traditional Qalyan. (Around 1850)

In Iran, the hookah is known as a ghalyun (Persian: قليان, قالیون, غلیون, also spelled ghalyan, ghalyaan or ghelyoon). It is similar in many ways to the Arabic hookah but has its own unique attributes. An example is the top part of the ghalyoun called 'sar' (Persian: سر=head), where the tobacco is placed, is bigger than the ones seen in Turkey. Also the major part of the hose is flexible and covered with soft silk or cloth while the Turkish make the wooden part as big as the flexible part.

Each person has his own personal mouthpiece (called an Amjid) (امجید), usually made of wood or metal and decorated with valuable or other stones. Amjids are only used for their fancy look. However, all the Hookah Bars have plastic mouth-pieces.

Use of water pipes in Iran can be traced back to the Qajar period. In those days the hoses were made of sugar cane. Iranians had a special tobacco called Khansar (خانسار, presumably name of the origin city). The charcoals would be put on the Khansar without foil. Khansar has less smoke than the normal tobacco. Nasser al-Din Shah Qajar, Shah of Persia (1848-1896) is reputed to have considered a hookah mouthpiece pointed at him an insult.

The smoking of hookahs is very popular with young people in Iran, and many young people can be seen smoking them in local tea shops.

The hookah was, until recently, served to all ages; Iranian officials have since passed a law forbidding its use by those under 20.

Israel

Smoking hookah is not only a tradition, but a culture.Hookah or Argialah أرجيلة is one of the most popular thing in Israel even more than Cigarettes almost every home has at least one Hookah. Hookah is everywhere in Israeli houses,shops,cafes.

South Asia

Afghanistan

In Afganistan the hookah has been popular for some time, especially in Kabul where it is better known as a "chillam".

It has been a long tradition to Afghans to smoke all together with family and friends on special occasions.

India

The hookah was invented in India by a physician during the Mughal reign as a purportedly less harmful method of cannabis use. The physician Hakim Abul Fath suggested that "cannabis smoke should be first passed through a small receptacle of water so that it would be rendered harmless."

In India, once the province of the wealthy, the hookah is becoming better known to the masses, and cafés and restaurants that offer it as a consumable are popular. The use of hookahs from ancient times in India was not only a custom, but a matter of prestige. Rich and landed classes would smoke hookahs. Tobacco is smoked in hookahs in many villages as per traditional customs. Smoking molasses in a hookah is now becoming popular amongst the youth in India. It is a growing trend amongst youngsters and adolescents. There are several chain clubs, bars and coffee shops in India offering a variety of hookahs. The new trends emerging are that of non-tobacco hookahs with herbal flavors.

Koyilandy, a small fishing town on the west coast of India, once made and exported these extensively. These are known as Malabar Hookhas or Koyilandy Hookahs. Today these intricate hookahs are difficult to find outside of Koyilandy and not much easier to find in Koyilandy itself.

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  The intricate work on a Malabar Hookah
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  The hookah family

Pakistan

In Pakistan, although traditionally prevalent in rural areas for generations,[2] hookahs have become very popular in the cosmopolitan cities. Many clubs and cafes are offering them and it has become quite popular amongst the youth and students in Pakistan. This form of smoking has become very popular for social gatherings, functions, and events. There are a large number of cafes and restaurants offering a variety of hookahs.

Southeast Asia

Malaysia

With the increase of Persian and Arab communities, Malaysia too has seen an increase in hookah use and cafes offering hookah more commonly known as shisha.

Philippines

In the Philippines, the Hookah or Shisha was particularly used within the minority Indian Filipino and Arab Filipino communities, although particularly among indigenous Muslim Filipinos, a historical following of social and cultural trends set in the Middle East or Indian Subcontinent led to the Hookah being a rare albeit prestige social-habit of noblemen in important trade cities such as Cotabato or Jolo.

Hookah was virtually unknown by Christian Filipinos before the latter 20th century, yet the popularity among contemporary younger Christians is now vastly growing. In the capital's most cosmopolitan city, Makati; various high-end bars and clubs offer hookahs to patrons.

Although hookah use has been common for hundreds of years and enjoyed by people of all ages, it has just begun to become a youth-oriented pastime in Asia in recent times. Hookahs are most popular with college students and young adults, who may be underage and thus unable to purchase cigarettes.

South Africa

In South Africa, hookah, colloquially known as a hubbly bubbly, is popular amongst the Cape Malay, Indian population, where it is smoked as a social pastime. However, hookah is seeing increasing popularity with white South Africans, especially the youth. Bars that additionally provide hookahs are becoming more prominent, although smoking is normally done at home or in public spaces such as beaches and picnic sites.

In South Africa, the terminology of the various hookah components also differ from other countries. The clay "head/bowl" is known as a "clay pot". The hoses are called "pipes" and the air release valve is known, strangely, as a "clutch".

Some scientists point to the dagga pipe as an African origin of hookah

Europe

Turkey

In Turkey, the hookah (Turkish: Nargile) is smoked on a social basis, usually in one's home with guests or in a cafe with friends. Most cities have hookah cafes where a hookah is offered with a non-alcoholic drink (mainly tea). This is mostly for health rather than cultural reasons. Often people will smoke a hookah after dinner as a replacement for cigarettes. In bigger cities such as Istanbul, Ankara, Izmir, and Adana, restaurants may have dinner & hookah specials which include a meal, beverage (alcoholic/non-alcoholic), Turkish coffee, and hookah.

Once the centre of Istanbul's social and political life, the hookah is considered one of life's great pleasures by the locals today. In certain parts of the country, people use hookah cafes to watch popular TV shows, national sports games, etc. and smoke hookahs to socialize.

Istanbul's most popular hookah cafe towns in Tophane and Ortaköy. In that towns all cafe's have a hookah service and lots of people enjoy the weekends in there.

Spain

In Spain, the use of the hookah has recently increased in popularity. They are usually readily available to smoke at prices between 5-10€ at tea-oriented coffeehouses, called teterías in Spanish, which are often run by Arab immigrants or have some other sort of affinity with the East. Hookah pipes are usually sold at prices between €10 and €70, and hookah tobacco and charcoal is easily found in those same coffee houses, or at stores run by eastern immigrants. Immigrants and native Spanish alike enjoy this custom, and it is usually seen as a lighter way of smoking than cigarettes. Buying one's own tobacco and hookah can be noticeably less expensive than ordering hookahs at a coffee house.

Eastern Europe

Hookahs are also becoming increasingly popular in Moscow and other Russian cities. Many bars employ a "hookah man" or "niam" which is commonly pronounced "ni-eem" (Russian: кальянщик, tr. kal'yanshchik), often of middle-eastern appearance and wearing an approximation of Arab or Turkish costume, to bring the pipes to customers' tables and wrappings may be provided to each person at the table for hygiene reasons.

Standard single-hosed hookah. The tobacco packet reads "Smoking may kill", as required by Danish law.

Hookahs are popular in Kyiv as well and other Ukrainian cities.

In Lithuania hookah bars (locally named "kaljanas") are popular among young and middle-aged people. It usually costs 30-200 euros.

Hookah ('vesipiip' in Estonian, 'vízipipa' in Hungarian) has also gained major popularity in Estonia and Hungary amongst teenagers, where it has caused controversy amongst the troubled parents. The same goes for Cyprus, its use extended to young adults too. In Nicosia it is offered not only in specialised coffee-shops, but also in restaurants and other places, and often it is considered a given.

Germany

In Germany, smoking hookah (locally called Shisha or "Wasserpfeife", "hookah" is an unknown term) has enormously risen in popularity, originating from a large population of Turkish immigrants in West Germany, particularly in big cities as Berlin and Cologne, where a large amount of hookah bars exist. Hookahs are also very easy to acquire and many shops are specialized in selling water-pipes, flavored tobacco and charcoal. The prices are affordable and as a result, many teenagers own a hookah. The hookah has become also popular in East Germany, where the number of Turkish immigrants is very small, which shows that smoking hookah has become a general youth-trend in the last years (since approx. 2001), no more depending on ethnical backgrounds. Hookah bars are even commonly found in towns with just 100,000 inhabitants and less. Since April 2006 there is a special-interest magazine about hookahs available which is called "hookahMag" .

Italy

In Italy, hookah bars are still uncommon, but their number is increasing, as hookah (usually known only as narghilè) smoking is currently gaining favor, and is seen as less dangerous and irritating than cigarettes for others nearby (though hookahs are still covered by anti-smoking laws). There used to be a ban by the Italian government on wet and fruit flavoured tobacco, but this ban has been abolished since the production of tobacco in Italy is no longer limited by "Monopolio di Stato." Italy is now itself a producer of high-quality hookah tobacco.

Switzerland

Hookahs are legal in Switzerland, and like in Germany, it also gained on popularity in the last years, therefore many teenagers own one.

Scandinavia

In Scandinavia, hookah smoking is on the rise. Cheap hookahs and hookah-related products, like tobacco and charcoal, are now available in the many kiosk-like businesses run by immigrants, mostly of middle-eastern origin, found in the larger cities. Hookahs are mostly used by teenagers and immigrants, but the use is slowly becoming more widespread. Hookah bars and similar establishments are still very rare though, in part due to anti-smoking laws which forbid smoking in restaurants and in public buildings.

Czech Republic

In the Czech Republic, hookah is relatively common in many tearooms (usually cost between 100 and 150 CZK). Hookahs are usually sold in specialized orient-shops and tearooms at prices mostly between 500 and 2500 CZK. Local names for hookah are "šíša", "vodárna", "vodnice", "voďár", "vodní dýmka", etc.

Poland

The word "hookah" is not popular in Poland, more common terms referring to water-pipe are "shisha" and "nargila". Shisha smoking is rather not popular but in every major city one can find either a tearoom where shisha is served as an addition to a tea or a restaurant where one can smoke shisha independently. Prices are between 20 - 50 PLZ for one shisha (7 - 12 euro).

France

Narghile smoking teahouses (also known as "chicha bars") had started becoming popular in France, but were hit full on by the recent ban on smoking in bars and restaurants. It remains to be seen if they will benefit from special exemptions or will disappear altogether.

Greece

Hookah, commonly referred to by Greeks as nargiles (ναργιλές) was first introduced in Greece during Ottoman rule. It has remained in Greek culture, and had a heavy influence on the Rembetiko music scene created in Greece in the early 20th Century.

Hookah was initially smoked by those in the Greek "underworld" who wished to disassociate themselves with mainstream Greek society. Many towns and cities such as Piraeus were home to numerous hookah bars and hash dens. Hookah has been ever present in Greek society for the past few centuries, although the 20th Century is where it saw its boom in popularity.

Hookah has also seen a recent surge in popularity amongst younger users, who can visit the more contemporary hookah-cafes. These tend to be very popular and often packed; reservations are usually needed to enter.

United Kingdom

In the United Kingdom Hookah cafes (sometimes known locally as "Shisha Bars") exist in most major cities. London's Edgware Road area is noted for a high distribution of shops which serve hookah, but hookah cafes can be found in most cities in the south. There are several bars in Leeds and Bradford.

Smoking was banned inside public places in England in July 2007 (Scotland, 2006). Since then, hookahs are only allowed to be smoked outside.

Hookah is often found in Indian restaurants but is most commonly found in Lebanese restaurants and Egyptian-run "hubbly-bubbly" bars. Concentrations of these hookah establishments are often found in close proximity to University campuses, as on Rusholme's Curry Mile in Manchester or in Oxford, and they cater to a mixture of British and Middle-Eastern clientele amongst students.

United States and Canada

A hookah and a variety of tobacco products are on display in a Harvard Square store window in Cambridge, Massachusetts, United States.

Main article: Hookah lounge

Recently many cities, states and countries have implemented smoking bans. In some jurisdictions, hookah businesses can be exempted from the policies through special permits. Some permits however, have requirements such as the business earning a certain minimum percentage of their revenue from alcohol or tobacco.

In some cases, hookah bars have been forced to close or consider alternatives, such as offering flavored tobacco based maasel. In many cities though, hookah lounges have been growing in popularity. From the year 2000 to 2004, over 200 new hookah cafes opened for business, most of which are targeted at a young-adult age group,and were particularly near college campuses or cities with large Middle-Eastern communities. This activity continues to grow in popularity within the post-secondary student demographic.

In North America, the term 'shisha' is not as commonly used as 'hookah'. Sometimes 'Shisha' can also refer to the Flavored Tobacco inside the pipe as opposed to the Hookah pipe itself.

Mexico

In Mexico hookah bars have gained popularity in recent years becoming a popular trend among young people. Some places are hookah cafes, while others are night-clubs offering hookah along with alcoholic beverages. They are often located at fashionable areas like Condesa or Santa Fe, two of the richest neighborhoods in Mexico City. The increasing popularity of the hookah is also due to the Middle Eastern immigrant families that have settled in Mexico for some time now. Unlike in Middle Eastern countries it is not habitual to smoke a hookah while, or immediately after, a dinner. The smoking of hookah is done usually in the late afternoon, and alcoholic beverages (such as vodka, tequila or Mezcal) are used as filters, instead of the traditional water.

Smoking was prohibited in enclosed spaces in Mexico City in April 2008 and in the State of Mexico in July 2008. This will greatly hinder the industry surrounding hookah, as many people only smoke socially.

New Zealand

In New Zealand, hookah pipes are considered by the Government to be a prohibited import. This is as a result of people using the pipes to administer cannabis and is made illegal by an Act of Parliament under the Misuse of Drugs (Prohibition of Cannabis Utensils and Methamphetamine) Notice 2003.

Structure and operation

Components

Excluding grommets, a hookah is usually made of five components, four of which are essential for its operation.

The bowl

Also known as the head of the hookah, the bowl is a container, usually made out of clay or marble, that holds the coal and tobacco during the smoking session. The bowl is loaded with tobacco then covered in a small piece of perforated tin foil or a glass or metal screen. Lit coals are then placed on top, which allows the tobacco to heat to the proper temperature.

There is also a variation of the head which employs a fruit rather than the traditional clay bowl. The fruit is hollowed out and perforated in order to achieve the same shape and system a clay bowl has, then it is loaded and used in the same manner.

Hose

The hose is a slender tube that allows the smoke to be drawn. The end is typically fitted with a metal, wooden, or plastic mouthpiece, and come in various shapes, sizes and colors. Smoking marijuana or especially other drugs out of a hookah is known to cause significantly more corrosion to the hose or hoses than shisha tobacco.

Body, gasket and valve

The body of the hookah is a hollow tube with a gasket at its bottom. On some occasions the body will contain a container at the top for ice in order to cool the smoke. The gasket itself has at least one opening for the hose, but it can have more openings, thus making a multi-hosed hookah. It may also have an additional opening with a valve for clearing the smoke from the water jar rather than through the hose. The gasket seals the connection of the body of the hookah with the water jar.

Water jar

Damascene woodworkers creating wood for hookahs, 19th century.

Placed at the bottom of the hookah, the water jar is a container through which the smoke from the tobacco passes before it reaches the hose. By passing through water, the smoke gains moisture and is lowered in temperature. The level of the water has to be higher than the lowest point of the body's tube in order for the smoke to pass through it. Liquids other than water may be used, such as alcohol, spirit and/or fruit juice, mint leaves with lemon slices, and in many cases, ice may be put in the bottom of the jar to dramatically lower the temperature, making for a smoother smoke.

Plate

The plate (ash tray) is usually just below the bowl and is used for "dead" coals from previous smoking sessions.

Grommets

Grommets in a hookah are usually placed between the bowl and the body, the body's gasket and the water jar and between the body and the hose. The reason for the usage of grommets although not essential (the use of paper or tape has become common) will help to seal the joints between the parts, therefore decreasing the amount of air coming in and maximizing the smoke breathed in.

Operation

Hookah cross-section view

The jar at the bottom of the hookah is filled with water sufficient to submerge a few centimetres of the body tube, which is sealed tightly to it. Tobacco is placed inside the bowl at the top of the hookah and a burning charcoal is placed on top of the tobacco. Some cultures cover the bowl with perforated tin foil to separate the coal and the tobacco, which minimizes inhalation of coal ash with the smoke.

When one inhales via the hose, air is pulled through the coal and into the bowl. The air, hot from the charcoal, roasts the tobacco, producing smoke . This smoke passes down through the body tube, which extends into the water in the jar. It bubbles up through the water, losing heat, and fills the top part of the jar, to which the hose is attached. When a smoker inhales from the hose, smoke passes into the lungs, and the change in pressure in the jar pulls more air through the charcoal, continuing the process.

Tobacco

Tobamel

Tobamel A sweet substance smoked in a hookah pipe, usually containing tobacco. Tobamel is legal in Canada, the United States, and Europe. The "toba" in Tobamel stands for tobacco and "mel" for honey in Latin (miel in Spanish and French, for instance).

Ma'sal

Ma'sal, معسل, Arabic for, literally, honeyed, is the name the "shisha tobacco" is labeled as by the Arabic producers like Egyptian based Nakhla Tobacco and Indian based Qehwa Tobacco'.

Hookah tobacco, as shown here, often has a damp and sticky appearance derived from the honey or other sweeteners added.

A popular variety of Ma'sal is "bahraini ma`sal", which is produced in Bahrain

Tumbâk

Tumbâk is of Turkish origin and refers simply to tobacco, not necessarily flavoured or sweetened. The Persian word tumbeki and the Hindi/Urdu word Tumbako are similar.

Jurâk

Jurâk, mainly of Indian origin, might be considered as an intermediate substance between traditional sweetened tobaccos and the fruity hookah of modern times. The term applies both to a tobacco mixture that includes fruits or aromatic oils as well as tobacco that is just sweetened.

Flavours

Molasses is sold in a variety of flavours. Some of the flavours in which it is available are derived from the addition of artificial flavourings; other manufacturers shun these. A few of the flavours are based upon the scent of flowers. Flavours include vanilla, coconut, rose, jasmine, honey, mango, strawberry, watermelon, mint, cherry, orange, raspberry, apple, apricot, chocolate, licorice, coffee, grape, peach, cola, bubblegum, pineapple, pistachio, along with many others.

Blending flavours has also become very popular amongst hookah smokers. By mixing two or more flavours more complex tastes have been achieved. The strength and flavor will also differ accordingly to the amount of molasses and how dry or humid the flavor is.

Merchandising

Hookah dealership in a Cairo marketplace.

Besides being sold in little packets as is rolling tobacco, Ma'sal is also sold in cardboard boxes and plastic jars. Packaging is generally illustrated with bright floral motifs, fruit, lush gardens and romantic images of sultans or pashas.

The relative proportions of tobacco, treacle, fruits and spices, on average, 30%, 50% and 20% respectively. The substance is generally valid for two years; boxes usually indicate the production date. Health warnings about lung cancer risks and cardiovascular disease appear on these products similar to other tobacco products elsewhere in the world.

Some manufacturers produce tobacco-free flavored herbal blends and market these as shisha as well. These herbal blends typically advertise themselves as having no tar and nicotine, thus a safer alternative that is still enjoyable. However some hookah smokers prefer the "light-headedness" that comes from inhaling the tobacco.

Health risks

The Caterpillar using a hookah, from Alice's Adventures in Wonderland.

According to tobacco companies, the idea that hookah is not as dangerous as cigarettes is a very plausible theory. Studies by tobacco companies have shown that use of hookah over many sessions will not be detrimental to a person's health, such as smoking cigarettes. . It seems the water moisture induced by the hookah makes the smoke less irritating to the cilia lining and the larynx. It is therefore harmless.

In 2005, the experts of the World Health Organization published an important report against the use of water pipes. One year later, this document was criticised in the Journal of Negative Results in Biomedicine for serious errors and misinterpretations regarding: -biomedical aspects (chemistry of smoke, health effects); -sociological (women and children use); - anthropological (Asia, Africa, use in a real environment, types of smoking mixtures and pipes, and the consequences on modelling a complex social and human situation); - historical (about the origins of the device since the first two sentences of the WHO report are inaccurate in this respect).

It should be noted that the WHO report is not a study per se but only a summary of studies selected by its authors for the purpose of issuing recommendations aiming at supporting national bans on smoking. Notably, the report was criticized for having dismissed (this error is called "publication bias") important studies whose conclusions were not in agreement with the above recommendations.

Each hookah session typically lasts more than 40 minutes, and consists of 50–200 puffs which range from 0.15–0.50 litre per puff.

Research shows that a single 45-minute session of hookah tobacco smoking (tobacco molasses) delivers slightly less tar and carbon monoxide (around 3-6%) than smoking a cigar.

Some hookah tobaccos claim to contain 0.0% Tar, but this is misleading because tar is a by-product of plant combustion. Tar may not be added to the shisha before smoking, but burning plant material always produces tar. Hookahs are designed to heat rather than burn tobacco, but for smoke to be produced some combustion must take place- although possibly at a slower rate than burning with direct flame.

Since the tobacco in a hookah is roasted as opposed to burned, the density and temperature of the tobacco may possibly ensure a safer quality of smoke . Distancing somewhat the coal from the tobacco and placing a perforated thermal cover (not to be confused with a wind cover) over the bowl may reduce tar output.

The first aetiologic study on hookah smoking and cancer ever carried out was published in May 2008. The authors conclude to various levels of carcinogenicity. Reference: Sajid KM, Chaouachi K, Mahmood R. Hookah smoking and cancer. Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduction Journal 2008 24 May;5(19)

Hookahs can also be smoked with tobacco-free flavors. There have been few studies to show the impact of smoking herbal flavors in Shisha pipes.

It should be noted that health laws in the UK require that importers and manufacturers must supply the Health Authorities with data on the contents of tobacco products for approval. At this time no Shisha products have been submitted for approval and therefore all those containing tobacco are illegal for sale in the UK.

External links

• The Sacred Narghile, a non-commercial site containing transdisciplinary anthropological (including on origins) and biomedical information and discussions of the above cited scientific studies

• WHO Report on water pipe (hookah), by WHO Study Group on Tobacco Product Regulation (TobReg).
• Critique of the WHO Report on water pipe (hookah) by Chaouachi K. A Critique of WHO's TobReg "Advisory Note" titled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. Journal of Negative Results in Biomedicine 2006 (17 Nov); 5:17 (Highly Accessed)
• Scientific Evidence of the Health Risks of Hookah Smoking (University of Maryland, College Park: June 9, 2008, vol 17, issue 23