Shisha smoking is being overlooked as a public health issue in the United Kingdom, experts said on Apr. 1 in The BMJ. They argue that the practice, which is popular among young people and some ethnic minority groups, requires more recognition and targeted campaigns to address its risks.
The concern comes as the Tobacco and Vapes Bill moves through Parliament. Experts say this legislation could help regulate shisha use but only if it includes culture-specific support for affected communities. Shisha, also known as hookah or narghile, involves using a waterpipe to smoke charcoal-heated tobacco mixes. There are nearly 1,000 shisha cafes across the UK—more than there are branches of McDonald's in London alone.
Unlike cigarettes, shisha tobacco has not been subject to decades of regulation. Mohammed Jawad, a public health consultant specializing in shisha tobacco smoking, said that its exclusion from flavour bans and lack of licensing for businesses selling it shows "underregulation." Hazel Cheeseman from Action on Smoking and Health said shisha is "every bit as bad for you as smoking cigarettes," adding that flavoured products make it seem less harmful.
Leena Ali at the University of York pointed out that most research specific to shisha use in the UK is outdated by about ten years. She also noted that middle eastern communities where shisha is popular are not well represented in existing data, making monitoring difficult.
Jawad explained that consumption patterns with shisha differ from cigarette use: single sessions can last up to an hour and deliver "quite a lot of toxins" compared to occasional cigarette smokers. He emphasized unique risks due to apparatus sharing and prolonged exposure.
While the upcoming bill may introduce consistent regulations across all tobacco products—including flavoured varieties—Ali questioned whether enough attention or funding would be directed toward addressing shisha specifically. She also raised concerns about whether raising the legal age for sale might push usage into private homes instead of public venues.
With new laws not expected until 2027, experts highlighted an immediate need for culturally tailored anti-smoking messages mentioning shisha specifically. Jawad said national campaigns currently do not mention it at all—a gap he believes increases misinformation—and suggested funding community-led research framed as a "health equity issue." Local councils such as Bradford have begun conducting their own studies targeting high-prevalence areas.
