Intended for healthcare professionals


Hookah smoking

BMJ 2007; 335 doi: (Published 05 July 2007) Cite this as: BMJ 2007;335:20
  1. Rashid Gatrad, consultant paediatrician1,
  2. Adam Gatrad, gap year student2,
  3. Aziz Sheikh, professor of primary care research and development3
  1. 1Manor Hospital, Walsall
  2. 2University of Central England
  3. 3Allergy and Respiratory Research Group, Division of Community Health Sciences, University of Edinburgh
  1. Correspondence to: A Sheikh Aziz.Sheikh{at}

    A hookah—also known as hubbly bubbly, shisha, or narghile—is a glass based waterpipe used for smoking. It operates by water filtration and indirect heat. Tobacco or molasses are placed in the bowl at the top of the apparatus, which is connected to the water filled base by a pipe. This bowl is then covered with perforated material, such as kitchen foil. Burning charcoal is then placed on top of the foil. During inhalation the smoke from the charcoal is pulled through the tobacco down the pipe and towards the water. After bubbling through the water, the cooled smoke surfaces and is drawn through the hose and inhaled. Some hookahs have a “choke” to control the amount of smoke inhaled. Electric burners are also available, which offer a quicker smoke than the original charcoal burners.

    How common is waterpipe smoking?

    Around 100 million people use a hookah daily worldwide.1 Some of these smokers are children—a study in the central region of Israel among predominantly Jewish …

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