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‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served
  1. Fadi Hammal1,
  2. Alyssa Chappell1,
  3. T Cameron Wild2,
  4. Warren Kindzierski2,
  5. Alan Shihadeh3,
  6. Amanda Vanderhoek4,
  7. Cong Khanh Huynh5,
  8. Gregory Plateel5,
  9. Barry A Finegan1
  1. 1Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
  2. 2School of Public Health, University of Alberta, Edmonton, Canada
  3. 3Faculty of Engineering & Architecture, American University of Beirut, Beirut, Lebanon
  4. 4Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
  5. 5Institute for Work and Health, Institut universitaire romand de Santé au Travail (IST), Lausanne, Switzerland
  1. Correspondence to Dr Barry A Finegan, Department of Anesthesiology & Pain Medicine, University of Alberta, 8–120 Clinical Sciences Building, Edmonton, Alberta, Canada T6G2G3; bfinegan{at}


Background There are limited data on the composition and smoke emissions of ‘herbal’ shisha products and the air quality of establishments where they are smoked.

Methods Three studies of ‘herbal’ shisha were conducted: (1) samples of ‘herbal’ shisha products were chemically analysed; (2) ‘herbal’ and tobacco shisha were burned in a waterpipe smoking machine and main and sidestream smoke analysed by standard methods and (3) the air quality of six waterpipe cafés was assessed by measurement of CO, particulate and nicotine vapour content.

Results We found considerable variation in heavy metal content between the three products sampled, one being particularly high in lead, chromium, nickel and arsenic. A similar pattern emerged for polycyclic aromatic hydrocarbons. Smoke emission analyses indicated that toxic byproducts produced by the combustion of ‘herbal’ shisha were equivalent or greater than those produced by tobacco shisha. The results of our air quality assessment demonstrated that mean PM2.5 levels and CO content were significantly higher in waterpipe establishments compared to a casino where cigarette smoking was permitted. Nicotine vapour was detected in one of the waterpipe cafés.

Conclusions ‘Herbal’ shisha products tested contained toxic trace metals and PAHs levels equivalent to, or in excess of, that found in cigarettes. Their mainstream and sidestream smoke emissions contained carcinogens equivalent to, or in excess of, those of tobacco products. The content of the air in the waterpipe cafés tested was potentially hazardous. These data, in aggregate, suggest that smoking ‘herbal’ shisha may well be dangerous to health.

  • Non-Cigarette Tobacco Products
  • Secondhand Smoke
  • Carcinogens

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