A shisha is a water pipe used to smoke flavored tobacco. You may also hear it called a hookah, narghile, or argileh depending on where in the world you are. The device works by passing tobacco smoke through a water-filled base before you inhale it through a long hose. Shisha smoking is a social tradition with roots in 16th-century India and the Middle East, and it remains popular in lounges, cafés, and homes worldwide.
Origins and What the Name Means
The water pipe was invented by Abul-Fath Gilani, an Iranian physician, in the Indian city of Fatehpur Sikri during the Mughal period. From there it spread across the Middle East, North Africa, and eventually the rest of the world.
The word “shisha” traces back to the Persian word šīše, meaning “glass,” a reference to the glass container that holds the water. In Egypt, Sudan, Saudi Arabia, and much of the Arab Peninsula, “shisha” is the standard term. “Hookah” comes from the Hindustani word huqqa, rooted in Arabic, and is the most common term in India and in English. In Lebanon, Syria, Jordan, and Iraq, you’ll hear “argileh,” while in Turkey and the Balkans the word is “nargile,” derived from a Sanskrit word for coconut, likely because the earliest versions were carved from coconut shells. All of these names refer to the same device.
How a Shisha Pipe Works
A shisha has four main components. The bowl sits at the top and holds the tobacco. Charcoal placed on or near the bowl heats the tobacco, producing smoke. The stem is a vertical shaft that channels smoke downward from the bowl into the base, a glass vase partially filled with water. As smoke passes through the water, it cools before rising into the air chamber above the waterline. Finally, a hose with a mouthpiece connects to the base, and when you draw on it, the cooled smoke travels up the hose and into your lungs.
The water makes the smoke feel noticeably smoother and cooler than a cigarette, which is one reason many people assume shisha is safer. That assumption, as the health data below shows, is wrong.
What’s in Shisha Tobacco
The tobacco loaded into a shisha bowl is not the same dry leaf you’d find in a cigarette. Called “maassel” (meaning “honeyed” in Arabic), it is a moist, sticky mixture of tobacco leaf, molasses or honey, glycerin, and concentrated flavorings. The flavors are almost exclusively fruity or sweet: apple, grape, mint, watermelon, and berry are among the most common. Glycerin is the key humectant that keeps the tobacco wet and produces the thick, billowy clouds shisha is known for.
Some of the flavoring compounds used in maassel, including limonene, linalool, and eugenol, are known skin allergens. While skin contact during smoking is limited, these compounds also enter the smoke you inhale.
The Water Filtration Myth
The single most widespread misconception about shisha is that water filters out the dangerous stuff. It doesn’t, at least not in any meaningful way. A study published in BMC Public Health found that on average only about 3% of the heavy metals present in shisha tobacco were trapped by the water. The remaining toxins split between the smoke you inhale (57%) and the leftover ash (40%). The water is mainly cooling the smoke, not cleaning it.
The most abundant metal found in the smoke across tested samples was uranium, detected at an average of 800 parts per billion. Iron concentrations in certain flavors were even higher, with mint-flavored tobacco reaching over 10,000 parts per billion of iron. These metals enter your lungs with every pull.
How a Shisha Session Compares to Cigarettes
A typical shisha session lasts 45 to 60 minutes, far longer than the few minutes it takes to smoke a cigarette. That extended exposure changes the math considerably. A single 60-minute session delivers at least 145 milligrams of carbon monoxide, roughly eight times the amount in one cigarette. Even just five minutes of shisha smoking produces four times the carbon monoxide of an entire cigarette.
Nicotine exposure follows a similar pattern. Peak nicotine concentration from shisha and cigarettes is about the same, but because a shisha session lasts so much longer, total nicotine intake ends up nearly double that of a single cigarette. The ratio of carbon monoxide to nicotine in shisha smoke is approximately 50 to 1, compared to 16 to 1 in cigarettes. That means you’re taking in disproportionately high amounts of carbon monoxide just to satisfy a nicotine craving.
Long-Term Health Risks
The CDC states plainly that smoking hookah carries many of the same health risks as smoking cigarettes. Shisha tobacco and smoke contain toxic agents linked to lung, bladder, and oral cancers. Some studies have directly associated shisha smoking with lung cancer. The sweeteners and flavorings mixed into the tobacco may actually increase exposure to certain smoke-related toxins, compounding the damage to lung tissue.
Cardiovascular risk is also significant. The toxic compounds in shisha smoke contribute to clogged arteries and heart disease. Regular use has been tied to reduced lung function and chronic bronchitis. For pregnant smokers, the risks extend to the baby: infants born to people who smoke shisha face a higher risk of respiratory disease.
Infection Risk From Sharing
Shisha is almost always a group activity, and the shared mouthpiece creates a direct route for transmitting infections. Research sampling water pipes from hookah bars found both gram-positive and gram-negative bacteria on the mouthpieces, including antibiotic-resistant strains. The highest bacterial diversity was concentrated right at the mouthpiece, the part every user puts their lips on.
The list of infections linked to shared water pipes is sobering. Tuberculosis was identified in a cluster of young hookah users in Queensland, Australia. The bacterium that causes stomach ulcers (Helicobacter pylori) and the fungus Aspergillus have both been isolated from hookah equipment. Hepatitis C transmission has been connected to shared mouthpieces, and hookah sharing was flagged as a risk factor for MERS-CoV transmission before the COVID-19 pandemic raised similar concerns about respiratory viruses spreading through shared smoking devices.
Nicotine-Free Alternatives
Herbal molasses and steam stones are marketed as safer, tobacco-free options. Herbal molasses replaces the tobacco leaf with sugarcane fiber or tea leaves but still uses glycerin and the same fruity flavorings. Steam stones are small porous mineral rocks soaked in glycerin-based flavoring liquid. Neither contains nicotine or tobacco.
That does not make them harmless. The CDC notes that smoke from herbal shisha products still contains toxic agents associated with cancer, heart disease, and lung disease. Heating glycerin and flavorings over charcoal produces combustion byproducts regardless of whether tobacco is present. And the same flavoring chemicals found in tobacco-based shisha, some of them known allergens, appear in herbal and steam stone products as well. Removing the tobacco eliminates nicotine addiction from the equation, but it does not eliminate the risks of inhaling heated, flavored aerosol over a prolonged session.