Shisha, also called hookah or waterpipe, is popular in many parts of Africa, Asia, and the Middle East, and the claim that one session equals 100 to 200 cigarettes is everywhere. It sounds alarming, and it is repeated by health campaigns and news reports. But what does the evidence actually say?
Quick answer
- Not exactly. The claim is a distortion of a real scientific finding. The documented fact is about the volume of smoke, not a direct equivalence to 100 to 200 cigarettes [1, 2].
- A typical 1 hour shisha session involves inhaling about 90,000 millilitres of smoke, which is 100 to 200 times the volume inhaled from a single cigarette (about 500 to 600 millilitres) [1].
- Scientists warn that smoke volume is not the same as the dose of toxins, so a simple cigarette count is not scientifically accurate [2, 3].
- This does not make shisha safe. One session can expose a smoker to nearly 9 times more carbon monoxide and 1.7 times more nicotine than a single cigarette [1].
- Smoking shisha is not a safe alternative to cigarettes. It carries risks of cancer, heart disease, and lung problems [1, 4].
What is shisha, and how does it work?
Shisha is tobacco smoked through a waterpipe. Other names for the same device include hookah, narghile, argileh, hubble-bubble, and goza [1]. The tobacco is often mixed with molasses and fruit flavors, which gives the smoke a sweet smell and can make it feel milder than it is.
Burning charcoal heats the tobacco. The smoke passes through a water bowl before reaching the smoker through a hose. A key point that surprises many people: the water cools the smoke but does not filter out the toxins [1, 4].
Where the 100 to 200 cigarette claim came from
The claim traces back to a World Health Organization advisory note on waterpipe smoking, first issued in 2005 and updated in 2015 [2]. An advisory note is a summary of the evidence written to guide health regulators.
The WHO noted that a typical 1-hour shisha session produces about 90,000 millilitres of smoke, while smoking a single cigarette involves about 500 to 600 millilitres [1]. That works out to roughly 100 to 200 times more smoke by volume.
Over time, health campaigns and media reports shortened this to one shisha session equals 100 to 200 cigarettes. That wording is a misreading. The WHO figure described how much smoke passes through the pipe, not how many cigarettes’ worth of harm a session delivers [2, 3].
Why smoke volume is not the same as harm
Volume measures how much smoke is inhaled. Harm depends on what is in the smoke and how much of it the body absorbs. Think of it like drinking a large bottle of a weak drink versus a small cup of a very strong one. The bigger bottle is more liquid, but the small cup may contain more of the substance that affects you.
Researchers who have tried to express shisha sessions in cigarette equivalents have reached very different numbers depending on the session length and method used. One estimate suggested 10 cigarettes per 45-minute session, while a WHO-based comparison put a 45-minute session at around 60 cigarettes, and an 80-minute session at about 100 [3]. The wide range shows there is no single honest answer.
What is clearly documented is that a session exposes the smoker to large amounts of harmful substances. Compared with one cigarette, a single session can deliver nearly 9 times more carbon monoxide (a poisonous gas that reduces the blood’s ability to carry oxygen) and 1.7 times more nicotine (the addictive chemical in tobacco) [1]. The charcoal itself adds carbon monoxide, heavy metals, and cancer-causing chemicals called carcinogens, which are substances known to cause cancer [1, 4].
The documented health risks
Shisha smoke contains many of the same harmful components as cigarette smoke, including nicotine, tar, and heavy metals [1]. Smoking it is linked to lung, bladder, stomach, esophageal, and oral cancers, as well as heart disease and reduced lung function [4].
There are added risks unique to the way shisha is used. Sessions are often social, with one mouthpiece passed between people, which can spread infections such as tuberculosis, herpes, and hepatitis [4]. Secondhand smoke from shisha includes smoke from the charcoal as well as the tobacco, so people sitting nearby are also exposed [1]. Smoking during pregnancy is linked to lower birth weight and breathing problems in babies [1].
Electronic hookahs, called e-hookahs or hookah pens, heat a liquid into a vapor. Research on these devices is still early, but health authorities state that use of vaping devices is not safe for most people and that tobacco use in any form is not safe [4].
Why the myth keeps spreading
Part of the reason is genuine public health concern. Health agencies sometimes use dramatic comparisons to get attention, and the 100 cigarette line is memorable. Surveys show many young adults believe shisha is less harmful than cigarettes, with one US study finding 32% held this belief [5]. The exaggeration is usually meant to counter that false sense of safety.
The irony is that the truth is serious enough on its own. A smoker does not need inflated numbers to justify concern, and misleading claims can backfire when people discover the exaggeration and stop trusting health advice altogether [2].
Myths vs facts
| Claim | Status | Explanation |
|---|---|---|
| 1 hour of shisha is equivalent to 100 to 200 cigarettes | Myth (as stated) | The documented finding is about smoke volume, which is 100 to 200 times larger, not a direct equivalence in harm [1, 2]. |
| A 1 hour shisha session involves inhaling far more smoke than one cigarette | True | About 90,000 ml versus about 500 to 600 ml, roughly 100 to 200 times more by volume [1]. |
| The water in the pipe filters out the toxins | Myth | The water cools the smoke but does not remove the toxic agents [1, 4]. |
| Shisha smoking is safer than cigarette smoking | Myth | Shisha is linked to cancer, heart disease, lung problems, and high carbon monoxide exposure, and is not a safe alternative [1, 4]. |
| A shisha session can deliver more carbon monoxide than a cigarette | True | Nearly 9 times more carbon monoxide and 1.7 times more nicotine per session than from a single cigarette [1]. |
| Herbal or tobacco-free shisha is harmless | Myth | The charcoal still produces carbon monoxide and toxic chemicals even without tobacco [1, 4]. |
| Scientists agree on a single cigarette equivalent for shisha | Unproven | Estimates range widely from around 10 to 100 cigarettes depending on session length and method, and researchers say any single number is an approximation [3]. |
Bottom line
The honest answer is that 1 hour of shisha is not literally equivalent to smoking 100 to 200 cigarettes, because the claim confuses the volume of smoke with the dose of harm. What is true is that a typical session floods the lungs with far more smoke than a cigarette, delivers multiple times more carbon monoxide and nicotine, and carries real risks of cancer, heart disease, and addiction. The water does not make it safe, and sharing a pipe adds infection risks. If you smoke shisha and want to quit, your doctor or a local quitline can help.
Disclaimer: This article is for general education only and does not replace professional medical advice. If you notice an error or would like to send feedback or corrections, please contact us.
References
[1] Hookahs, Centers for Disease Control and Prevention
[2] Advisory note: Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators, World Health Organization
[3] Waterpipe tobacco smoking and cigarette equivalence, BMJ (PMC)
[4] Hookah smoking: Is it safer than cigarette smoking?, Mayo Clinic
[5] Is hookah worse than cigarettes?, Prevent Cancer Foundation
