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Shisha and smokeless tobacco use

Our position

  • Increase engagement with communities which use these substances. NICE recommends local authority led interventions, engaging community leaders and ensuring that communities have access to oral health advice.
  • An independent national review on the use of these substances with recommendations and effectiveness reviewed on an annual basis.

What is the problem?

  • Many myths persist around shisha use: that it is not as harmful as smoking cigarettes, that flavoured shisha is harmless, that water filters out impurities.
  • Shisha smoking creates significant levels of carbon monoxide poisoning and smokers inhale more smoke than from cigarettes.
  • Herbal Shisha produces large amounts of carbon monoxide and a high level of other toxins associated with smoking.
  • Both the International Agency for Research on Cancer and the World Health Organisation are clear that betel quid and areca nut are carcinogenic to humans.
  • The Mouth Cancer Foundation states that people using paan are five times more likely to develop mouth cancer than people who do not.
  • Many people who take betel nut in one form or another are not aware that it is carcinogenic.