Shisha smoking has continued to be overlooked as a significant public health concern in the United Kingdom.

According to experts writing in the BMJ (British Medical Journal), despite its rising popularity and the health risks associated with its use, shisha has not received the same level of regulatory scrutiny as cigarettes.

They suggested that the forthcoming Tobacco and Vapes Bill could have represented a key opportunity to address this gap, but only if it had included clearer recognition of shisha use alongside targeted, culturally appropriate public health strategies.

Shisha also referred to as hookah, narghile, or hubble-bubble is a method of smoking tobacco through a waterpipe, where the tobacco was typically heated using charcoal. Over the past decade, its availability had expanded considerably across the UK, with close to 1,000 shisha cafés operating nationwide.

Shisha is especially popular among young people and some ethnic minority groups, mainly in urban areas such as Birmingham, London, and Manchester. In London, shisha use among secondary school aged children has been reported to be as high as 40%.

Recent survey data indicates that approximately one in ten tobacco users in the UK smoked non-cigarette tobacco products, including shisha, exclusively. National youth surveys, including those conducted by Action on Smoking and Health and the International Tobacco Control Policy Evaluation Project, also shows that a notable proportion of young people engaged in shisha smoking.

Unlike cigarette smoking, shisha had not benefited from decades of dedicated regulatory frameworks covering packaging, taxation, and advertising restrictions. This lack of comparable oversight had contributed to inconsistencies in how it was governed.

The disregard for shisha tobacco as a public health problem is exemplified by its exclusion from the flavour ban, which some experst describes as a “textbook example of policy incoherence.”

While earlier European legislation had exempted shisha tobacco from restrictions on flavoured products, a later update introduced in 2023 no longer applied in the UK, leaving flavoured shisha tobacco still legally available domestically.

Calls Grow for Stronger Shisha Regulation in UK Tobacco Laws

According to Mohammed Jawad, a Public Health Consultant and Specialist in Shisha Tobacco Smoking, its exclusion from flavour bans, for example, and a lack of licensing for businesses selling shisha tobacco is evidence of this “underregulation,” adding that data deficiency has been a key reason for this oversight.

“We don’t have strong data, nationally or locally, around shisha use, and questions are not being asked in quite the right way to elicit public health risk.urveys are often underpowered to pick up accurate prevalence in marginalised groups. That is a common structural inequality that marginalised groups face in the national discourse, and it’s a cultural blind spot.”
Mohammed Jawad

Jawad further emphasized that shisha should not have been treated simply as another form of smoking covered by existing tobacco laws. Usage patterns differed significantly, with sessions often lasting up to an hour and potentially exposing users to higher levels of toxins compared with typical cigarette consumption.

While the forthcoming legislation was expected to help create greater consistency across tobacco regulation, particularly in relation to flavoured products, licensing experts, however, have stressed that immediate action is still needed as the bill is not expected to take effect until 2027.

Jawad also pointed to the absence of shisha-specific messages in national anti-smoking campaigns, which may have contributed to widespread misinformation. He advocated for increased funding for community-led research, framing the issue as a matter of health equity rather than cultural criticism.

Moreover, Leena Ali, a doctoral researcher at the University of York focusing on the role of culture in shisha-related interventions, raised additional concerns regarding ethnicity data collection. She noted that although shisha was commonly used among individuals from Middle Eastern backgrounds, these populations were not accurately represented in existing datasets and were often grouped into broad other categories, obscuring meaningful disparities.

Ali also highlighted that much of the UK’s shisha-specific research was outdated, with the most recent studies dating back around a decade and pointed out that despite repeated calls for more research and greater awareness, progress in this area had remained limited.

Advocacy organizations have similarly raised concerns about perceived inconsistencies in tobacco regulation. Hazel Cheeseman from Action on Smoking argued that “every bit as bad for you as smoking cigarettes, and the flavours make it appear less harmful and make it more palatable, it’s an inequality not to apply the law equally.” This perceived imbalance, she argued, allowed shisha to remain less scrutinized.