Charities say the number of people using the tobacco pipes has increased in the last year. The activity has moved out of mostly ethnic communities into mainstream groups and is becoming popular with students.
A major concern is “underground” shisha bars, which illegally allow people to smoke indoors, where they could be exposed to high levels of carbon monoxide given off by the pipes as well as the cancer-causing chemicals contained in the tobacco.
Health experts said they wanted more people to be aware that use of shisha poses a major threat to health.
Shisha is a tobacco-based product designed to be smoked through a water pipe, often known as a hookah. It comes in flavours, including cherry, vanilla and chocomint, and colourful packaging, which has led some to describe it as the tobacco equivalent of alcopops. Even tobacco-free herbal versions of the products have been found to produce chemicals linked to cancer.
This week, a two-day conference in Edinburgh, hosted by Action on Smoking and Health (ASH) Scotland, to discuss ways countries can work towards a smoke-free generation will include research into the threats posed by shisha use.
ASH has joined forces with Fast Forward, a Scottish charity working with young people, to produce a document outlining the risks of smoking shisha and to dispel myths that it is safer than smoking cigarettes.
Registered shisha bars have been set up in recent years which allow users to buy and smoke the products within the laws covering tobacco use. But some of these have faced fines for allowing the pipes to be used inside, including a crackdown on premises in Glasgow last year.
In December, a shisha bar in the city became the first to be prosecuted in court for flouting Scotland’s smoking ban. Limelight – one of several cafés offering the Middle Eastern water pipes to customers – was fined £620 after raids by council inspectors.
Fears have emerged that people are setting up illegal venues to allow shisha to be smoked indoors, which increases the risks of exposure to high levels of carbon monoxide generated by the charcoal used to heat the tobacco. This colourless and odourless gas is highly toxic and in large concentrations can cause organ damage and death.
Experts are concerned that if people choose to smoke shisha in bars, or in poorly-ventilated rooms in their own homes, they will increase their risk of carbon monoxide poisoning as the gas has nowhere to escape.
Allison Brisbane, senior information officer at ASH Scotland, said her work had uncovered risks linked to shisha use, including the dangers posed by carbon monoxide.
She said bars often operated like illegal raves in the past, with people given a number to phone to find out where they were set up and venues moving to different places to remain undetected.
“These places are not going to have fire exits or any health and safety,” Brisbane said. “They will be smoking carbon monoxide in an enclosed space, which they shouldn’t be. There is a real risk and that is what we are not getting across to people.
“In my work I concentrated on carbon monoxide because it seemed to be the worst part of the whole thing. What is in the shisha varies from product to product, but what they all have in common is they all use smouldering charcoal to make it give off smoke and that will always be a problem.
“You could be smoking what you think is healthy, herbal stuff but the charcoal is still giving off carbon monoxide in the same way a half-extinguished barbecue would be.”
Chris Read, from Fast Forward, said in the last year the charity had become aware of more youngsters using shisha.
“A lot of people think there is no harm or risk to these products,” he said. “But there have been cases of it being smoked in places without any windows or ventilation and it produces carbon monoxide which can be very dangerous.”
Sheila Duffy, chief executive of ASH Scotland, said: “Shisha smoking is increasingly popular with young people but, as a tobacco product, it is illegal to supply it to under-18s. Some users believe it to be neither as harmful nor as addictive as cigarettes. But shisha not only potentially exposes smokers to the danger of carbon monoxide poisoning, it also makes them vulnerable to harm from tobacco.”
She added: “Bars which sell lit, smoked tobacco-free shisha still need to comply with smoke-free legislation.”
A Scottish Government spokeswoman said: “We have been clear that smoking tobacco, by any means, damages health. Smoking shisha is covered by smoke-free legislation in Scotland.”