ISSUE
The Smoke-Free Ontario Act, 2017 (SFOA) prohibits the use of tobacco and vapour products in all enclosed public spaces and workplaces in Ontario. Since its introduction in 2006, the SFOA has contributed to a significant reduction in smoking in public places and exposure to second-hand smoke (Ontario Tobacco Research Unit, 2009). However, the smoking of non-tobacco products such as herbal shisha using waterpipes (e.g. hookahs) remains permitted under the Act, resulting a regulatory gap in provincial smoking legislation. The permissibility of waterpipe use for non-tobacco products creates mixed messages for the public about the safety of waterpipe smoking and diminishes its many potential health risks (Public Health Ontario, 2021). Therefore, municipal governments have the opportunity to address this legislative loophole by implementing or enforcing by-laws that are more restrictive than the SFOA that prohibit the use of waterpipes for non-tobacco products (Canadian Public Health Association, 2021; Smoke-Free Ontario Act, 2017).
BACKGROUND
Non-tobacco shisha that is smoked through a waterpipe is sometimes perceived as healthier than smoking or vaping because of the absence of tobacco as well as the use of water to pass smoke through. Although the smoke passes through water before being inhaled, waterpipes do not filter out toxins as they can still produce high levels of carbon monoxide and expose the person smoking to heavy metals and carcinogenic chemicals (Ottawa Public Health, 2025; Mayo Clinic, 2025). Furthermore, non-tobacco shisha products come in a variety of flavours, contributing to an image of safety and accessibility as well as youth appeal (Chappell, 2021).
Waterpipe smoking creates a plethora of health risks. The use of a hookah to smoke both tobacco and non-tobacco shisha contributes to a significantly greater risk of respiratory diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), and chronic bronchitis. (Public Health Ontario, 2025; Ottawa Public Health, 2025). Waterpipe smoking is also associated with adverse cardiovascular effects including elevated heart rate, increased blood pressure, reduced exercise capacity, and coronary artery disease (Public Health Ontario, 2025; UCLA Health, 2018). Waterpipe smoking during pregnancy is associated with low birth weight, sudden infant death syndrome, and childhood respiratory, learning, and behavioural problems (Public Health Ontario, 2021; Ottawa Public Health, 2025; My Health Alberta, 2024). Furthermore, the sharing of hookah mouthpieces as well as bacteria within the pipe can contribute to infectious diseases such as hepatitis, tuberculosis, influenza, herpes, and COVID-19 (Public Health Ontario, 2021; Ottawa Public Health, 2025; My Health Alberta, 2025).
Waterpipe use also has negative health effects for those exposed to second-hand waterpipe smoke. Even when tobacco is not present, herbal shisha can worsen air quality by producing carbon monoxide and particulate matter (Public Health Ontario, 2025; Zhou et al., 2015). Because of the typically long duration of waterpipe smoking sessions (approximately one hour), individuals are exposed to greater levels of carbon monoxide and heavy metals (e.g. nickel and arsenic) using a waterpipe compared to tobacco cigarettes (Mayo Clinic, 2025; Chappell, 2021), further exacerbating health concerns for those who smoke as well as others exposed to second-hand smoke. Research from the University of Alberta finds that some hookah bars can have air quality that is similar to “being downwind from a forest fire” (University of Alberta, 2013), highlighting the importance of restricting indoor waterpipe smoking to protect the health of patrons as well as employees.
Although establishments may advertise their shisha as free of tobacco, tobacco has been found in shisha samples in Windsor and across Ontario (Chappell, 2021). Since 2024, five charges have been laid at hookah lounges in Windsor where tobacco has been found in shisha samples, representing a 50% non-compliance rate based on ten inspections conducted. Prohibiting indoor hookah use would eliminate the possibility of tobacco use indoors that persists despite current smoking legislation. Several cities throughout Ontario have banned waterpipe use within enclosed public spaces and workplaces such as Ottawa, Peterborough, Barrie, Niagara, Orillia, Toronto, and Hamilton (Public Health Ontario, 2025). Furthermore, the Canadian Public Health Association recommends that municipalities establish by-laws prohibiting hookah use in public places, as stated within their position statement The Winnable Battle: Ending Tobacco Use in Canada (2021).
PROPOSED MOTION
Whereas, waterpipe smoking is associated with negative health outcomes including lung cancer, chronic obstructive pulmonary disease (COPD), low birth weight, communicable diseases, and cardiovascular conditions such as high blood pressure and coronary artery disease; and
Whereas, non-tobacco smoking products (e.g. shisha) contain heavy metals, carcinogens, and carbon monoxide which are hazardous to the health of those who smoke as well as those subject to second-hand smoke; and
Whereas, the Smoke Free Ontario Act, 2017 does not restrict the smoking of non-tobacco products indoors, providing an opportunity for municipalities to implement local by-laws which include the prohibition of waterpipe use for non-tobacco products in enclosed public spaces and workplaces;
Now therefore be it resolvedthe Windsor‑Essex County Board of Health endorses the Windsor‑Essex County Health Unit working collaboratively with area municipalities to develop, update, and enforce by‑laws that restrict the use of waterpipes, including non‑tobacco products, in enclosed public spaces and workplaces.
Further that, the Windsor-Essex County Board of Health supports efforts to educate the public, business owners, and municipal partners on the health risks associated with waterpipe smoking, including non-tobacco products, and the importance of protecting workers and the public from exposure to second-hand emissions in enclosed public spaces and workplaces.
REFERENCES
Canadian Public Health Association. (2021). Tobacco and vaping use in Canada: moving forward. Retrieved from https://www.cpha.ca/tobacco-and-vaping-use-canada-moving-forward
Chappell, G. (2021). Waterpipe (hookah) smoking – policy considerations. Niagara Region. Retrieved from https://pub-niagararegion.escribemeetings.com/filestream.ashx?DocumentId=19010
Mayo Clinic. (2025). Hookah smoking: is it safer than cigarette smoking? Retrieved from https://www.mayoclinic.org/diseases-conditions/nicotine-dependence/expert-answers/hookah/faq-20057920
My Health Alberta. (2024). Hookah and waterpipe smoking. Retrieved from https://myhealth.alberta.ca/Alberta/Pages/Hookah-and-waterpipe-smoking.aspx
Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evidence brief: health impacts of waterpipe smoking and exposure. Toronto, ON: Queen's Printer for Ontario; 2021.
Ontario Agency for Health Protection and Promotion (Public Health Ontario). Ontario tobacco, vaping & cannabis by-law summary-2025. 4th ed. Toronto, ON: King’s Printer for Ontario; 2026.
Ontario Tobacco Research Unit. Toward a Smoke-Free Ontario: Progress and Implications for Future Developments [Special Reports: Monitoring and Evaluation Series (Volume 13, No. 3)]. Toronto, ON: Ontario Tobacco Research Unit, February 2009.
Ottawa Public Health. (2025). Vaping and hookah. Retrieved from https://www.ottawapublichealth.ca/en/public-health-topics/vaping-and-hookah.aspx
Smoke Free Ontario Act, (2017, c. 26 Sched. 3). Retrieved from https://www.ontario.ca/laws/statute/17s26
UCLA Health. (2018). Hookah smoking raises cardiovascular risk comparable to traditional cigarette smoking, study finds. Retrieved from https://www.uclahealth.org/news/release/hookah-smoking-raises-cardiovascular-risk-comparable-to-traditional-cigarette-smoking-study-finds
University of Alberta. (2013). Herbal shisha a potential health hazard: study. Retrieved from https://www.ualberta.ca/en/folio/2013/11/herbal-shisha-a-potential-health-hazard-study.html
Zhou, S., Weitzman, M., Vilcassim, R., Wilson, J., Legrand, N., Saunders, E., Travers, M., Chen, L. C., Peltier, R., & Gordon, T. (2015). Air quality in New York City hookah bars. Tobacco Control, 24(0), e193-e198. https://pmc.ncbi.nlm.nih.gov/articles/PMC4390442/