Item - 2014.HL29.1

Since 2006, the Smoke-Free Ontario Act (SFOA) has prohibited the smoking of lighted tobacco in enclosed public places and workplaces, including the use of waterpipes (also known as hookahs) for this purpose. However, the SFOA does not apply to indoor use of waterpipes to smoke herbal, non-tobacco products. This has led to a proliferation of waterpipe bars, restaurants and cafes across the province where indoor smoking of ostensibly ‘tobacco-free’ products is permitted.

Waterpipe smoking gives rise to at least four concerns for public health: 1. smoking of waterpipe tobacco products poses well-established health risks for users and those exposed to second-hand smoke; 2. waterpipe smoking of even non-tobacco products indoors undermines the success of the SFOA, because it contributes to the social acceptability of smoking in public places; 3. it is difficult for smokers or enforcement staff to ensure that the product smoked is non-tobacco based; and 4. emerging research indicates that waterpipe smoking of non-tobacco/herbal substances has an adverse impact on indoor air quality that can lead to unhealthy exposures.

This report reviews evidence on the use and health effects of waterpipe smoking in indoor public places, including recent evidence on indoor air quality at waterpipe cafes in Toronto. It recommends that the Medical Officer of Health report, in consultation with the City Solicitor and community stakeholders, on measures to address health risks from indoor waterpipe use at commercial establishments, including possible prohibition.