It is often asserted that a waterpipe session is equivalent to smoking 100 or more cigarettes. This originates from a 2005 statistic used by the World Health Organization (WHO) comparing the volume of aerosol produced during a waterpipe session to the volume of smoke produced by a single cigarette, without reference to the composition of the respective emissions or different consumer behaviours and consumption patterns.

The aim of the present study was to evaluate this assertion, based on an assessment of “tar”, nicotine and carbon monoxide yields from a commercially available flavoured waterpipe tobacco product (Al Fakher “Two Apples with Mint”) and the University of Kentucky 3R4F reference cigarette.

Waterpipe aerosol was collected in accordance with the International Organisation for Standardisation (ISO) draft Technical Specification 22486 “Water pipe tobacco smoking machine — Definitions and standard conditions”, using a Cerulean SPS-Shisha smoking machine with conventional charcoal as the heating source (Global Laboratory Service Inc., U.S.A.). Waterpipe aerosol TNCO yields were compared with those from the 3R4F under a machine-smoking regime of “puff” volume 55 ml, “puff” duration 2 s and “puff” interval 30 s.

Machine derived waterpipe tobacco aerosol was found to contain significantly reduced concentrations of “tar”, nicotine and carbon monoxide (84 %, 99 % and 90 % respectively) compared to the smoke generated from a single 3R4F. Furthermore, in contrast to the numerous toxicants present in the “tar” from the 3R4F cigarette, waterpipe tobacco residue was found to be primarily composed of humectants (i.e. glycerol, propylene glycol and triacetin) and water.

These data do not support the WHO statistic that conflates the volume of aerosol produced from a flavoured waterpipe session with the yields associated with smoking 100 or more cigarettes.