Exposure to hookah has burgeoned among youth with ~ 40% responding to “ever used?” in a recent UK sample. Hookah use has been touted as safe especially if ‘herbal’ shisha is smoked and defended as a ‘cultural’ practice when banning hookah use in public spaces is proposed. Our data convincingly demonstrates that both these assertions are baseless. ‘Herbal’ shisha products tested contained toxic trace metals and PAHs levels equivalent to, or in excess of, that found in cigarettes. Their mainstream and side stream smoke emissions contained carcinogens equivalent to, or in excess of, those of tobacco products. The content of the air in the water pipe cafés tested where ‘herbal’ products were smoked contained potentially dangerous micro-particle and CO levels. Our qualitative research strongly suggests that peer influence, availability of flavoured products and facile access to hookahs in cafés are the major factors in initiation. Ethno-cultural issues play only a minor role.