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Medicine and Society
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Clinical Research and
Methods
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Education
and Training
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| October 2014 -
Volume 12 Issue 8 |
|
Emerging
trends of Shisha smoking in Pakistani youth
Manzoor
Butt
Correspondence:
Dr Manzoor Ahmed Butt
Rawalpndi, Pakistan
Email:
drmanzoor@ymail.com
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Shisha
seller
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Origin of hookah smoking
Hubble bubble, hookah or waterpipe smoking historically
started in the time of the Safavid dynasty in
the Persian Empire. From there, it reached the
Indian subcontinent, Egypt and the Levant during
the Ottoman dynasty. Hookah smoking is now prevalent
over many countries of the world mainly due to
immigrants from the native areas.
Hookah is a way of smoking dry or wet tobacco
through a bowl of water with a tube or pipe. Most
people use dry or wet tobacco but some also mix
tobacco with molasses sugar. Traditionally it
was popular in the old and adult (mainly men)
but now it is more prevalent and popular in youth
who through their innovations transformed traditional
hookah into modern Shisha with the belief of making
smoking safe. The incidence of shisha smoking
is rising quickly in young boys and even in children
in Pakistan. A small number of girls also use
shisha on special occasions. This starts as fashion
but soon becomes a need due to nicotine addiction.
Shisha smokers mostly use flavored tobacco mixed
with fruit or molasses sugar which makes the smoke
more aromatic than cigarette smoke. Popular flavourings
include apple, plum, coconut, mango, mint, strawberry
and cola. The fruit syrup or sugar renders the
tobacco damp, therefore, wood, coal, or charcoal
is burned in the shisha pipe to heat the tobacco
and create the smoke.
Misconception about shisha smoking
Many people believe that shisha smoking is not
addictive because the water used in the shisha
/ hookah can absorb nicotine. This is not true
as only some of the nicotine is absorbed by the
water and enough nicotine enters their blood to
cause an addiction.
Our youth claim that the Shisha is not just an
activity rather its part of an interesting lifestyle
that brings along with it good times, good company
and great memories. Shisha smoking is typically
done in groups, with the same mouthpiece passed
from person to person. Shisha cafes are now increasingly
popular in Pakistan.
The latest trends in shisha smoking
Many new types of Shisha have been invented. These
are marketed with the claim of no or very low
toxicity. These include Herbal Shisha, Shisha
pens and steam stones. Shisha Pens also known
as Shisha sticks are the world's first portable
electronic shisha smoking device.
Non-tobacco Hookah Products
Some sweetened and flavored non-tobacco products
are sold for use in a hookah. Labels and ads
for these products often claim that users can
enjoy the same taste without the harmful effects
of tobacco. Studies of tobacco-based shisha
and "herbal" shisha show that smoke
from both preparations contain carbon monoxide
and other toxic agents known to increase the
risks for smoking-related cancers, heart disease,
and lung disease. [1]
Health hazards of Shisha smoking
Shisha smoking has now become an industry comprising
of shisha manufacturers, tobacco sellers and
shisha café owners. There are false claims
of harm reduction and safety as compared to
cigarette smoking in print and electronic commercial
media by the promoters.
Using a hookah / shisha to smoke tobacco poses
serious health risks to smokers and others exposed
to the smoke from the hookah. The main ingredient
of hookah or Shisha is tobacco. Shisha / Hookah
smokers may be at risk for some of the same
diseases as cigarette smokers. These include:
reduced lung function, lung cancer, heart disease,
TB, oral cancer, stomach cancer, cancer of the
esophagus and decreased fertility [1]
When someone smokes shisha, he and all sitting
near him are breathing in smoke which releases
toxins including carbon monoxide and heavy metals
like arsenic and lead. Flavored tobacco is smoked
over coals and fumes from these fuels add new
toxins to the already dangerous smoke. A typical
hour long shisha session involves inhaling 100
to 200 times the volume of smoke inhaled when
smoking a cigarette. A latest study provides
the first evidence about the potential hazards
of exposure to waterpipe-associated secondhand
smoke. Hazardous particles of various sizes
can build up gradually during waterpipe use
to reach dangerously high levels presenting
a risk to non-smokers and a particular risk
to pregnant women. [2]
Social hazards of Shisha smoking
The social hazards of Shisha may affect personal
life, family and friends. These may reduce working
ability and performance. Shisha smoking is done
in groups. Youth is often in a high mood and
it is not uncommon to see violence due to non
tolerance of various groups. The quest for more
pleasure and fun sometimes leads to drug addiction.
Some are also involved in unprotected sexual
activities leading to sexually transmitted infections
(STIs), mostly gonorrhea and hepatitis-B. The
long hour sittings cause distraction from studies
and other useful and healthy activities like
sports.
| CONCLUSIONS
AND
RECOMMENDATIONS
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Centers for Disease Control
and Prevention (CDC) and
World Health Organization
(WHO) have clearly warned
that Hookah smoking is
not a safe alternative
to smoking cigarettes.
[1] [2] Tobacco users
should quit all tobacco
products to reduce health
risks.[1] Waterpipes should
be subjected to the same
regulations as cigarettes
and other tobacco products.
Waterpipes and waterpipe
tobacco should contain
health warnings. Claims
of harm reduction and
safety should be prohibited.[2]
There is an intense need
to address the misconceptions
about the myths of shisha
smoking. We should create
healthy and useful activities
for our youth. The youth
councilors and sports
institutions must play
their proactive role towards
this end.
1)
Smoking
&
Tobacco
Use;
CDC
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/
2)
Water
Pipe
Tobacco
Smoking:
Health
effects,
Research
needs
and
recommended
actions
by
regulators
(WHO)
http://www.who.int/tobacco/global_interaction/tobreg/Waterpipe%20recommendation_Final.pdf
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