There is a widespread belief that smoking shisha is ‘safer’ than smoking cigarettes. We are constantly bombarded with messages about the dangers linked to smoking traditional cigarettes - whether it be on TV, billboards or graphic images on cigarette packets. But there is a lack of awareness and education around shisha smoking? Joanna Andrews dispels the myths around alternative forms of smoking.
There are many “trendy” names for Shisha whether it be hubbly-bubbly, hookah, nargile or waterpipe, but like any form of tobacco, it has an impact on your health. Contrary to ancient lore and popular belief the smoke that emerges from a waterpipe contains numerous toxicants known to cause lung cancer, heart disease and other health related issues like respiratory problems.
Tobacco smoke contains over 4,000 chemicals, 69 of which are carcinogenic. The Word Health Organisation (WHO) has listed second-hand smoke (SHS) as a human carcinogen to which there is “no safe level of exposure”. It says 30 minutes exposure to SHS reduces blood flow to the heart in fit, healthy adults. “Long term exposure increases a non-smoker’s risk of developing heart disease and lung cancer by a quarter and stroke by three quarters. Children are especially at risk from the effects of second-hand smoke because they have smaller vessels and their organs are still developing. “
Shisha is a glass-bottomed water paper in which fruit-flavoured tobacco is covered with foil and roasted with charcoal. The tobacco smoke passes through a water chamber and is inhaled slowly and deeply. The misconception that shisha smoking is ‘better for you’ than smoking traditional cigarettes stems from the fact that the smoke passes through water, where it picks up the flavour and disguises the smoke. However, experts warn that the carcinogens and nicotine are still there.
A report conducted by the WHO says, “Waterpipe smoking shisha delivers nicotine - the same highly addictive drug found in other tobacco products. Smokers typically take in 12 puffs on a cigarette compared with up to 200 puffs for hookah pipes. The volume of smoke inhaled in an hour-long shisha session is estimated to be the equivalent of smoking more than 100 cigarettes, the WHO warns. “A waterpipe smoking session may expose the smoker to more smoke over a longer period of time than occurs when smoking a cigarette.”
The report says that cigarette smokers typically take 8-12, 40-75 ml puffs over about 5 to 7 minutes and inhale 0.5 to 0.6 litres of smoke. “In contrast, waterpipe smoking sessions typically last 20-80 minutes, during which the smoker may take 50-200 puffs which range from about 0.15 to 1 litre each.”
Findings from the National Institutes of Health (NIH) in the US show that a single waterpipe session produces “the equivalent of at least one and as many as 50 cigarettes.” It adds, “Misconceptions about waterpipe smoke content may lead users to underestimate health risks.”
Added Risk
In addition, the charcoal used to heat the tobacco for a shisha user can raise the health risk by producing high levels of carbon monoxide, metals and cancercausing chemicals. Even after it has passed through water, the smoke from a hookah has high levels of toxin agents that can cause clogged arteries and heart disease.
“The water achieves nothing at all,” says Paul Aveyard, Professor of Behavioural medicine at Oxford University. “The content of cigarette smoke is very different from shisha smoke. Most of the smoke comes from burning charcoal and the temperature of combustion of the tobacco is much lower in shisha than in a cigarette. The main risk that people who smoke the occasional shisha face is that there is a very high concentration of carbon monoxide in the smoke.”
Aside from the obvious health risks, there is an additional risk associated with shisha smoking. As the mouthpiece is passed around from person to person, this raises the risk of transmitting diseases such as tuberculosis and hepatitis.
The emergence of electronic cigarettes is becoming popular nowadays, however, these products are currently unregulated and unlicensed in many parts of the world and thorough tests are being conducted by various government bodies. The latest fad is perceived to be “better for you than traditional cigarettes”. However, the US Food and Drug Administration (FDA) warns that e-cigarettes have not been fully studied, so consumers are in the dark about the potential risks.
Professor Aveyard says, “They are not tobacco and contain almost no known toxins. While it is possible that e-cigarettes may have some harms, there is no doubt that cigarettes are much more harmful.”
The Big Four
The cigarette industry is one of the most profitable - and deadliest industries - in the world. The global tobacco market is estimated to be valued at nearly $400 billion, with an estimated five trillion cigarettes being made annually. The Tobacco Atlas says that revenues from the tobacco industry amount to half a trillion US dollars every year. The four biggest international tobacco companies - British American Tobacco, Imperial Tobacco, Japan Tobacco and Philip Morris International - account for some 45 per cent of the global market.
Changing Perceptions
Shisha smoking may have originated in the Middle East centuries ago, however, parts of the region are waking up to its dangers. Earlier this year the UAE government clamped down on it by restricting shisha cafes near residential buildings, mosques and schools. It also enforced a law that all cigarette packages must display a graphic warning about the potential health issues.
Even Turkey, where the waterpipe is iconic and regarded as a symbol of the country’s culture, is running a major health campaign to reduce the use of tobacco in all forms.
Statistic show tobacco use causes many of the world’s leading lethal ailments, including cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. The UK Department of Health says tobacco smoking is “the single largest preventable cause of ill health, premature death and health inequalities” in the communities it serves. “One in two long-term smokers die prematurely as a result of smoking… On average, each smoker loses 16 years of life and experiences many more years of ill-health than a non-smoker.”
The United States also lists tobacco smoking as “the leading preventable cause of death”, even as considerable success has been achieved in curbing the tobacco epidemic over the past 20 years. “This success is threatened by alternative methods of tobacco use, including waterpipe tobacco smoking,” the NIH says.
The WHO says that tobacco kills nearly six million people each year. More than five million of those deaths are the result of direct tobacco use, while more than 600,000 are the result of nonsmokers being exposed to second-hand smoke.
Making smoking less desirable, less acceptable and less accessible is perhaps the key to stop people smoking shisha, cigarettes or any form of tobacco. Stop and think before you next light up!