Shisha and its side effects

5 05 2008

Urdu: حقہ hukka) or shisha (Arabic: شيشة‎, Hebrew: נרגילה, Nargilah‎),(Persian: قلیان Ghelyan) or (Turkish: nargile) is a single or multi-stemmed (often glass-based) water pipe device for smoking. Originating in India, it has gained popularity, especially in the Arab World.[1][2] It had gained popularity under the reign of the Ottoman Dynasty. A hookah operates by water filtration and indirect heat. It can be used for smoking herbal fruits.

Depending on locality and supply, hookahs may be referred to by many other names (often of Arab, Indian, Turkish, Uzbek, or Persian origin). Arghile or Nargila is the name most commonly used in Lebanon, Syria, Iraq, Jordan, Israel, Albania, Kosovo, Greece, Turkey, Armenia, Palestine, Bulgaria and Romania, though the initial “n” is often dropped in Arabic. “Narghile” is from the Persian word “nārgil” or “coconut”, from Sanskrit nārikela (नारिकेल)–as the original hookahs were made out of coconut shells.[3] Shisha (شيشة) is from the Persian word shishe (شیشه, literally translated as glass and not bottle), and is primarily used for water pipes in Egypt and the Arab countries of the Persian Gulf (such as Kuwait, Bahrain, Qatar, UAE, and Saudi Arabia) as well as Morocco, Tunisia, Somalia and Yemen. In Iran it is called ghalyun (غلیون), ghālyun (قالیون), or ghalyān (قلیان) and in India and Pakistan it is referred to as huqqa (हुक्का /حقہ). The more colloquial terms “hubble-bubble” and “hubbly-bubbly” may be used in the region surrounding the red sea.

Health risks

Today’s media sometimes suggests that hookah sessions are more threatening to a person’s health than smoking cigarettes.

Research shows that each hookah session typically lasts from 20 – 80 minutes and consists of 50 – 200 puffs which range from 0.15 – 1 liter per puff . This exposes the hookah smoker to considerably more smoke over a longer time period compared with a cigarette which ranges from 0.5 – 0.6 liters per cigarette. While the water absorbs some of the nicotine in the tobacco smoke, the smoker can be exposed to enough nicotine to cause addiction . Furthermore, the water moisture induced by the hookah makes the smoke less irritating and may give a false sense of security and reduce concerns about true health effects .

Other research shows that a 45 minute session of hookah tobacco smoking (tobacco molasses) delivers slightly more tar and carbon monoxide (around 5-10%) than a pack of cigarettes. This study has, however, come under criticism for using unrealistically high temperatures for the tobacco (600-650 degrees C) and using arbitrary figures for tar filtration rates. This could possibly have skewed results, as the carcinogenic and toxin levels of smoke increases dramatically with temperature (Wynder 1958). Common practice is to keep temperatures to degrees which do not “char” the hookah; that is within a temperature range of 100-150 C. (Chaouachi K: Patologie associate all’uso del narghile). The effects of these lower temperatures on tar are inconclusive, though Chaouachi indicates the tar would be less harmful.

Some hookah tobaccos claim to contain 0.0% Tar, but this is misleading due to the fact that tar is created when tobacco burns. However, when smoking a hookah the tobacco is heated rather than burned. More research is needed to determine the exact amount of tar produced in a session before the burning of the tobacco.

The World Health Organization Study Group on Tobacco Product Regulation (TobReg) presented an advisory note in 2005 on waterpipe (hookah) tobacco smoking  and concluded that “waterpipe smoking is associated with many of the same health risks as cigarette smoking, and may, in fact, involve some unique health risks” and recommends that “waterpipes and waterpipe tobacco should be subjected to the same regulation as cigarettes and other tobacco products.” However, Kamal Chaouachi, a French researcher who has been studying hookah usage and effects throughout the world since 1997, has criticized the WHO advisory note in a report and a book.

Some research has suggested that the use of the hookah may have less comparative cancer risks, though such studies are not conclusive (Hoffman, Rakower, Salem 1983 and 90, Gupta Dheeraj 2001, Tandon 1995, Lubin 1992, Hazelton 2001, Stirling 1979). The levels of carbon monoxide produced during a hookah session varies widely depending on the type of coal used. Japanese charcoals are thought to produce lower amounts of carbon monoxide. However there is a notable difference in areas of carbon monoxide absorption, in that while cigarettes have a notable effect on the small respiratory tracts rather, shisha smoking mostly affects the major airways (Bakir 1991, Kiter). This means a lessened FEV vs FEV1/FVC ratio compared to cigarettes, which is believed to be less harmful for the airways long-term though it may lead to general hoarseness.

The level of impact on a smoker’s health is linked to the set-up and components of the hookah as well. A hookah only utilizing the basic components listed above is believe to have much harsher health consequences than one setup properly and with various safety devices installed: Since the tobacco in a hookah is roasted as opposed to burned, the density and temperature of the tobacco is paramount to ensure a safer quality of smoke (Wynder 1958). Distancing somewhat the coal from the tobacco and placing a perforated thermal cover (not to be confused with a wind cover) over the bowl will reduce tar output. Using a Heba diffuser around the downstem in the water basin may provide a slightly greater amount of filtration, however a properly conducted study is needed to validate these claims. The use of a nicotine filter at some stage of the smoke cycle, preferably in the hose, may reduce health risks, but once again a properly conducted study is needed to validate these claims.

Hookahs can also be smoked with tobacco-free herbal flavors. These contain Sugar Cane Bagasse with no tobacco, nicotine or tar. This new method of smoking is aimed at replacing tobacco and thus eliminating its negative health effects. There have been few studies to show the impact of smoking herbal flavors in Shisha pipes.

Many articles suggest that there is simply not enough research to provide answers to determine the effects of hookah smoking. Research is under way by Fogarty International Center-funded Syrian Center for Tobacco Studies, Egyptian Smoking Prevention Research Institute, Research for International Tobacco Control-funded Tobacco Prevention and Control Research Group at the American University of Beirut, Lebanon.

The archaic form of this latter Indian name hookah is most commonly used in English for historical reasons, as it was in India that large numbers of English-speakers first sampled the effects of the water pipe. William Hickey wrote in his Memoirs that shortly after his arrival in Kolkata, India in 1775:

The most highly-dressed and splendid hookah was prepared for me. I tried it, but did not like it. As after several trials I still found it disagreeable, I with much gravity requested to know whether it was indispensably necessary that I should become a smoker, which was answered with equal gravity, ‘Undoubtedly it is, for you might as well be out of the world as out of the fashion. Here everybody uses a hookah, and it is impossible to get on without’…..[I] have frequently heard men declare they would much rather be deprived of their dinner than their hookah.

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