Current Lunar Phase

Tuesday, May 19, 2009

Shisha no less hazardous than a cigarette

The Hazards of Shisha

The use of “shisha” also known as hookah or water pipe is rapidly increasing in the major cities of Pakistan. Unfortunately most people who use shisha are not aware of its harmful effects. Most restaurant owners tell their customers that it is merely flavored smoke and that there is no tobacco in it.

Recently, however, the World Health Organization (WHO) released a report on the health consequences of shisha use and it has proved to be an eye-opener. A commonly held belief is that shisha is harmless because the smoke first passes through water before it is inhaled. The shisha smoker may inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes. Even after it has passed through water, the smoke produced by a shisha contains a high level of toxins, including carbon monoxide, heavy metals and other carcinogens.

A similar hazard is posed to other people who are not directly using shisha by means of passive smoking. It is indeed sad that in spite of an ordinance in place, which bans smoking in public places many restaurants; offer shisha to their customers. Tobacco used in these water pipes is often sweetened and flavored, making it very appealing to children and teenagers. A survey done on youngsters of school-going age in Karachi recently showed that almost 70 per cent had tried shisha in the past six months, and this included children as young as seven.

Many of the commercially available packets, which are used for shisha smoking, have misleading labels such as 0.5 per cent nicotine and zero tar. WHO in its report has strongly recommended that healthcare professionals educate the public about the potential dangers of shisha use. Moreover, the sharing of shisha between people poses an additional risk of TB, herpes, flu, meningitis and hepatitis transmission. I would urge the ministry of health not only to ban shisha use in the restaurants but also to take other practical steps for the full implementation of the “Prohibition of smoking ordinance 2002” in the country.

Shisha 200 times worse than a cigarette

ASH news release: Embargo: 00:01 27th March 2007

“Shisha 200 times worse than a cigarette” say Middle East experts

Three leading experts from across the Middle East have warned that excluding “shisha bars” when England goes smokefree on July 1 could worsen the grave inequalities in health that already affect ethnic minorities.

Owners of shisha bars and cafes, which provide Arab style waterpipes to customers, are asking to be exempt from the law when it comes into force. However new research suggests that the waterpipes have three additional lethal risks over the risks of smoking cigarettes:

• Flavoured tobacco is smoked over coals and fumes from these fuels add new toxins to the already dangerous smoke.

• Shisha smokers inhale up to 200 times more smoke in a single shisha session that they would from a cigarette.

• Café owners have stress the social importance of their product but researchers say it is exactly that social aspect that results in high levels of highly dangerous secondhand smoke.

Far from discriminating against ethnic minorities, any exemption for indoor shisha smoking would only worsen health inequalities, say experts.Following the recent publication by the American Lung Association “An emerging Deadly Trend: Waterpipe Tobacco Use” (1) Mostafa Mohamed, Professor of Community Medicine in Cairo said, "Heat sources that are commonly used in Shisha pipes to burn the tobacco are likely to increase the health risks because when they burn they produce their own toxins. Shisha smokers and those around them are put at greater risk.”

Professor Mohamed is among the authors of a World Health Organisation report on shisha smoking published in 2005 (2). He was joined in his statement by co contributors from Syria and the Lebanon .

Dr Wasim Maziak, Associate Professor at the University of Memphis USA and Director of the Syrian Center of Tobacco Studies expects to publish new research very soon. The new study stresses that it is the very social nature of shisha smoking that makes the problem worse.

“Our latest study makes clear that that clean air policies should include the waterpipe, as it can be responsible for the build up of toxic levels of indoor air pollutants similar to what is seen in cigarettes. The social nature of this tobacco use method makes such regulations more needed, but perhaps more difficult to implement as well. The public health community in the meantime must wake up to the hazardous nature of this emerging tobacco use method both to users and those exposed.”

A typical hour long shisha session involves inhaling 100 to 200 times the volume of smoke inhaled when smoking a cigarette and there is no proof that any adaptation can make waterpipes safer. Professor Maziak's 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 particular risk to pregnant women.

Dr Alan Shidaheh of the American University in Beirut suggested that the problem was only recently being addressed by western scientists and that had lead to dangerous misconceptions.

"One of the enduring legacies of colonialism is that many problems of public health which are more relevant to the global South have received scant scientific attention due to a lack of resources available there. Knowledge of the potentially detrimental health consequences of shisha smoke, first or second hand, is a good example. The historical lack of evidence has unfortunately allowed many shisha users to believe that the practice was safe, or at least safer than other forms of tobacco use. We have recently learned otherwise.”

Dr Shidaheh went on to stress that it was not only the shisha smoker who is at risk and warned that the tobacco industry will try to undermine the science, “Every recent study has found that shisha smoke contains large quantities of the chemicals that lead to heart disease, cancer, and addiction in cigarette smokers."

In their report to the WHO the researchers stressed, “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.”

Notes and links:

[1] “An Emerging Deadly Trend: Waterpipe Tobacco Use”, American Lung Association February 2007,

[2] “Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators” WHO Study Group on Tobacco Product Regulation 2005

[3] A brief report written for ASH is available on

[4] ASH Factsheet on waterpipes including photograph

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