Whether you come from a Middle-Eastern background or not, you may be familiar with hookah. A hookah (also known as a waterpipe, shisha, narghile or goza) is a piece of equipment used to smoke various types of flavoured tobacco (1).
From 2006 to 2010, there was an increase in the use of hookah among youth by 6% (2). Hookah/shisha smoking is becoming more common among youth and is an emerging epidemic that requires attention. In order to understand hookah use among youth, it is important to understand why young people participate in hookah smoking:
Cultural Influences: Hookah use is known to be a culturally-influenced practice of Middle Eastern cultures and countries and it is common way of introducing hookah use to youth (3). Many individuals have been introduced to hookah use by visiting Middle Eastern countries or through links with Middle Eastern cultures (3). Among Arab Canadians, hookah use was a means of expressing Arabic heritage with those of the same background (3).
Stress Relief: In some situations, individuals may avoid alcohol for religious reasons and this may instead lead to using hookah as a means of relaxation (3).
Socializing: One of the most common reasons for hookah use is for socializing purposes and it is also considered to be an inclusive activity (3). Hookah use is seen as less harmful than cigarette smoking so as a social activity, is more acceptable than cigarette smoking and can include non-smokers as well (3). In fact, research shows that social factors played a much bigger role in hookah use as opposed to cultural factors (4).
Other: some people have used hookah because as a means of trying something new.
Health Effects of Hookah/Shisha Smoking
Hookah use has similar health risks to cigarette smoking and it is not a safe replacement for cigarette smoking (1). Similar to cigarettes, hookah smoke contains chemicals that can harm health.
Hookah smoke contains (6,7,8):
Cancer-causing compounds: nitrosamines, tar and heavy metals
These compounds can lead to both short-term and long-term side effects.
Did you know that the smoke inhalation within a single hookah session (typically lasting 20-80 minutes) is estimated to equal to smoking 50-100 or more cigarettes (9, 10)?
Long-term effects of hookah use are similar to those that result from cigarette smoking and are mostly related to the free radicals and carcinogens (cancer-causing compounds) found in the smoke (6, 7, 8). Some long-term effects of hookah smoking include:
Heart disease, high cholesterol, atherosclerosis
Lung disease such as chronic bronchitis and other small airway disorders
Decreased immune strength and risk of potential viruses (herpes and hepatitis) and tuberculosis from sharing a common mouthpiece.
Certain types of cancers
Weight gain and obesity
Myth 1: Hookah smoking is less harmful than regular cigarette smoking.
Truth: Hookah use is not a safe alternative to cigarette smoking (1). Hookah smoke is created by using charcoal to heat tobacco, which produces carbon monoxide and many cancer-causing chemicals (15).
Myth 2: Hookah use is not as addictive as regular cigarette smoking.
Truth: Since hookah sessions are generally longer, hookah smokers may inhale more total volume of smoke than cigarette smokers during a single smoking session (13). Therefore, hookah users may be exposed to more nicotine and cancer-causing chemicals (12, 16). The nicotine that is found in hookah may be addictive (13).
Myth 3: Hookah smoke is filtered by the water in the pipe, which decreases the amount of toxins.
Truth: The water in the hookah pipe filters out less than 5% nicotine (17). Just like cigarette smoking, hookah smoke affects the lungs and heart because it contains many cancer-causing chemicals (6).
Myth 4: Herbal or fruit-containing shisha are healthier than smoking regular shisha that contains tobacco.
Truth: Both herbal shisha and regular shisha contains carbon monoxide and other cancer-causing chemicals that increases the risks for smoking-related cancers, lung disease, and heart disease (18, 19).
Myth 5: Secondhand smoke from hookah smoking is not harmful.
Truth: Secondhand hookah smoke is a health-risk for non-smokers because of the smoke from the tobacco and from the charcoal used to burn the tobacco (11, 12, 13). It is also important for expecting mothers to know that hookah smoke, just like cigarette smoke has negative effects on the baby. Secondhand hookah smoke is also a health risk for non-smokers because the smoke still contains adverse compounds and should be avoided, especially for expecting mothers as well as children (11, 12, 13).
This project was funded by Toronto Public Health Investment in Youth Engagement Initiative.
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