…A national call for action
I feel sad seeing so many youths engaging in this shisha smoking. It is rather unfortunate that as young men and women, most of us leave life in the present and do not consider the future. I read a scientific statement from the American Heart Association(2019) that reported that about 4.8 percent of high school students and 13.6 percent of adults 18 to 24 years old participate in shisha smoking.
Rates of shisha smoking among those ages 18 to 24 are more than 50 percent higher than in adults 25 to 44 years old, and nearly 200 percent higher than adults ages 45 to 64. About 1.2 percent of middle school students smoked shisha in 2018, King noted. Among adults, hookah smoking is the fifth most commonly used tobacco product behind cigarettes, cigars, e-cigarettes, and smokeless tobacco, King added. People who use a hookah are more likely to start smoking cigarettes compared to those who have never smoked hookah, the study authors say.
The Centers for Disease Control and Prevention (CDC) also found that up to 17 percent of high school senior boys and 15 percent of high school senior girls in the United States have used a shisha.
The CDC notes that shisha smoking is slightly higher among college students, with about 22 percent to 40 percent having tried it. This might be because it’s typically a group event and done in special cafés, tea houses or lounges.
Some also believe that shisha is less harmful as compared to smoking cigarettes because the tobacco is filtered through water, but there is no scientific evidence that supports that claim. However, there is evidence to suggest that hookah smoking is addictive and can lead to the use of other tobacco products, such as cigarettes.
The report further explained people who smoke from a water pipe, also known as hookah, narghile, or shisha, can inhale more toxic chemicals than if they smoked a cigarette.
Each hookah smoking session lasts for about 30 or more minutes. Burning charcoal is placed on top of a bowl filled with tobacco, which is connected with a water base and hose that attaches to a mouthpiece. The tobacco often includes dried fruit, flavoured tobacco, and other substances so the tobacco does not dry out.
Users inhale many litres of smoke that are filled with large quantities of particulate matter. One hookah session results in more carbon monoxide exposure compared with smoking one cigarette. Hookah smoke includes other chemicals that can impair the cardiovascular system, such as nicotine, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons, acrolein, lead, cadmium, and arsenic. Again, most of the toxin levels are higher in hookah than in cigarette smoke.
Also, a study by Rezk-Hanna et al.(2018) found that people’s heart rates went up by 16 beats per minute after 30 minutes of shisha smoking. Also, their blood pressure rose. Smoking also stiffened arteries to a degree similar to the damage that can be caused by having one cigarette.
“Hookah smoking has many of the same health risks as cigarette smoking, and hookah smoke contains several toxic chemicals known to cause lung, bladder, and oral cancers,” Brian King, PhD, deputy director for research translation from the Centers for Disease Control and Prevention’s Office on Smoking and Health, told Healthline. “Because of the way a hookah is used, including the number of puffs over a longer period, smokers may even absorb more of these toxic chemicals than cigarette smokers.” In this article, I explore the scientific aspect of shisha.
Shisha can make you high
Shisha is made up of a rubber hose, pipe, bowl, and smoke chamber. Tobacco is heated on coals or charcoal, and it may have flavours added to it, like apple, mint, licorice or chocolate. A common myth is that hookah smoking is safer than cigarette smoking. This isn’t true. Though shisha smoking won’t get you high, it does have other health risks and can be addictive. The tobacco in it can give you a buzz. You may feel lightheaded, relaxed, dizzy or wobbly.
Shisha smoking can also make you feel sick in your stomach. This is more common if you smoke too much or smoke on an empty stomach. The coals used to light a hookah might make some people feel nauseous. Fumes from the coals can cause other side effects, including slight headache. Shisha tobacco is the same tobacco found in cigarettes. This means that when you smoke shisha, you’re breathing in nicotine, tar and heavy metals, including lead and arsenic. Smoking one shisha for 45 to 60 minutes is about the same as smoking a pack of cigarettes. Nicotine is the chemical that causes addiction when you smoke or chew tobacco. According to the National Institutes of Health (NIH), nicotine is as addictive as heroin and cocaine.
In the course of shisha smoking, the body absorbs nicotine. It gets into the brain in about 8 seconds. The blood carries nicotine to the adrenal glands, where it triggers the production of adrenaline, the ‘fight-or-flight hormone’.
Adrenaline raises your heart rate, blood pressure, and breathing rate. It also makes you feel more awake and less hungry. This is why nicotine makes you feel good for a little while. In the long run, nicotine can confuse the brain, causing you to feel sick and anxious if you don’t have it. As a result, smoking cigarettes or other tobacco products with nicotine may make you feel better. This is known as nicotine addiction.
Shisha smoking is often done in social situations. A study by Jawad et al.(2013) of 32 people who smoke shisha found that they believed they had a “social addiction” to it. They didn’t believe they were addicted to nicotine.
Even, a “herbal” hookah may still contain tobacco. Though tobacco-free shisha exists, they’re not as common. Besides, even if you’re not smoking tobacco, you’re still inhaling chemicals from coal and other substances. In a shisha, the smoke passes through water before it reaches the hose and mouthpiece. A common myth is that the water filters out harmful substances. This isn’t true.
A study by Strulovici-Barel et al.(2016) compared respiratory (breathing) health in shisha smokers compared to non-smokers. They found that young people who smoked from a shisha only sometimes had several lung changes, including more coughing and sputum, and signs of inflammation and fluid build-up in the lungs. In other words, even occasional shisha smoking can cause health effects. Like cigarettes, shisha also gives off harmful second-hand smoke.
Strulovici-Barel et al.(2016) study also found that shisha smokers also had some of the same chemicals as cigarette smokers. They found other harmful chemicals like carbon monoxide. These chemicals likely come from the coal that’s used to burn tobacco.
Another study by Kadhum et al.(2014) tested 61 people, including 49 men and 12 women, immediately after shisha smoking in London cafés. They found that shisha smokers had levels of carbon monoxide that were about three times higher than those of cigarette smokers.
Carbon monoxide can lower how much oxygen the body absorbs. This is because it can bond to the red blood cells 230 times stronger than oxygen. Breathing in too much carbon monoxide is harmful, and it might raise your risk of heart disease and other illnesses. The researchers also found that study participants had higher blood pressure after shisha smoking. The average blood pressure rose from 129/81 mmHg to 144/90 mmHg. Over a period, shisha smoking may cause chronic high blood pressure, which can also increase the risk of heart disease and stroke.
Healthline.com explained that shisha smokers normally share one shisha in a group. Smoking from the same mouthpiece can cause infections to spread from person to person. Additionally, some bacteria or viri may stay in a shisha if it isn’t cleaned properly.
Infections that can spread from sharing a shisha include:
- cold and flu
- cold sores (HSV)
- hepatitis A
A 2013 review by Aslam et al. established that shisha smoking may also be linked to some cancers. Tobacco smoke has more than 4,800 different chemicals, and more than 69 of these are known to be cancer-causing chemicals.
Moreover, shisha smoking may lower the body’s ability to fight some cancers. That 2013 review also highlights research in Saudi Arabia that found that shisha smokers had lower levels of antioxidants and vitamin C than non-smokers. These healthy nutrients may help prevent cancer. Several other studies mentioned in the review link tobacco use to mouth, throat, pancreas, bladder, and prostate cancers.
Healthline also found that shisha smoking causes other health effects, including:
- low birth weight of babies whose mothers smoked during pregnancy
- higher blood sugar levels, which can increase one’s diabetes risk
- larynx (voice box) swelling or damage
- changes in blood clotting
- stained teeth
- gum disease
- loss of taste and smell
Shisha is dangerous
A study by Primack et al.(2016) compared shisha with a single cigarette and found that smoking shisha for “one session” delivers 25 times the tar, 125 times the smoke, 2.5 times the nicotine, and 10 times the carbon monoxide.
The danger is that the smoking of shisha goes beyond those who smoke alone. For instance, one study by Zhou et al.(2015) confirmed that second-hand shisha smoke is damaging as well. Another issue is that employees at shisha bars are exposed to “elevated concentrations of indoor air pollutants,” which may cause “adverse health effects”, concluded the authors.
So comparing cigarettes to shisha is not an apple-to-apple comparison. Cigarette smokers generally smoke at least several cigarettes throughout the day, whereas someone who likes to smoke shisha, may only do so on the weekends or a few times a week but the health implications are the same. Some studies confirmed the health implications of shisha surpass that of cigarettes.
Shisha smoke comes in many aromatic flavours and the evidence shows that one smoke session delivers more tar, nicotine, and carbon monoxide than a handful of cigarettes.
I recommend that our universities and schools have to start raising awareness of these dangers to correct the many misconceptions surrounding shisha.
After reviewing studies on shisha, I feel there is a pretty good chance that the young adults who smoke shisha lack clarity on what exactly they’re doing to their bodies. I also feel the majority of them have been misinformed and led into this without knowing the future implications.
Parents must take the responsibility to educate their children that the health implications of shisha are more than smoking cigarettes. I also believe that it is the responsibility of everyone, and the Food and Drugs Authority (FDA) has to act on this issue to save the youth. It is a call for national action.
Prof. Nyarkotey has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations to justify his write-ups. My articles are for educational purposes and do not serve as medical advice for treatment. I aim to educate the public about evidence-based scientific naturopathic therapies.
Prof. Raphael Nyarkotey Obu is a Professor of Naturopathic Healthcare, a Medical Journalist, and a science writer. Regina Adu Safowaah is a Celebrity and Enterprenuer. E. mail: [email protected]