Waterpipe smoking: a culture of health hazards

Waterpipe smoking has gained grand popularity in the world and specifically in Arab countries. Some research revealed an estimated 100 million daily users of waterpipes around the world. Noticeably, waterpipe smoking is spreading among various age groups, especially among youth. It is dangerous (as much as cigarettes if not more) and seems to be addictive. People seem to have different views, however, regarding waterpipe smoking. Some of its users simply do not consider themselves as smokers. They argue that they only ‘puff’ and do not inhale, saying this kind of smoking is harmless to their health, or at least, less risky than smoking a cigar or cigarette. Others feel that they are doing their health a favor by shifting from smoking cigarettes to waterpipes. Interestingly, some people believe that waterpipe smoking can be harmful to health depending on the type of tobacco being used. They explain that fruit lavored tobacco (muassel) is ‘harmless.’ These misconceptions, along with the fact that to many, it has become trendy to smoke a waterpipe, might explain why some non-smokers do not mind having a waterpipe frequently. They still, how-ever, would consider themselves non-smokers. Such assumptions might also reveal why parents allow adolescents to have a waterpipe but strongly mind those smoking cigarettes.

Limited research has been conducted on the prevalence of waterpipe smoking in Syria. The only published population based data is available from a house-hold survey conducted in Aleppo. This survey indicates that around 20% of men and 5% of women in Syria smoke tobacco using a waterpipe. The rising epidemic of smoking in Syria (both waterpipe and cigarettes), along with lack of knowledge and capability to address this problem, led to the establishment of the “Syrian Center for Tobacco Studies” (SCTS). This center is located in Aleppo and is a joint project among several international universities, Aleppo University, and the Aleppo-based “Syrian Society against Cancer.” This center mainly works on tailoring a culturally suitable smoking cessation program for Syria and the neighboring countries. It also aims at conducting studies on prevalence and patterns of smoking in Syria, in addition to training Syrian researchers how to carry out relevant studies.

Hazards of waterpipe smoking

Contrary to common perception, water-pipe smoking is not harmless and in fact, can be as dangerous—if not more—as cigarette smoking. Most tobacco-related research has mainly covered hazards of cigarette smoking. Some health- hazards, however, were noted as waterpipe specific. These include:

Some of the chemicals found in cigarettes are also found in the tobacco used in waterpipes. These chemicals cause cancer, heart and other diseases.

Using charcoal to light the waterpipe makes the smoker inhale the chemical components resulting from burning both of the tobacco (tumbak or muassal) and the charcoal. In turn this causes respiratory disease.

A typical waterpipe smoking session takes anywhere between 15 to 90 minutes. This exposes the smoker to a longer period of inhaling the chemicals coming out of the fumes. It also exposes other people sitting in the same room to a relatively long period of negative smoking (equal to smoking 100-200 cigarettes).

A common practice is sharing the same waterpipe. This helps transmitting various diseases between smokers, even if the tip of the tube is changed. Additionally, the same tube is usually used many times without being cleaned or changed.

Recommendations Several actions can be taken to stop or limit the waterpipe craze that has over-taken Syria. They include:

Conducting more research to further assess the prevalence of waterpipe smoking in Syria, the attitudes of people toward it, and the feasibility of cessation programs.

Providing smokers who are willing to quit with accessible smoking cessation programs. These cessation programs should be culturally tailored to suit the Syrian population.

Spreading awareness among youth in schools on hazards of smoking water-pipes. This could be achieved through inserting health messages in text books and through extracurricular activities.

Stressing on the hazards of waterpipe smoking in the yearly anti-smoking awareness campaigns and not restricting them to cigarette smoking.

Restricting waterpipe smoking to certain areas in restaurants and cafes. This will help minimize negative smoking and protect non-smokers, especially children from inhaling dangerous chemicals.

Prohibiting waterpipe smoking in public areas, especially in places where children are found, like public gardens and children entertainment centers.

Prohibiting the media from promoting waterpipe smoking through images of ‘cool’ smokers in films and advertisements. Finally, I dedicate this article to a friend who suggested that I write about the hazards of waterpipe smoking. Knowing that he is a waterpipe fan himself, I appreciate his request and wish him to quit after reading this article.

References:

1. Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T; Tobacco smoking using a Waterpipe: an e-emerging strain in a global epidemic. Tobacco Control (2004) , 13:327-333

2. Maziak W, Eissenberg T, Ward KD. Patterns of Waterpipe use and dependence: implications for intervention development. Pharmacology, Bio-chemistry and Behavior. (2005), Jan; 80 (1). Epub 2004 Dec 24.

3. Ward KD, Eissenberg T, Rastam S, Asfar T, et al., The Tobacco epidemic in Syria, Tobacco Control, (2006). June; 15 Suppl 1: i24-29