Smoking shisha is a form of smoking tobacco that was established in Persia and India centuries ago. It is also called hookah, narghile, argileh, waterpipe, goza or hubble bubble smoking.
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The apparatus which is used consists of a water pipe with a chamber for smoke, a bowl, a pipe and a hose. When in use, charcoal is burned in the pipe which heats a specially-prepared tobacco mixture and creates the smoke that is filtered through water. Interestingly, it is thought that the original shisha used a water pipe carved from a coconut shell and milk to filter opium or hashish.
Smoking shisha can cause the following harmful effects:
On average, shisha smokers seem to absorb a higher concentration of toxic smoke than cigarette smokers. This is partially due to characteristics in the way that shisha smoking is practiced such as the frequency of puffing and depth of inhalation compared to cigarette smoking. Typically, the length of a shisha session is an hour, during which the user may inhale up to 200 times the volume of smoke inhaled from a cigarette.
Additionally, even though the water in a shisha pipe acts as a filter, it is not actually effective in removing high levels of toxic products, such as carbon monoxide, heavy metals, and carcinogens which are present in the smoke that shisha produces.
Toxins from the shisha smoke enter the bloodstream and contribute to atherosclerosis that in turn hardens and narrows arteries. The lining of the arteries also get damaged from the smoke leading to the accumulation of a fatty deposit (atheroma) which narrows the artery. These changes can cause many cardiovascular complications such as angina, congestive heart failure, a heart attack or a stroke.
Shisha smoking provides almost the same amount of nicotine to users as cigarettes do therefore nicotine addiction is an unsurprising consequence. The nicotine also stimulates adrenaline production thereby raising blood pressure, making the heart work harder and increasing the risk of heart attack or stroke.
Unlike cigarettes, shisha is burnt using charcoal or wood cinders so users can also be exposed to incredibly high levels of carbon monoxide gas. This level of carbon monoxide in the tobacco smoke reduces the oxygen-carrying capacity of the user’s blood so their heart must pump harder to supply the body with sufficient oxygen.
There are also risks associated with the way in which shisha smoking is socially practiced. The apparatus is generally smoked in special bars and the mouthpiece provided may not be hygienic to use due to improper cleaning. Thus, using it risks the spread of infectious diseases including bacterial by tuberculosis, fungal by aspergillus (affecting the lungs), helicobacter (responsible for stomach ulcers) and viral by herpes and hepatitis.
Due to the fact that users are not always aware of the harms associated with smoking shisha there have been studies by the WHO suggesting initiatives aimed at raising awareness and subsequently decreasing the usage of shisha. These include:
- Providing education to all audiences concerned (including health professionals and the public) about the risks of smoking shisha both to an individual and to the public as second-hand exposure.
- Ensuring that the regulations governing cigarettes and other tobacco products also apply to shishas and their related flavored tobacco products.
- Labelling shisha products with the appropriate health warnings and prohibiting those which are misleading (i.e. implying safety).
- Prohibiting shisha smoking in places with active bans on cigarette and other forms of tobacco smoking.
Reviewed by Yolanda Smith, BPharm