Tobacco Info

From Tobacco Info No. 3 - November 2010
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Water-pipe smoking a major public health threat

Study cites concern with youth and correlation with psychoactive substance use

As cigarette usage has declined over the past few years, a new smoking trend may be gaining popularity with North American youth.

A study published in the journal Pediatrics, in May, has found that 23% of young adults surveyed had used water-pipes, also commonly known as shishas or hookahs, in the past year.

“The popularity of water-pipes may be due in part to perceptions that they are safer than cigarettes,” said researcher Jennifer O’Loughlin, a professor at the University of Montreal’s Department of Social and Preventive Medicine and a scientist at the university’s Hospital Research Centre. “However, water-pipe smoke contains nicotine, carbon monoxide, carcinogens and may contain greater amounts of tar and heavy metals than cigarette smoke.”

What is a water-pipe?

A water-pipe is a century-old tradition in Arabic countries that involves smoking tobacco using an upright device with a small platform where tobacco is burned using charcoal, a metal body, a base half-filled with water and a hose with a mouth-piece for inhaling. Water-pipes are gaining popularity in North America, Europe and Australia.

The research paper, titled Water-pipe Smoking Among North American Youth, sought to analyze and identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use.

“Many [young people] use water-pipes and they likely do not understand the potential harmful effects on health,” said O’Loughlin.

The research team, comprised of O’Loughlin, Erika Dugas and Daniel Cournoyer from the University of Montreal, Michèle Tremblay of the National Institute of Public Health of Quebec and Nancy C. P. Low of McGill University, examined data from 871 respondents in Quebec, aged 18-24, of the Nicotine Dependence in Teens longitudinal survey. They found that 23% of respondents had used a water-pipe within the last 12 months and that 5% had used water-pipes one or more times in the past month.

“Younger age, male gender, English-speaking, not living with parents and higher household incomes independently increased the odds of water-pipe use,” said O’Loughlin, adding that water-pipe use was markedly higher among participants who had smoked cigarettes, used other tobacco products, drank alcohol, engaged in binge drinking, smoked marijuana or had used other illicit drugs in the previous year.

As a result, O’Loughlin suggests that water-pipe usage is a concern, and needs further investigation.

More in-depth surveillance of apparently increasing use is required. Research is needed to increase understanding of the health effects, natural history and determinants of water-pipe smoking, as well as the reasons for the high levels of concurrent psychoactive substance use,” she said.

Pre-emptive strike

Tobacco control groups, such as the Non-Smokers Rights Association, argue that these results demonstrate the need for a pre-emptive response to a potential problem.

 “From a public health standpoint, we really do need to nip this in the bud before we’ve got a hookah lounge on every corner,” said Pippa Beck, a policy analyst with the Non-Smokers Rights Association. “There are many problems associated with water-pipe smoking. It’s confusing to the public who see herbal hookahs being smoked indoors, burning anything is not healthy due to combustion by-products and some of the products claim to contain no tobacco, but it’s impossible to tell without laboratory testing.”

She also noted that these herbal smoking products contain flavouring, labels are often minimal to non-existent and may be written in poor English, foreign or indiscernible languages. “I’ve even found one such package with warnings written in pig latin,” said Beck.

Flory Doucas, codirector of the Quebec Coalition for Tobacco Control, suggests that a first step would be to extend the federal ban on flavouring additives to all smoked products, thus limiting shisha’s appeal and making it less marketable.

“Quebec has extended the 2008 ban on tobacco displays to smoking accessories and all smoked products,” said Doucas. “There is also a moratorium on new hookah cafés post smoking ban of 2005,” adding that shisha’s appeal remains exotic, appears innocuous and the flavours make these products taste and smell nice.

- by Joe Strizzi



WHO reports


According to a 2005 report by the World Health Organization entitled Water-pipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators, users in a one hour hookah session may inhale as much smoke as a cigarette smoker would inhale smoking 100 cigarettes. Another study, entitled The effects of water-pipe tobacco smoking on health outcomes: a systematic review, published in the International Journal of Epidemiology, systematically reviewed medical literature pertaining to the effects of water-pipe tobacco smoking on health outcomes. Researchers Elia A. Akl et al. found that water-pipe tobacco smoking was significantly associated with lung cancer, respiratory illness, low birth weight and periodontal disease.