Shisha: a dangerous pastime

Water-pipe use poses a threat to smokers and non-smokers, with a variety of cancers, cardiovascular disease, impaired mental health, strokes and infertility associated with it.

Water-pipe products are made more attractive by the addition of sweet flavours. Silvia Razgova / The National
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As part of a healthy, balanced lifestyle, it’s important to relax, catch up with friends, eat good food and – provided it’s only now and then – smoke a little shisha, right? Wrong.

As the World Health Organization’s World No Tobacco Day falls on May 31, the effects of smoking shisha have been brought under the spotlight, and with a variety of cancers, not to mention cardiovascular disease, impaired mental health, strokes and infertility just some of the dangers associated with the pastime, its rising popularity is a cause for great concern.

Gemma Vestal, legal officer and scientist for the World Health Organization’s Tobacco Free Initiative, says erroneous beliefs and a lack of awareness of the health risks have prevented people from stubbing out the habit.

“Water-pipe use is largely unregulated. Its products and venues are often exempt from tobacco-control policies, and where policies do exist, especially in the developing world, the lack of enforcement renders water-pipe-related policies ineffective,” she says.

UAE regulations are toughening up, however, with Federal Law No 15 of 2009 requiring shisha cafe owners to have a permit to sell tobacco or related products, and a sign at the front of the premises stating that customers younger than 18 are banned. The legislation also states that the distance between cafes and residences, kindergartens, schools and institutes should “not be less than 150 metres” and the distance between the shop and places of worship should “not be less than 100 metres”. Furthermore, the area occupied by each smoker must be at least two square metres.

The law has introduced much-needed tobacco control to the UAE while also raising awareness of the effects of smoking shisha, which even today are widely misunderstood.

“Misconceptions about the less-harmful nature of water pipes are widespread and reinforced by marketing tools,” Vestal says.


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The mistaken belief that shisha smoke is filtered as it is drawn through water and therefore less harmful than cigarette smoking is widespread, and contributes to its growing popularity and acceptability. In reality, shisha pipes are thought to be 72 times more toxic than cigarettes because they release much higher levels of arsenic, cobalt, lead, nickel and other harmful substances into the air.

Vestal also claims that water-pipe products are made more attractive by the addition of maassel, or sweet flavours.

“Circumstantial evidence suggests a temporal link between the production of maassel at the beginning of the 1990s and the surge in the number of water-pipe smokers in the Middle East,” she says.

“Maassel industrialisation and commercialisation, and its increased availability and variety made it appealing to young people, paving the way for mass marketing through the internet, and simplified water-pipe preparation.”

Research into the effects of shisha on young people is limited, in particular on children who smoke passively in the presence of parents who smoke.

The results of a study in Spain, however, revealed that children exposed to tobacco smoke at home are up to three times more likely to have attention deficit hyperactivity disorder (ADHD) than unexposed kids.

Researchers found that the association was stronger for children with one or more hours of second-hand smoke exposure every day. The results held even after the researchers took into account a parent’s mental health and other factors that could lead to ADHD.

Alicia Padron, one of the study’s authors and a researcher at the University of Miami Miller School of Medicine in Florida, says: “We showed a significant and substantial dose-response association between second-hand smoke exposure in the home and a higher frequency of global mental problems.”

While the study was based on cigarette smoke, Vestal says its results can be applied to water-pipe tobacco smoke, too.

“The results are not surprising,” she says. “Since shisha smoke contains nicotine and toxicants found in cigarettes, studies on the health effects of second-hand cigarette smoke also apply to children exposed to water-pipe smoke.

“Second-hand water-pipe smoke poses a serious threat to adolescents and foetuses. Pregnant women who smoke shisha expose their unborn child to health risks associated with water-pipe smoke. It also increases exposure of non-smokers to nicotine and a number of toxicants. These bystanders often include children,” she says.

Terry Gordon, a professor from New York University School of Medicine, and his colleague Michael Weitzman have been studying the effect of water-pipe smoking on indoor air quality in UAE homes. They collected air samples from 33 Dubai residences before, during and after shisha smoking had taken place inside.

“Our study clearly demonstrated that indoor air quality was worse in UAE homes where water pipes were smoked in comparison with homes where only cigarettes were smoked or homes where no smoking was conducted,” he says.

“Rooms where water pipes were smoked contained high levels of particulate matter and black carbon and these levels were higher than those found in rooms where only cigarettes were smoked.”

Worryingly, Gordon found the levels in some instances to be as high as those found in shisha cafes.

“Although few countries have indoor regulatory standards for air quality, the levels found in this study are likely to be sufficiently high to have negative consequences for the health of children and adults in these homes,” he concludes.