Is Hookah Safer than Cigarette Smoking?

Public Health Literature

November 27, 2015

By: Ramandeep Kaur

Is Hookah Safer Than Cigarette Smoking?

Ramandeep KaurPublic Health Literature

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Table of Contents

Topic Page

I. Abstract…………………………………………………………………………….4II. Introduction………………………………………………………………………...4III. Methods………………………………………………………………………….....5IV. Findings………………………………………………………………………….....7

a. Perception of Society on Hookah versus Cigarettes…………………………...7b. Chemical Yield of Hookah versus chemical yield of Cigarettes……………....7c. Second Hand Smoking ………………………………………………………..7d. Aging of Smoke between Hookah and Cigarettes……………………………..8e. Correlation Between Hookah Smoking and Diseases…………………………8f. Regulations Involved with Hookah Smoking…………………………………9

V. Discussion………………………………………………………………………....11VI. Conclusion…………………………………………………………………………12

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Table of Figures

Topic Page

I. Figure 1…………………………………………………………………..10a. Perception of Society on Hookah Smoking

II. Figure 2…………………………………………………………………..10a. The Comparison of Water Pipe to Cigarettes

III. Figure 3…………………………………………………………………..10a. Chemical Yield of Hookah Smoking versus Cigarette Smoking

IV. Figure 4…………………………………………………………………..11a. Morbidity Rate of Diseases Due to Cigarettes

V. Figure 5…………………………………………………………………..11a. The Prevalence of Lung Cancer in Smokers and Nonsmokers in

Kashmir

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Abstract

Although there is advanced knowledge about smoking around the world, there still is not

enough studies and awareness of certain methods of smoking, such as hookah. Within the past

decade, hookah is becoming a popular aspect of the social culture. Over the past few years, it has

become common knowledge that excessive smoking causes lung cancer, so why is hookah so

popular? Unfortunately, the society does not realize how harmful hookah really is to the health

and wellbeing. This research will examine the degree to how harmful hookah is by comparing it

to cigarette smoking. By comparing the side effects of something recent to something that

everyone knows about, it will give the society a perspective and will spread awareness on the

issue at hand.

Introduction

Although this issue of hookah has not completely been recognized, hookah is one of the

number one causes for various diseases and social problems. If hookah is banned, this would

benefit the society’s health significantly. The society is aware of the fact that cigarette smoking

can cause up to 87% deaths worldwide; along with lung cancer, it can also cause cancers of

larynx, oral cavity, pharynx, esophagus and bladder. However, the society does not have much

knowledge about the effects of hookah. Hookah originated in India and spread to the Middle

Eastern culture. Since the past decade, it has been spreading in Europe and the US (Aljarrah,

Ababneh and Al-Delaimy). Hookah lounges are growing in the population exponentially. Also,

hookah lounges provide fancy drink options with hookah to make it a delightful experience. The

lounges also incorporates different flavors for hookah. These tactics are enticing the society,

especially the young generation, to make hookah lounge their social hang out spot. This is very

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concerning because the young generation is not aware of effects of hookah, especially since there

are not enough programs and studies that advocate the harmfulness of hookah. Programs, such as

D.A.R.E., discourage the use of alcohol, drugs, and cigarette smoking but do not discourage the

use of hookah smoking.

An analysis of the perception of the society on hookah smoking was done. According to

figure 1, 62.6% of the male population thinks that hookah is less harmful than cigarettes while

52.5% of the female population think that hookah is less harmful than cigarettes. This data shows

that most people think that cigarette smoking is worse than hookah smoking. The population

does not know about the risks associated with hookah smoking (Aljarrah, Ababneh and Al-

Delaimy). Also, looking at the fact that hookah is becoming a popular aspect of the culture

allows people to assume that hookah must not be bad. People also think that hookah is safe

because it has less nicotine and less toxic due to the filtering mechanism (Morris, Fiala and

Pawlak). However, that is not true. As explained further in this research, there is tar, nicotine and

various other chemicals in the hookah, which are not filtered. Therefore, this research highlights

the facts which explain why hookah smoking is worse than cigarette smoking.

Methods

In order to understand the thinking of the society on the issue of hookah, this research does

an analysis of the perception of the society on what they think is worse: hookah or cigarettes.

Providing this information will explain the reasoning of why this research is being conducted in

the first place. In order to fully understand the harmful effects of hookah smoking, this research

first examined the comparison between hookah smoking and cigarette smoking. This step

provides information on the types of chemicals inhaled, the amount of chemicals inhaled, and

which type of smoking has a greater side effect. It also explains how many packs of cigarettes

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need to be smoked in order to yield the same amount of chemicals that one session of hookah

smoking yields. In addition to that, the effects were seen of second hand hookah smoking in

lounges. There was a comparison done between second hand smoking of cigarettes versus

second hand smoking of hookah. This analysis demonstrates that there are different mechanisms

for different type of smoking, making one type of smoking worse than the other. Hence, this

provides the degree to which hookah smoking can be harmful to the health and wellbeing.

After analyzing the effects of cigarette smoking versus hookah smoking, this research did

an analysis of the correlation of hookah smoking to various diseases. This provided information

of how badly hookah affects the body compared to how badly cigarettes affect the body. If

smoking one cigarette a day (500 mL) can cause lung cancer, one can imagine what a session of

hookah (90,000 mL) per day can do (Martinasek, McDermott and Martini). Therefore,

comparing two methods of smoking gives the society a perspective of how detrimental hookah

smoking really is.

To support the statement that hookah is worse than the society thinks it is, this research

included the study of areas in which hookah is part of their culture, such as Kashmir. This

involved an analysis of how many smokers and nonsmokers are in Kashmir. Amongst the

smokers, there was a count of how many were hookah smokers, cigarette smokers or both. Then,

it shows the prevalence of lung cancer amongst different type of smokers and nonsmokers. By

examining the effects of hookah in the society and acquiring an understanding of the current

issue, the future progression of this issue can be made. Therefore, this research will show the up

rise of this new culture that involves hookah and the effects of it in the society. It will also show

the degree to which hookah is harmful. This insight helps the society that is involved in hookah

smoking to understand the scale to which they are really affecting their body.

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Findings

Figure 2 shows the comparison of chemical yield between hookah smoking and

cigarette smoking. According to the figure, hookah smoking yields 60 ng/ mL of nicotine while

cigarette smoking yields approximately 18 ng/ mL of nicotine (WHO.int). Looking at further

chemical yields, the figure also shows that hookah smoking yields 15 ppm of carbon monoxide

(CO) while cigarette smoking yields 5 ppm of CO (WHO.int). To put it in perspective, figure 3

shows how many packs of cigarettes a person needs to smoke in order to equal the amount of

chemicals hookah yields in one smoking session (1 gm), which lasts an hour on average. A

person needs to smoke eleven packs of cigarette to equal the amount of carbon monoxide yield

from one session of hookah smoking (WHO.int). Furthermore, a person needs to smoke four

packs of cigarettes to equal the amount of nicotine yield from one session of hookah smoking

(WHO.int). All these risks are also associated with the level of exposure to smoke itself. One

hookah smoking session involves 200 puffs while one cigarette involves 20 puffs (CDC).

Anyone can assume and/ or agree with that fact because hookah emits a cloud of smoke, unlike

cigarettes. The amount of smoke inhaled during a single hookah session is 90,000 mL while the

amount of smoke inhaled by a single cigarette is 500-600 mL (CDC).

In addition to the comparison of chemical yield between hookah and cigarettes, the

second hand smoking with hookah versus cigarettes is a significant factor in determining which

method of smoking is worse. WHO offers a universal definition for second hand smoking:

“Second-hand tobacco smoke (SHS) refers to the smoke from burning tobacco products,

generated by people smoking them.” The specificity of the universal definition is not accurate

enough because it does not include the mechanism of hookah smoking. The reasoning is that

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hookah smoking is formed by heating using mechanisms like charcoal (Chaouachi). The organic

compounds produced at high temperature are condensed and retained in the water in hookah

bowl. As mentioned earlier, a significant amount of carbon monoxide is formed as well from

heating mechanism which is very toxic due to its competitive binding with hemoglobin, a protein

molecule that is supposed to carry oxygen (Khan, Akhter, and Malik). Therefore, when a person

is second hand smoking hookah, he or she is inhaling the smoking product in the hookah bowl,

along with the heating product (e.g. charcoal, carbon monoxide). This is more dangerous than

second hand smoking of cigarette because a person would not be inhaling any heating product

(Chaouachi).

Furthermore, smoke exhibits aging which contributes to which type of smoking is

worse. For example, in cigarette smoking, the decrease in NO from fresh smoke is accompanied

by increase in NO2 (Chaouachi). The NO2 reaches a maximum and beings to decrease after a

minute (Chaouachi). Then, the CH3OH is stable but then begins to decrease alongside the NO2

(Chaouachi). This causes a reaction, which makes the fresh tobacco smoke to not be fresh

anymore—it is aging (Chaouachi). Now this example can be compared to the magnitude of

harmfulness of hookah smoking. Hookah smoke covers twenty five times the distance of

cigarette smoke (Chaouachi). Therefore, the aging of hookah has a bigger effect on the health of

the community than the aging of cigarettes.

Now that a comparison has been done between hookah smoking and cigarette smoking,

let’s have a glance on the correlation between hookah smoking and diseases. Figure 4 shows that

cigarette smoking causes over 20,000 deaths per year due to diseases such as acute respiratory

infection, otitis, asthma, ischaemic heart disease and lung cancer (CDC). If cigarette smoking

can cause that many deaths, one can imagine how many deaths hookah smoking can cause.

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Furthermore, a study was conducted in Kashmir to show the prevalence of lung cancer due to

hookah smoking, cigarette smoking or both (Koul et al.). Figure 5 shows the results of the study.

The figure shows that 48% of exclusive hookah smokers have lung cancer; 18% of exclusive

cigarette smokers have lung cancer; 11% of combines smokers have lung cancer and 23% of

nonsmokers have lung cancer (Koul et al.). The percentage of nonsmokers who have lung cancer

is significantly high because there was so much hookah smoke in Kashmir that the chemicals

were being absorbed by the water that was running in the community’s household (Koul et al.).

Unfortunately, there are not enough public health initiatives that discourage the use of

smoking hookah. Policies related to smoking includes efforts such as tax, restriction on selling

product to minors, regulation of advertising, and control of the content of the product. Although

there is less mention of water pipe smoking (hookah), the rules by WHO apply to all tobacco

products, including hookah (Martinasek, McDermott and Martini). After a decade of increasing data

of the increased prevalence of diseases from hookah, WHO declared an advisory note that states:

“using a water pipe to smoke tobacco poses a serious potential health hazard to smokers and

others exposed to the smoke emitted” (Martinasek, McDermott and Martini). Despite of the

cautionary note by WHO, water pipe smoking is still not regulated. The product coming from

places like Dubai, Palestine, Jordan, Bahrain, etc., have a sign saying “no tar” (Martinasek,

McDermott and Martini). However, that is not accurate. The tar is a combustion product for

hookah smoking so hookah is not in compliance with rules (Martinasek, McDermott and Martini).

Hence, hookah continues to be very popular in U.S. and Europe and there are no set regulations

against it.

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Figure 2. The comparison of water pipe to cigarette smoking

Figure 3. Chemical Yield of Hookah Smoking vs.

Cigarette Smoking

Figure 1. Perception of Society on Hookah

Smoking

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Discussion:

Hookah Smoking has become so popular over the past decade because the society is

unaware of the harmful effects of hookah. In fact, many nonsmokers have smoked hookah

Figure 5. The prevalence of lung cancer in smokers and

nonsmokers in Kashmir

Figure 4. Morbidity Rate of Various Diseases Due to

Cigarette Smoking

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thinking that is harmless and does not contain any significant chemicals that can deteriorate the

body (Nakkash, Khalil and Afifi). This research shows the degree to which hookah affects the body

negatively. The comparison of cigarettes and hookah was done and the analysis shows that

hookah is much worse than cigarettes. In the past decade, WHO has made an effort to regulate

hookah smoking. However, there is still plenty of work to be done.

Conclusion

Increasing hookah lounges in parts of the world is becoming a prevalent issue that needs

to be resolved. It is becoming such a popular aspect of the culture that many public health

initiatives decided to focus on the epidemic to see if it poses any possible threat to the health of

the community. The public health initiatives does encourage tactics such as health warnings,

counseling, providing statistics of smoking causing various cancer, etc. However, the regulation

does not cover the complete scope of threat. Therefore, further regulations need to be

implemented in order to guarantee the safety of the community.

Public health initiatives and programs such as the CDC or WHO need to focus on

changing classification and/ or characterization of the regulation so that the harmful effects of

hookah are completely discouraged. It may not be possible to ban hookah entirely but one

possibility that public health analysts should work on is decreasing the number of hookah

lounges in different parts of the world. Furthermore, public health analysts should think about

decreasing the selling of hookah products. This can significantly decrease the popularity of

hookah smoking in the recent culture.

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Works Cited

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Predictors And Characteristics Among Current Hookah Users'. Tob. Induced Dis. 5.1 (2009): 16.

Web. 4 Dec. 2015.

Barnett, Tracey E., et al. "Evidence of emerging hookah use among university students: a cross-sectional

comparison between hookah and cigarette use."BMC public health 13.1 (2013): 302.

Chaouachi, Kamal. 'Hookah (Shisha, Narghile) Smoking And Environmental Tobacco Smoke (ETS). A

Critical Review Of The Relevant Literature And The Public Health Consequences'. International

Journal of Environmental Research and Public Health 6.2 (2009): 798-843. Web. 5 Dec. 2015.

Cobb, C. O. et al. 'Indoor Air Quality In Virginia Waterpipe Cafes'. Tobacco Control 22.5 (2012): 338-343.

Web. 5 Dec. 2015.

Koul, ParvaizA et al. 'Lung Cancer In The Kashmir Valley'. Lung India 27.3 (2010): 131. Web.

Martinasek, Mary P., Robert J. McDermott, and Leila Martini. 'Waterpipe (Hookah) Tobacco Smoking

Among Youth'. Current Problems in Pediatric and Adolescent Health Care 41.2 (2011): 34-57.

Web. 6 Dec. 2015.

Morris, Daniel S., Steven C. Fiala, and Rebecca Pawlak. 'Opportunities For Policy Interventions To Reduce

Youth Hookah Smoking In The United States'. Preventing Chronic Disease 9 (2012): n. pag. Web.

4 Dec. 2015.

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Nakkash, Rima T, Joanna Khalil, and Rema A Afifi. 'The Rise In Narghile (Shisha, Hookah) Waterpipe

Tobacco Smoking: A Qualitative Study Of Perceptions Of Smokers And Non Smokers'. BMC

Public Health 11.1 (2011): 315. Web. 7 Dec. 2015.

Sajid, Khan Mohammad, Mahfooz Akhter, and C. Q. Malik. "Carbon monoxide fractions in

cigarette and hookah (hubblebubble) smoke." Journal of the Pakistani Medical

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Who.int,. 'WHO | Tobacco'. N.p., 2015. Web. 5 Dec. 2015.