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November 15th, 2011:

Shisha 200 times worse than a cigarette say Middle East experts.

Tuesday 27 March 2007

ASH news release: Embargo: 00:01 27th March 2007

For more up-to-date information, please download our fact sheet on waterpipes (pdf).

Three leading experts from across the Middle East have warned that excluding “shisha bars” when England goes smokefree on July 1 could worsen the grave inequalities in health that already affect ethnic minorities.

Owners of shisha bars and cafes, which provide Arab style waterpipes to customers, are asking to be exempt from the law when it comes into force. However new research suggests that the waterpipes have three additional lethal risks over the risks of smoking cigarettes:

  • Flavoured tobacco is smoked over coals and fumes from these fuels add new toxins to the already dangerous smoke.
  • Shisha smokers inhale up to 200 times more smoke in a single shisha session that they would from a cigarette.
  • Café owners have stress the social importance of their product but researchers say it is exactly that social aspect that results in high levels of highly dangerous secondhand smoke.

Far from discriminating against ethnic minorities, any exemption for indoor shisha smoking would only worsen health inequalities, say experts. Following the recent publication by the American Lung Association “An emerging Deadly Trend: Waterpipe Tobacco Use” (1) Mostafa Mohamed, Professor of Community Medicine in Cairo said,

“Heat sources that are commonly used in Shisha pipes to burn the tobacco are likely to increase the health risks because when they burn they produce their own toxins. Shisha smokers and those around them are put at greater risk.”

Professor Mohamed is among the authors of a World Health Organisation report on shisha smoking published in 2005 (2). He was joined in his statement by co contributors from Syria and the Lebanon.

Dr Wasim Maziak, Associate Professor at the University of Memphis USA and Director of the Syrian Center of Tobacco Studies expects to publish new research very soon. The new study stresses that it is the very social nature of shisha smoking that makes the problem worse.

“Our latest study makes clear that that clean air policies should include the waterpipe, as it can be responsible for the build up of toxic levels of indoor air pollutants similar to what is seen in cigarettes. The social nature of this tobacco use method makes such regulations more needed, but perhaps more difficult to implement as well. The public health community in the meantime must wake up to the hazardous nature of this emerging tobacco use method both to users and those exposed.”

A typical hour long shisha session involves inhaling 100 to 200 times the volume of smoke inhaled when smoking a cigarette and there is no proof that any adaptation can make waterpipes safer. Professor Maziak’s latest study provides the first evidence about the potential hazards of exposure to waterpipe-associated secondhand smoke. Hazardous particles of various sizes can build up gradually during waterpipe use to reach dangerously high levels presenting a risk to non-smokers and particular risk to pregnant women.

Dr Alan Shidaheh of the American University in Beirut suggested that the problem was only recently being addressed by western scientists and that had lead to dangerous misconceptions.

“One of the enduring legacies of colonialism is that many problems of public health which are more relevant to the global South have received scant scientific attention due to a lack of resources available there. Knowledge of the potentially detrimental health consequences of shisha smoke, first or second hand, is a good example. The historical lack of evidence has unfortunately allowed many shisha users to believe that the practice was safe, or at least safer than other forms of tobacco use. We have recently learned otherwise.”

Dr Shidaheh went on to stress that it was not only the shisha smoker who is at risk and warned that the tobacco industry will try to undermine the science,

“Every recent study has found that shisha smoke contains large quantities of the chemicals that lead to heart disease, cancer, and addiction in cigarette smokers.”

In their report to the WHO the researchers stressed,

“Waterpipes should be subjected to the same regulations as cigarettes and other tobacco products. Waterpipesand waterpipe tobacco should contain health warnings. Claims of harm reduction and safety should be prohibited.”


Notes and links:

[1] “An Emerging Deadly Trend: Waterpipe Tobacco Use, American Lung Association February 2007, (pdf)

[2]Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators

WHO Study Group on Tobacco Product Regulation, 2005 (pdf)

Hookah, line and stinker

South China Morning Post – Nov. 15, 2011
Shisha bars are gaining popularity in Hong Kong, but are smokers of the
aromatic tobacco playing with fire?

Shisha bars are gaining popularity in Hong Kong, but are smokers of thearomatic tobacco playing with fire?

In addition all tobacco products imported into Hong kong have to be approved and registered with the Government Chemist with details of tar content etc.

‘The rules and regulations stipulated by the WHO Framework Convention on Tobacco Control

(WHO FCTC) apply to all tobacco products and not only cigarettes. Fourteen Member States of

the WHO Eastern Mediterranean Region are now Parties to the Convention. Consequently when

Articles 10 and 11 call upon countries to regulate tobacco products, that regulation will include

tobacco consumed by use of the waterpipe, a traditional form of smoking common to the Region. The

regulation of tobacco products includes health warnings, information about contents and emissions,

as well as packaging and labelling. All these elements and others indicated in Articles 10 and 11 of the

WHO FCTC are pertinent to the waterpipe as they are to all methods of tobacco consumption.’

Download PDF : Shisha

Singer: Should we ban cigarettes?

Editor’s Note: Peter Singer is professor of bioethics at Princeton University and Laureate Professor at the University of Melbourne. His books include Animal LiberationPractical EthicsThe Ethics of What We Eat, and The Life You Can Save. For more from Singer, visit Project Syndicate’s website, or check it out on Facebook and Twitter.

By Peter Singer

U.S. President Barack Obama’s doctor confirmed last month that the president no longer smokes. At the urging of his wife, Michelle Obama, the president first resolved to stop smoking in 2006, and has used nicotine replacement therapy to help him. If it took Obama, a man strong-willed enough to aspire to and achieve the U.S. presidency, five years to kick the habit, it is not surprising that hundreds of millions of smokers find themselves unable to quit.

Although smoking has fallen sharply in the U.S., from about 40% of the population in 1970 to only 20% today, the proportion of smokers stopped dropping around 2004. There are still 46 million American adult smokers, and smoking kills about 443,000 Americans each year. Worldwide, the number of cigarettes sold – six trillion a year, enough to reach the sun and back – is at an all-time high. Six million people die each year from smoking – more than from AIDS, malaria, and traffic accidents combined. Of the 1.3 billion Chinese, more than one in ten will die from smoking.

Earlier this month, the U.S. Food and Drug Administration announced that it would spend $600 million over five years to educate the public about the dangers of tobacco use. But Robert Proctor, a historian of science at Stanford University and the author of a forthcoming blockbuster entitled Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, argues that to use education as one’s only weapon against a highly addictive and often lethal drug is unpardonably insufficient.

“Tobacco control policy,” Proctor says, “too often centers on educating the public, when it should be focused on fixing or eliminating the product.” He points out that we don’t just educate parents to keep toys painted with lead-based paints away from their children’s mouths; we ban the use of lead-based paint. Similarly, when thalidomide was found to cause major birth defects, we did not just educate women to avoid using the drug when pregnant.

Proctor calls on the FDA to use its new powers to regulate the contents of cigarette smoke to do two things. First, because cigarettes are designed to create and maintain addiction, the FDA should limit the amount of nicotine that they contain to a level at which they would cease to be addictive. Smokers who want to quit would then find it easier to do so.

Second, the FDA should bear history in mind. The first smokers did not inhale tobacco smoke; that became possible only in the nineteenth century, when a new way of curing tobacco made the smoke less alkaline. That tragic discovery is already responsible for about 150 million deaths, with many times that toll still to come, unless something drastic is done. The FDA should therefore require that cigarette smoke be more alkaline, which would make it less easily inhaled, and so make it harder for cigarette smoke to reach the lungs.

Much of Proctor’s book, which will be published in January, is based on a vast archive of tobacco-industry documents, released during litigation. More than 70 million pages of industry documents are now available online.

The documents show that, as early as the 1940’s, the industry had evidence suggesting that smoking causes cancer. In 1953, however, a meeting of the chief executives of major American tobacco companies took a joint decision to deny that cigarettes are harmful. Moreover, once the scientific evidence that smoking causes cancer became public, the industry tried to create the impression that the science was inconclusive, in much the same way that those who deny that human activities are causing climate change deliberately distort the science today.

As Proctor says, cigarettes, not guns or bombs, are the deadliest artifacts in the history of civilization. If we want to save lives and improve health, nothing else that is readily achievable would be as effective as an international ban on the sale of cigarettes.(Eliminating extreme poverty worldwide is about the only strategy that might save more lives, but it would be far more difficult to accomplish.)

For those who recognize the state’s right to ban recreational drugs like marijuana and ecstasy, a ban on cigarettes should be easy to accept. Tobacco kills far more people than these drugs.

Some argue that as long as a drug harms only those who choose to use it, the state should let individuals make their own decisions, limiting its role to ensuring that users are informed of the risks that they are running. But tobacco is not such a drug, given the dangers posed by secondhand smoke, especially when adults smoke in a home with young children.

Even setting aside the harm that smokers inflict on nonsmokers, the free-to-choose argument is unconvincing with a drug as highly addictive as tobacco, and it becomes even more dubious when we consider that most smokers take up the habit as teenagers and later want to quit. Reducing the amount of nicotine in cigarette smoke to a level that was not addictive might meet this objection.

The other argument for the status quo is that a ban on tobacco might result in the same kind of fiasco as occurred during Prohibition in the US. That is, like the effort to ban alcohol, prohibiting the sale of tobacco would funnel billions of dollars into organized crime and fuel corruption in law-enforcement agencies, while doing little to reduce smoking.

But that may well be a false comparison. After all, many smokers would actually like to see cigarettes banned because, like Obama, they want to quit.

Europe switches to self-extinguishing cigarettes

BRUSSELS — It’s lights out in Europe this weekend for old-style cigarettes that manufacturers haven’t adapted to burn themselves out if left unattended.

Come Friday, in a bid to cut down on smoking-induced fire deaths across the continent, all cigarettes sold in the 27-state European Union — home to half a billion consumers — will have to be self-extinguishing.

“Evidence shows that the number of fatalities can be reduced by more than 40 percent with the introduction of ‘Reduced Ignition Propensity’ (RIP) cigarettes,” the executive European Commission said on Monday, citing data from Finland, the first EU state to implement new legislation agreed in 2008.

Brussels estimates that nearly 500 lives a year can be saved in this way from some 30,000 annual fires started by lit cigarettes that are forgotten.

On Thursday, a three-year phasing-in period for the legislation will come to an end, meaning all 27 EU states will thereafter have to adopt the same norms as the United States, Canada and Australia.

The changes do not affect cigars.

Manufacturers insert two rings of thicker paper within the cigarette that restricts air and oxygen supply and so block the lit tobacco’s progress.

EU Commission health spokesman Frederic Vincent said: “If you don’t puff on them, the cigarettes go out all by themselves.”

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