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

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

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.”

ENDS

[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)