Hookah (aka shisha) – Ignorance and Harmful Effects

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Shisha, also referred to as Hookah, Water-pipe, Hubble-bubble and Narghile is a relaxed and social way of smoking tobacco, as opposed to the conventional method of smoking a cigarette (Azar, et al. 2015). It majorly involves passing vapour over water before inhalation, through a pipe.  Research has found that the use of shisha, especially among the youths, is on the increase, spreading across Europe, Africa, America, and the rest of the world, with its root firmly in the eastern Mediterranean region (Azar, et al. 2015; Holtzman, et al. 2013; Buss and Hurst, 2015). Interestingly, new forms of shisha smoking have been introduced. They include; steam stones and hookah pens, also known as Vapes. What is not known however is that these products, although battery-powered, rely on the conversion of the components of a liquid they contain into vapour for inhalation; this liquid contains Nicotine and flavouring among other chemical compounds (Wagoner, et al. 2016)

Correspondingly, It is a known phenomenon that ‘smokers are liable to die young, thanks to the incessant and constant campaigns bothering on the health hazards of smoking of cigarettes. As a result, it is not rare to find chronic shisha smokers that have never smoked a cigarette in their life, as they are fully aware of the hazardous effect cigarette smoking has on the human body; this aids them in making the conscious decision of snubbing cigarettes and ‘playing safe’ with shisha, totally oblivious of the fact that shisha smoking makes them just as liable to the harmful effects of tobacco. According to Maziak (2011), the major selling point/attraction for young people to hookah is flavouring as many youths are considered to have a sweet tooth. Asides from that, the hookah settings are usually set in social gatherings, making it more appealing as it serves as an avenue to socialise with people. Consequently, Holtzman, et al. (2013); Al-rawi, et al. (2018) and Omotehinwa, et al. (2018) have jointly established that the chief consumers of shisha are mostly university students, high school and college students, and other grown adults from the ages of 40, downwards. this explains the sporadic spread of this social trend as  Chouhan (2014) describes the youth as the fulcrum of any society, adorned with the special ability to influence and communicate trends across the world through fast and direct means like social media. At this juncture, it is worthy of note that shisha and cigarette both contain tobacco, the only difference is that the tobacco consumed through shisha is coated with a flavoured taste, in order to make it relaxing and seemingly harmless (Wagoner, et al. 2016).

According to Maziak (2011), public health officials have placed the ‘epidemic’ status on shisha, as it has been found to be a major threat to public health. More significant is the fact that it is majorly and widely consumed by youths, as such contributes majorly to reducing life expectancy rates as these youths are exposed to large quantities of tobacco at early stages in life. Hoffmann, et al. (2001) and Sajid, et al. (2008) have identified over 4,500 chemical components of shisha, with more than 60 found to be carcinogenic (liable to cause cancer) and tumour promoters. Sadly, this is an unpopular opinion as there exists a gross misconception that shisha is less or entirely harmless and can’t be compared to cigarettes as the vapour in shisha is passed over the water, where water acts as a filter, filtering out the hazardous components, before inhalation, thus making it completely safe (Aslam, et al. 2014). According to research carried out by the University of Pittsburgh, smoking a stick of cigarette involves about 10-12 puffs, with each puff containing a volume of about 49ml of smoke. A 45-60 minute shisha session, on the other hand, can involve an average of 100 puffs with each puff giving off about 50ml each (Science daily, No date). This explains why smoke loads and subsequently nicotine loads are higher for constant shisha smokers, so high that it becomes even deadlier than cigarette consumption.


Research has proven that shisha consumption presents the same health risks as cigarette consumption; owing to the fact that they both contain tobacco, which is burnt and inhaled directly into the lungs Wagoner, et al. 2016). Some researchers have argued that passing the vapour over water, as is the case in shisha smoking, does not guarantee its detoxification (Chaouachi, 2009). Conversely, other researchers have come up to refute this claim as false, stressing that the water, to a very insignificant degree, actually tries to detoxify the nicotine content of the vapour inhaled. However, it does this only slightly, leaving the consumer exposed to a very sufficient dose of nicotine, enough to wreak havoc on the system of the individual (Akl, et al. 2013). Aside from the looming tendency of addiction, shisha smokers are at risk of suffering from high carbon-mono-oxide, combined with tar and heavy metals which predisposes the consumer to cancer, as is the case with cigarette smokers (Jawad, 2015). It is for this reason that the WHO declared that a single smoking session of hookah capitulates a nicotine intake equivalent to the consumption of more than one pack of cigarette at a time (WHO, 2005). furthermore, Farah, et al. (2017); Alhazzazi (2016) and Awan, et al. (2017) have also found that shisha smokers are also predisposed to cancer of the lips, tongue, mouth, lungs, throats and inability to breathe or even exercise or work-out, giving room for cardiovascular diseases that could subsequently lead to death. Another very important health risk shisha smokers fail to consider is the fact that the typical shisha setting facilitates the transmission of communicable diseases orally, making it even riskier than cigarette smoking. As the CDC hookah factsheet (2017) highlights the fact that, unlike weed smokers who tend to share their blunts among themselves, passing it around, you hardly find cigarette smokers passing lit sticks of cigarettes among each other, as cigarette smoking is more personal and private, consequently sanitary. This in effect exposes how unhygienic shisha smoking is, as people tend to share the inhalation pipes with each other, puffing and passing it among themselves as the shisha pots traditionally possess one to two pipes, and It is not uncommon to have more than two people smoking from the same pot at the same time.


To Summarise, many people today are unaware of the hazardous health implications of smoking shisha. As a result, this habit has gained ground and is still spreading around the world. from this paper, it can be clearly seen however that this ignorance is a major boost for the spread of this practice as many of the chronic shisha smokers today do not smoke cigarettes, because they are aware of its health demerits, unaware of the fact that they are just as liable to these health hazards as much as cigarette smokers are. This consequently brings to focus the need for sensitization and adequate awareness creation, as a means of health improvement and health protection.


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Last modified: April 11, 2021

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