Not another smoking article!

By Nauman Shahid, MPH, BSc
May 31, 2013

Thank you for taking the time in reading my first ever blog post for St. Georges University and its MPH program. I am a graduate of the program and on my way to become a term ¾ School of Medicine student.

Today is May 31, 2013, a day that many may think is any other normal day. In some ways it is. But dive in closer and you quickly realize May 31, 2013 is also “World No Tobacco Day”. I promise this will not be another post on cigarettes and it will probably be to your benefit to read till the end, because chances are, you probably are going to be provoked, intellectually that is!

Smoking, why are we so concerned with it? Well, the field of Public Health, focuses on one key mantra, that is, PREVENTION! Yes, prevention!. If you simply search for “preventable diseases” on any data mining health site, (i.e. WHO), you will quickly realize smoking tobacco is listed as the number two in rank as the leading causes of preventable death globally. You may ask, what is number one? Well, its hypertension, a disease that is amplified by smoking. We can clearly see the implications smoking tobacco has on our health and simply abstaining from this practice can and will alleviate this preventable disease from further inflating. But sadly, the statistics aren’t great, in fact, since 2001, the positioning of these risk factors for death haven’t changed at all.

Today’s focus will be on a form of smoking that has transmitted through the population faster than a traveling bullet! Well not that fast, but you get the analogy. It’s mainly popular amongst high school students, college students, the youth, and young adults in the age group between 15-30. Yet it doesn’t stop there, males, females, different cultures, religions, are all affected. You might ask, well what could this be?

This form of smoking is no other than, Hookah, also known as water pipe smoking.

As part of my MPH at St. Georges University, I was asked to furnish a research thesis of my choice to the capstone committee. I very eagerly chose this topic mainly to enhance my own knowledge, as I personally am guilty of commencing in this practice.

The findings startled me. Although the research I did is far too much for a blog post, I’ll give you the nuts and bolts of it. If it interests you enough, let me know, and I’ll get you PDF copy of it.

Hookah smoking, is a form of smoking that involves one to smoke through a pipe attached to a water base in which suction is used to smoke flavored tobacco which is situated at the top and is ignited by a charcoal. The desired flavors vary to a consumers liking. Many folks have argued that filtering mechanism filters the tobacco and other contents out, but as studies suggest, this is not the case.

The tobacco mixture in Hookah smoking consists of nicotine of varying concentrations in which one session can have levels comparable to smoking 10-20 cigarettes in just one session! In addition to this, it also includes carcogenic agents such as arsenic, beryllium, nickel, cobalt, chromium and of course carbon monoxide. Apart of the smoking, Hookah smoking is also prone to transmitting infectious disease through the usage and sharing of the pipe mechanism in which consumers may or may not have at their disposal plastic cover caps to limit this. These diseases include HIV, Hep-C, TB and many other communicable diseases.

But what is the one fact, that startled me personally, was the idea that the FDA, does NOT regulate this form of smoking. That is why you have many young teenagers involved in this practice.

Hundreds of Hookah lounges exist in the USA, and they are not regulated as they being marketed as tobacco retail stores, shops, and bars. In the research I conducted, it was evidenced that, 14 different studies were conducted involving Hookah smoking measuring blood serum levels of the different toxicants, age, perceptions, race, and prevalence.

The USA tobacco industry collects nearly $25.3 billion dollars, yet not ONE state meets the CDC recommended expenditure for tobacco control. On average, only 14% of this is met in accordance to the CDC recommended allocation by state. Clearly, the effort to prevent is not the priority of health governing bodies statewide.

Physiologically speaking, Hookah smoking casts a similar profile when compared to cigarettes. For example, from the data in the studies I read, CO (Carbon Monoxide), was elevated on average by 23.9 ppm (Hookah) and only 2.7 ppm for cigarettes. This is probably because, Hookah has a strong social ideology behind it, in which consumers gather in a circle and share the pipe which would clearly raise the levels of smoke volume in a closed room setting. The smoke can reach as large as 48.6 liters of environmental tobacco smoke (ETS), far greater than cigarettes. The studies also revealed that, the formation of CarboxyHemoglobin (product of Carbon monoxide and Hemoglobin) is 3 times higher than cigarettes

Studies also revealed, many high school students (i.e. New Jersey state survey) were involved in smoking Hookah. Of the many consumers in the different studies, on average, 55% thought Hookah was LESS harmful than cigarettes. Nearly 60% of these consumers also practiced in Hookah for the social aspects of smoking.

As far as race is concerned, mainly Asians and Whites were amongst the leading consumers of Hookah. However, bear in mind, some studies reported that this was a self-reported identifier, so these may very well include other ethnicities such as Arabs.

One might ask, well why has this taken off with great speed into a public health issue? Well, simply look at the demographics. Due to the regulation of alcohol and cigarette smoking, many who are below 21 and 18, resort to this practice in need of a social outlet. The misconception of it being “less harmful” compared to cigarette smoking has developed into a protective factor against it. Having compared each individual state smoking ordinance, only a handful even recognized Hookah as a form of smoking. Yet very few even mentioned or required the need for ventilation systems, separate rooms to minimize the secondary effects, and use of prepackaged food or covered drinks.

More studies need to be conducted measuring bio-plasma markers, prevalence, and incidence.

Federal, state and local health bodies need to recognize this as a form of smoking where they are grandfathered into the already in place smoking ordinances for cigarettes.

There is no quick fix, and given its historical context, many consumers will continue to consume at an alarming rate. The job of public health officials is to regulate and inform the public. The consumer’s bears the responsibility to act based on the information given.

However, Hookah smoking is a growing problem, and will continue to grow in prevalence. We may not fully understand the health implications of this yet, however give it a few years and when today’s 25 year old ages to 52 with continued bouts of emphysema, maybe, and just maybe, Hookah smoking may have something to do with it.

Thanks again for reading my post.

Wishing everyone a great day and far greater health!


Nauman Shahid is a current Term 3/4 medical student at St. Georges University. He acquired his BSc. of Biology from George Mason University in Fairfax, VA. He further received his Masters in Public Health with a concentration on Health Policy and Administration from St. Georges University. He has worked numerous executive level positions over the years and offers a diverse telling experience promoting the idea of “humanism” for others. Nauman’s article on “Envisioning Medicine” was recently featured in SGU’s MACE Magazine 2013 and was dubbed by his peers as “-a very inspiring read”.

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