Smoking cessation practitioner Anne Buttigieg. Photo: Jason BorgSmoking cessation practitioner Anne Buttigieg. Photo: Jason Borg

The use of the shisha, or water pipe, is becoming more popular among young people but many are under the illusion that it is a safe alternative to cigarettes, according to a health official.

The nicotine exposure from daily water pipe use is estimated to be equivalent to smoking 10 cigarettes a day. When it comes to passive smoking, in a typical one-hour shisha session a person is exposed to the smoke equivalent emitted by 100 to 200 cigarettes, Anne Buttigieg from the health promotion directorate warned.

Ms Buttigieg, who is a smoking cessation practitioner within the directorate, is concerned that young people do not realise the health hazard of the shisha, also known as a hookah.

The directorate is currently working on putting together an educational leaflet for young people. This was triggered by concerns of parents whose children, some under the age of 18, tried smoking the shisha.

A typical one-hour hookah smoking session involves about 200 puffs, while an average cigarette is 20 puffs

Ms Buttigieg stressed that while there is no law specific to water pipes, they are regulated by the law regulating tobacco. This means they should not be available to minors and could not be smoked indoors.

Hookahs are used to smoke specially-made tobacco that is available in a variety of flavours such as apple, mint, cherry, chocolate and coconut. The scent of the smoke often serves as a mask to the smell of tobacco and enforces the misconception that it is not as harmful as cigarettes, Ms Buttigieg said.

Another misconception is that the water inside the shisha filters out the toxic components and harmful chemicals.

“This is not the case. Water pipe tobacco smoke has a mixture of 4,000 compounds that include hundreds of toxins,” she said.

The water only serves to humidify the smoke inhaled, making it feel smoother, less irritating.

Shisha smoking carries the same risks of diseases like other tobacco products that include lung, mouth and stomach cancer, respiratory problems and heart diseases among others.

The shisha comes with an added health hazard resulting from the charcoal used.

A typical modern shisha comprises a head, a metal body, a water bowl and a flexible hose with a mouthpiece. The tobacco is placed on the top with charcoal above it. Once the charcoal is lit, the tobacco-filled fumes travel into the water container from where they are inhaled.

According to the US Centre for Disease Control and Prevention (CDC) due to the mode of smoking – including frequency of puffing, depth of inhalation and length of the smoking session – hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke.

Apart from that, sharing of the mouthpiece can lead to transmission of diseases such as cold sores, tuberculosis, hepatitis and pneumonia.

Ms Buttigieg said that despite these risks Malta was following the international trend and shishas have become more popular. The social aspect of the shisha, often smoked in groups, attracted young people to try it out. This could lead to the development of nicotine cravings and eventually regular smokers.

Shisha – what you might not know*

• Hookahs originated in ancient Persia and India and have been used extensively for centuries.

• A typical one-hour hookah smoking session involves about 200 puffs, while an average cigarette is 20 puffs.

• The volume of smoke inhaled during a typical hookah session is about 90,000ml, compared with 500 to 600ml inhaled when smoking a cigarette.

• Second-hand smoke from hookahs poses a serious risk for non-smokers, particularly because it contains smoke not only from the tobacco but also from the charcoal used in the hookah.

• Babies born to women who smoked one or more water pipes a day during pregnancy have lower birth weights than babies born to non-smokers and are at an increased risk of respiratory diseases.

*Source: CDC factsheet

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