Harmful effect of ‘shisha smoking’ on maternal health

It is no longer hidden knowledge that smoking water pipes, globally recognised as “hookah” or more commonly called “shisha” has found its way into many local restaurants, cafes, bars, lounges and even private homes in Nigeria. Often described as a social activity by those who engage themselves in smoking it, hookah smoking is perceived to be safer than smoking a cigarette or weed, particularly, because it contains some flavouring agent and the water contained in the base helps to filter the air. Some others believe it is less addictive to cigarette because of the size of the apparatus as it cannot be conveyed easily as one would have the latter carried about in one’s pocket.

I quarrelled only twice with Maryam in our 40 years as husband and wife —IBB

What is worrisome is that most people who have formed the habit of using this device are oblivious of the enormous harmful effects hookah smoking has on the general well-being of an individual especially on the oral health.

To relinquish any confusion as regards the subject matter, a hookah is a water pipe used to smoke specially–flavoured tobacco through cooled water. The tobacco is usually heated in a bowl which is located at the topmost part of the hookah. The smoke generated from heating the tobacco is thought to be filtered through water located at the base of the hookah. Globally, there are other names given to this, such as; water pipe, goza, hubble-bubble, borry, arhile, and narghile.

The use of hookah dates back to at least 500 years; where studies have shown that it originated in the Middle East regions of the world especially Egypt, India, and Turkey. Notably, hookah smoking is one of the oldest, most popular Turkish traditions. As a matter of fact, it is considered rude if you have a hookah and you refuse to share it with guests in some parts of India. This tradition of hookah smoking has now travelled to the length and breadth of the world including, for example, the United States of America which boasts of more than 300 hookah establishments.

According to the Center for Disease Control and Prevention (CDC), 2.3 million Americans smoke tobacco from pipes. Remarkably, the trend is found among the young age group (particularly, students and business class working people) with an increasing number of women smoking shisha than men. As it stands, no conclusive empirical study has shown the prevalence and incidence of shisha smoking in Nigeria.

Out of curiosity, conversations with some ardent lovers of this tobacco-smoking medium in Nigeria show that they lack proper intuition about its role on their general well-being. For example, they believe that the since the hookah smoke is filtered through water, hence, it filters out harmful ingredients but the truth is smoking tobacco through water does not filter out cancer-causing chemicals. In fact, water-filtered smoke can damage the lungs and heart as much as cigarette smoke.

Another myth is that inhaling hookah smoke does not burn the lungs, so it is not unhealthy but studies have shown that although the hookah smoke does not burn the lungs when inhaled because it is cooled through the water in the base of the hookah. According to Dr. Alexander Nwogu, a practising dental surgeon hookah still contains carcinogens, hence, it is still unhealthy. In fact, hookah smokers puff more often and inhale more deeply, absorbing higher concentrations of the same toxins in cigarette smoke

However, some people also believe that smoking a hookah is not as addictive as smoking a cigarette because there is no nicotine. The above reasoning is false and it has been proven that just like regular tobacco, shisha contains nicotine. In fact, in a 1-hour Hookah session, smokers are exposed to 100 to 200 times the volume of smoke inhaled from a single cigarette (the Bacchus network). The World Health Organisation (WHO) also supports this notion as it is clearly scribbled on its website that, “smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session”

Moreover, some other folks believe that Shisha tobacco contains fruit, so it is healthier than regular tobacco but many studies have disproved this myth. This myth is misleading as tobacco is tobacco, no matter what. The practice of adding strong flavours (e.g., apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon) is a relatively recent one but has grown in popularity in the past 20 years but it still contains cancer-causing chemicals and nicotine. Compared to a single cigarette, hookah smoke is known to contain higher levels of arsenic, lead, and nickel, 36 times more tar, and 15 times more carbon monoxide than cigarettes. This is because smoking a hookah requires taking longer and harder drags, increasing levels of inhaled nicotine and carcinogens in the lungs.

Another fact is that if one chooses to use a hookah, remember that sharing mouthpieces without washing them can increase the risk of spreading colds, flu, and infections—even oral herpes.

Even if one does not inhale it but such individual is found consistently hanging around people who do, such individual is still at risk as exposure to the carbon monoxide filled smoke can be harmful (secondary smoker)

According to Dr. Alex, hookah smoking has been associated with gum diseases, dry socket, oral cancer and esophageal cancer among other conditions particularly in pregnant women.

Hookah smoking, like cigarette smoking, has been shown to be implicated in many different health abnormalities including lung cancer, heart attacks, strokes, impotence, vascular abnormalities such as stenosis, and low birth weight of infants.

Of note is its link to several oral health abnormalities such as an increase in plaque (food debris) and calculus (tartar) build-up leading to persistent bad breath (halitosis), altered sense of taste and smell, discoloured teeth (as a result of sticky tar deposits that leave black staining on the teeth), increased periodontal disease, premature loss of teeth, head and neck cancers, sinusitis, and in severe cases, black hairy tongue and smoker’s lip and  palate (red inflammation on the lip and roof of the mouth).

It is important that government through its ministry of health, policy makers and other stakeholders in the health sector have roles to play in coming up with significant policies which can aid in sensitising its citizenry about the potential health hazards that shisha smoking possesses.