Hookah Use Among Today`s Youth

 Hookah Use Among Today’s Youth
Author: Sweta Ukani Independent Study: Public Health Public Health Education Abstract:
An important public health issue that seems to be ignored is the use of tobacco
amongst adolescents. With new, emerging forms and uses of tobacco, young individuals’
health is a rising matter. While there are some measures being taken to educate youth
about the risks of tobacco use, the arising problem is that there are new forms of smoking
tobacco. Adolescents are being educated about not smoking or chewing tobacco but
public health administrators have not been keeping up with new trends with tobacco-use.
Hookah use specifically among adolescents is a growing concern, which is addressed in
this paper. This paper aims to summarize the origin of hookah, laws, regulations,
programs, and statistics, and prevention of tobacco-use among adolescents.
Introduction:
Smoking has been a fad among younger populations for generations. According to
the Merriam Webster dictionary, smoking is defined as “the cloud of black, gray, or
white gases and dust that is produced by burning something; a cigarette, the cigar.” When
a individual thinks of the term smoking, their thoughts will automatically go to either a
cigar or a cigarette. The general public tends to keep smoking within those parameters
and fail to see new forms and trends occurring with smoking as generations go on. One
new trend that has developed is the increased use of smoking “hookah”. Many users,
particularly adolescents believe that hookah is not as harmful as cigarettes, however they
are mistaken. Water-pipe smoking does not make the tobacco any less detrimental to
one’s health.
Tobacco is a plant known to be part of the same family as “the potato, pepper, and
the poisonous nightshade
(http://academic.udayton.edu/health/syllabi/tobacco/history.htm). It has been grown
natively in the Americas since 6,000 B.C. and has been used as a multipurpose, including
practices of medicine and religion. This plant was a “cure-all” crop chewed to relieve
toothache pains (http://academic.udayton.edu/health/syllabi/tobacco/history.htm).
Tobacco went from a curing crop to a currency crop. This is when scientists started
realizing and understanding the dangerous chemicals and health effects of tobacco. Until
1826, nicotine was an undiscovered poison. Nicotine causes loss of appetite, nausea,
increase in saliva and phlegm, and increase in heartbeat and blood pressure
(http://www.nlm.nih.gov/medlineplus/ency/article/000953.htm). It takes about two to
three hours for a person to go through nicotine withdrawal after the last tobacco use. This
addictive substance is found in tobacco leaves which is either smoked, sniffed, or chewed
(http://www.nlm.nih.gov/medlineplus/ency/article/000953.htm). Aside from nicotine,
there are nineteen more chemicals found in tobacco, collectively known as tar. Tar is
brown and sticky, and stains fingernails, teeth, and lung tissue. What it contains is
carcinogen benzopyrene, which causes
cancer. Both tar and nicotine affect
about every single organ in the human
body, which does not only cause
diseases but also reduces overall health.
The human body is comprised of
intricate systems and organs. Smoking
tobacco affects the respiratory system,
circulatory system, immune system,
musculoskeletal system, and sexual
organs. The respiratory system helps
facilitate breathing by carrying oxygen
to the lungs and releasing the carbon
dioxide from the lungs via an airway, the
mouth or nose. Tobacco use makes it
difficult to breathe and causes lung
infection. The lung passages develop an
http://www.ucsf.edu/news/2013/04/105
236/smoking-­‐hookah-­‐not-­‐harmless-­‐
alternative-­‐cigarettes up of poisonous chemicals. The air sacs become
permanently damaged leading to COPD,
excess build up of mucus as well as a build
chronic obstructive pulmonary disease. Tobacco smokers are at greatest risk for improper
breathing, “chronic cough, and sputum production”
(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Lung_conditions_obstru
ctive_pulmonary_disease). The circulatory system, also known as the cardiovascular
system, permits blood circulation and transportation of nutrients, hormones, and oxygen
from cell to cell which allows the body to fight diseases and maintain in balance. This
system is affected greatly by tobacco smoke as it increases risk of heart attacks and
strokes. Heart rate and blood pressure rises with smoking tobacco, which also causes
blood clots, tightening of blood vessels, and reduction blood flow. The immune system
protects the body from infection or disease. However, this system’s function is impaired
with tobacco use causing illnesses to last longer, levels of antioxidants to lower, and
susceptibility of infections to increase. The musculoskeletal system allows the body
move, but most importantly it provides stability and support to the human body. With
smoking tobacco, bone density starts to reduce and muscles start to tighten which leads to
twitching muscles and aching or pain of the body. Sexual organs in both male and female
are harmed as well. For males, there is a higher chance of having deformed and damaged
sperm and impotence. On the other hand, females experience irregular menstruation and
are at higher risk of heart attack, stroke, and cervical cancer
(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Smoking_effects_on_yo
ur_body). Nearly the entire body is affected by tobacco, from the respiratory system to
sexual organs. Slow realization of these effects and risks, a new form of smoking tobacco
emerged in the United States, hookah.
Hookah:
Hookah, “originated in the Middle East regions of the world
(http://www.health.umd.edu/sites/default/files/Hookah%20Brochure-%20Final_0.pdf), is
a form of smoking tobacco. It has been five centuries since this type of tobacco use was
first introduced. Originally, this type of smoking was created as a less injurious process
of tobacco use due to the understanding that the smoke first passed a vessel of water
(http://ntr.oxfordjournals.org/content/9/12/1339.full.pdf+html). This widespread belief
eventually died out as more studies were done on hookah use. As time passed, hookah
became quite popular and hookah bars emerged in European cities around the 1900s.
Recently, this traditional method has expanded out to the United States. Even though this
style of tobacco use has been around for centuries, this nation is not completely aware of
the side effects and potential dependence of hookah smoking.
Unlike cigarettes and cigars, a
hookah has multiple components. A
hookah has a base, head, hose, coal tray,
coals, and shisha tobacco. The base, or
bowl, made of glass, is the bottom part
of the hookah and it holds water. These
bases come in a variety of shapes and
colors. The body, also known as the
pipe, has a release valve and a hose
socket. It is made of steel or tin and
connects the base and the head, which is
made
http://recoveryplus.utah.gov/wp-­‐
content/uploads/Hookah%20fact%2
0sheet.pdf from clay
(http://www2.hawaii.edu/~ztomasze/hookahmanual.ht
ml). The head looks like a bowl with three to five
holes at the bottom of it and the purpose of this
accessory is to hold the shisha, or tobacco. “Shisha is
http://hookahjohn.com/Al
-­‐Fakher-­‐Flavor-­‐1-­‐KG-­‐
AFA.htm the very moist and sticky tobacco that has been
soaked in honey or molasses. There are a variety of
shisha flavors” (http://www.health.umd.edu/sites/default/files/Hookah%20Brochure%20Final_0.pdf) ranging from fruity to minty to fruity and minty. This head is foiled
after packed with shisha and is heated with coals. The piece that allows smoke to come
out is the hose. The hose has two ends, one of which is fixed into the hose socket and the
other, which is used to smoke with
(http://www2.hawaii.edu/~ztomasze/hookahmanual.html). The concept of filtrating the
tobacco through the water before smoking it does not make smoking hookah safer than
cigarettes. Hookah smoke contains many of the same harmful toxins as cigarette smoke.
Comparison between Cigarette Smoking and Hookah
According to the World Health Organization, a hookah smoker inhales as much
smoke during one standard hookah session as a cigarette smoker would from a hundred
cigarettes. Compared with cigarette smoking, hookah smoking is associated with
comparable or even more inhalation of toxicants. The smoke from hookah contains
higher levels of arsenic, lead, and nickel, thirty-six times more tar, and fifteen times more
carbon monoxide than cigarettes. The higher levels are due taking longer and harder
drags, increasing levels of inhaled nicotine and carcinogens in the lungs. Hookah use
increases contact with carcinogens because smokers use the hookah over a much longer
period of time, often forty to forty-five minutes, rather than the five to ten minutes it
takes to smoke a cigarette. In those forty minutes of hookah use, about two hundred puffs
are taken compared to the twenty puffs taken with a cigarette. The societal facet of
smoking hookah put many users at risk for other infectious diseases due to the fact that
the same mouthpiece is shared (http://www.ncbi.nlm.nih.gov/pubmed/18544194). While
smoking tobacco has its own effects to health, hookah smoke has the added health effect
of the charcoal. The charcoal is used to heat the tobacco. As it does its job of heating the
shisha, it also increases health risks with its high levels of metal, carbon monoxide, and
cancer causing chemicals (http://www.cdc.gov/features/hookahsmoking/).
Young Generation:
In recent years, there has been a growth in smoking hookah around the world,
most prominent among youth. Hookah smoking is the premier among young people, as in
high school students and non-college population. The use of hookah was observed in
association with increased opportunity for outdoor recreation, holiday, exams, and
periods of stress (Asfar et al., under review; Maziak et al., 2004b).
As the new form of tobacco use emerged, the rate of smoking cigarettes went
down among high school student form 70.4% to 46.3% in a decade
(http://eds.a.ebscohost.com.proxy.libraries.rutgers.edu/eds/pdfviewer/pdfviewer?sid=481
79783-ef80-4341-a2d9-0ad81ebe7bfa%40sessionmgr4003&vid=2&hid=4108). However,
the use of hookah started to increase as soon as the downfall of cigarettes occurred.
According to the Monitoring the Future Survey, in 2011, approximately 19% of high
school seniors used hookahs to smoke tobacco
(http://www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2011.pdf).
A study was done in San Diego, California among high school student ages
eighteen or younger. The subjects were given a survey regarding the use of hookah and
cigarettes, as well as questions about hookah lounges and how they heard about this new
trend. Out of the six hundred and ninety-six participants, more than 25% of them had
smoked hookah before. Less than 5% of the subjects currently were users of both tobacco
forms. Half of the subjects had heard about hookah and got their knowledge of it from
friends. Less than a quarter found out about hookah by actually going to a hookah lounge.
More than half of the subjects view hookah as socially acceptable compared to cigarettes.
About half of them view hookah smoking as a safer alternative to cigarettes. The same
study conducted also showed that the average age of many hookah beginners is around
the age of fifteen
Correlation between Hookah and Other Behaviors
Although hookah is legal after a certain age, as is cigarettes, there are behaviors
that both activities have a positive correlation to. Most adolescents and young adults
some tobacco and nicotine containing substances while intoxicated by alcohol.
“Consistent with existing research [17], these data indicate that hookah use is highly
correlated with the use of other substances, specifically current cigarette smoking and
alcohol use” (http://omicsonline.org/2155-6105/2155-6105-S2-001.php?aid=2236 ).
The combined use of alcohol and hookah is not limited to the simultaneous or
followed consumption of one each other. A light was recently shone upon a new trend
that involves hookah where adolescents began to use alcohol in the base of the hookah
instead of water. This fad was titled “smoking alcohol” by the media. By smoking
alcohol, the alcohol gets sent straight to the brain and lungs which causes the body’s
warning signs about over consumption to be eliminated. “Experts say it’s the quick
absorption of the alcohol from the hookah that makes it so dangerous. Instead of
absorbing alcohol through the stomach and liver ”
(thttp://www.wsbtv.com/news/news/local/doctors-warn-dangers-smokingalcohol/nYT8C/ )
Another practice, that is not commonly used or known is the mixing of hookah
shisha with cannabis. There is not much data or many complete studies conducted on the
correlation between weed and hookah but this is a practice common among those that use
cannabis. This fact is made apparent just by human observation during research on
hookah use. The substance is mixed with the flavored tobacco by one of two ways:
sprinkling marijuana on top of the tobacco and the bowl or mixing the substance with the
flavored tobacco used for hookah. Similar to the effect of smoking alcohol, smoking
marijuana by a hookah causes a high.
Enforced Laws and Regulations: (NJPHE)
Influence:
Prevention:
The use of hookah continues to increase among the younger population. Proper
limitations and restrictions need to be set in order to bring down the high number of
youth smoking and to mainly prevent underage individuals from smoking. Smoking starts
in adolescent years and continues from there on out. Like cigarettes, any alternative
forms of smoking tobacco need regulatory measures that adapted to the younger
population. The smoking of hookah is a matter that is not given enough attention. Due to
the lack of accurate knowledge of smoking hookah, the percent of adolescents smoking
continues to increase without any measures taken to control and prevent this social
activity.
There are many loopholes as to how the younger aged population gets access to
smoking hookah. The great numbers of hookah lounges opening up seem to bend the
rules in certain areas of this country. Each state has its own age requirement to smoke just
tobacco and to be able to purchase it. The same laws and regulation also apply for
smoking hookah. Each hookah lounge is responsible for checking every customer’s
legitimate documentation for legitimacy of being of age to enter and smoke. Regardless
of such strict enforcements, there are many loopholes that allow underage individuals
within these vicinities. There are hookah lounges that disregard the fact that it is illegal to
admit minors and allow them to smoke underage. A more strict surveillance system
would prevent these loopholes and mostly prevent the youth population from any access
to hookahs.
Despite the fact that there are age requirement standards and laws to smoke
hookah, similar to cigarettes, the best prevention method is health education.
“Educational efforts are needed to increase awareness of the potential hazards of this
increasingly popular form of tobacco use”
(http://ntr.oxfordjournals.org/content/9/12/1339.full.pdf+html). The common
misconception that smoking hookah is better than smoking cigarettes must be debunked.
Adolescents should be taught about the similarities and detrimental affects of smoking
hookah from an early age, as is done for cigarette smoke.
Conclusion:
Hookah smoking is the rising trend of the 21st century. The United States has had
an increase use of this new trend especially among the youth. Within five years, this
country has managed to open 300 new lounges that provide hookahs to smoke and
purchase. Generally this new form of tobacco use is viewed as a social activity that is fun
and cheap. As hookah smoking gets more publicity and introduced to new publics, the
popularity and attractiveness of it is increasing. The socially accepted aspect of hookahs
does not make smoking tobacco through a water pipe a safe alternative to smoking
cigarettes.
Reference:
- http://www.merriam-webster.com/dictionary/smoke
- World Health Organization Study Group on To- bacco Product Regulation. TobReg
Advisory Note: Waterpipe Tobacco Smoking: Health Effects, Research Needs and
Recommended Actions by Regulators. Geneva, Switzerland: World Health Organization;
2005.
- Asfar T, Ward KD, Eissenberg T, Rastam S, Hammal F, Bachir ME, et al. The
evolution of waterpipe (narghile) smoking: comparison between cafe ́ customers and
university students. Addiction [under review].
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