IT would be germane to begin this reflection with a basic definition of what wastepipe or shisha is about. The British Heart foundation (BHF) states that shisha smoking is a way of smoking tobacco, sometimes mixed with fruit or molasses sugar, through a bowl and hose or tube. Shisha smoking, also called hookah, narghile, waterpipe, or hubble bubble smoking, is increasingly becoming a public-health issue in many towns and cities of Nigeria. Shisha also poses the same risks as cigarette smoking. I have decided to write this article to create some form of awareness about it. Few days ago, I watched a YouTube interview which featured a popular Nigerian artist. Throughout the interview, the artist was smoking shisha—which was quite shocking to me. Following the recent issues emanating with codeine and tramadol abuse among Nigerian youth, the Federal Ministry of Health has to be proactive in educating the general public on the harmful effects of social substances that are dangerous to the health. There are mixed messages regarding shisha smoking from uninformed and misinformed people that do not understand its contents.
Recently, I read a comment on social media made by a young Nigerian lady advising people that there is nothing wrong with shisha and that it could be used as nutritional supplements. The lady went on to say shisha contains vitamins and minerals, and those who smoke it get vitamins and minerals from it. Her comment had hundreds of likes from people who are as uninformed as she is. The World Health Organisation’s (WHO) fact sheet on waterpipe tobacco smoking states that waterpipe smoke is toxic. Laboratory analyses of waterpipe smoke reveal measurable levels of carcinogens (including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons [PAH], volatile aldehydes like formaldehyde, and benzene), and toxicants such as nitric oxide and heavy metals. Additionally, the burning charcoal generates high levels of carbon monoxide.
Systematic reviews of existing research point to significant associations between waterpipe smoking and lung cancer, periodontal disease and low-birth weight. More recent data suggests probable associations with oral, oesophageal, gastric and urinary bladder cancer, as well as chronic obstructive pulmonary disease, cardiovascular disease, stroke, chronic rhinitis, male infertility, gastro-oesophageal reflux and impaired mental health. Shisha smoking is becoming popular among artists and some celebrities in the country. This is a worrisome trend. Such people could easily influence their fans and followers into smoking it as well. I do not see anything classy in engaging in risky behaviours that could endanger ones health and probably shorten life span.
As a clinician, I believe basic information as regards self-care and healthy living would help in this disturbing health/social situation. A lot of people believe that smoking shisha is safer than smoking cigarettes, but this is not true. Facts show that it is even more risky and harmful to health than cigarettes. Shisha pipes use tobacco sweetened with fruit or molasses sugar, which makes the smoke more aromatic than cigarette smoke. Popular flavourings include apple, plum, coconut, mango, mint, strawberry and cola. Wood, coal or charcoal is burned in the shisha pipe to heat the tobacco and create the smoke because the fruit syrup or sugar makes the tobacco damp. When a person is smoking shisha, the person and anyone closer to him or her breathes in the smoke replete with toxins including carbon monoxide and heavy metals, which reduces the body’s ability to circulate oxygen in the blood.
Traditionally, shisha tobacco contains cigarette. Tobacco, like cigarette, contains nicotine, tar, carbon monoxide and heavy metals such as arsenic and lead. As a result, shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy. It is difficult to say exactly how much smoke or toxic substances one is exposed to in a typical shisha session. People smoke shisha for much longer periods of time than they smoke cigarette. In one puff of shisha, one inhales the same amount of smoke as one gets from smoking cigarette. The average shisha-smoking session lasts an hour and research has shown that in this time one could inhale the same amount of smoke as from more than hundred cigarettes. Some people think that shisha smoking is not addictive because the water used in the pipe could absorb nicotine. In reality, because only some of the nicotine is absorbed by the water, shisha smokers are still exposed to enough nicotine to cause an addiction.
Is herbal shisha safer? No, it is not. Shisha, herbal or otherwise, usually contains tobacco. Fruit or herbal flavours do not mean the product is healthy. Even if one uses tobacco-free shisha, one is still at risk from the carbon monoxide and other toxins in the coal or charcoal used to burn it. Second-hand smoke is also a worry. If someone is smoking with other people or in a public place and the shisha includes cigarette tobacco, it is likely other people would breathe in the second-hand smoke too. Now that the basic medical facts and information about shisha are in the public space, it is expected that one makes an informed decision whether to use it or not. Healthy living is the greatest gift one could give him or herself.
- Efuribe is a clinical pharmacist and a United Nations SDGs advocate
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