Hookahs – also known as narghile, hubble-bubble, goza, or shisha are commonly used in the Middle East including the Persian Gulf, Kuwait, Iraq, Bahrain, Qatar, Oman, Saudi Arabia, and UAE (Sajid, Chaouachi, & Mahmood, 2008). Over the past few years, the use of hookahs has quickly spread throughout the Southeast Asia, Europe, and other developed and developing countries around the world.
Since there are a lot of clinical evidences that shows the adverse health consequences of smoking hookahs, several studies reported that some of the public health officials consider the smoking of hookah as a ‘global tobacco epidemic’ (Chaouachi, 2009; Anjum, Ahmed, & Ashfaq, 2007; Chaouachi, 2007). This is the main reason why there is a need to educate the public about the health effects of smoking hookas.
Differences and Similarities of Tobacco Used in Hookah and Cigarette
The tobacco paste used in hookas is known as either moassel and/or jurak. This type of tobacco paste is different with the type of tobacco used in cigarettes since moassel and jurak contains around 30 to 50% more tobacco combined with molasses – sugarcane juice, different spices and dried fruits, glycerol, and flavoring essences (Khater et al., 2008).
Tobacco leaves used in manufacturing cigarettes is similar with the tobacco substance used in hookah smoking in the sense that both contains a high level of nicotine, carbonaceous materials, and tar (Maziak, Ward, & Eissenberg, 2007; Chaouachi, 2007; Al-kubati et al., 2006). Even though addiction to hookah smoking is much lesser as compared to cigarette smoking (Al-Mutairi et al., 2006), individuals who smoke hookahs once in awhile could still develop a long-term habit of smoking hookahs.
Evidences behind the Harmful Effects of Smoking Tobacco through Hookah
Aside from a total of 69 carcinogens that are present in tobacco smoking, there are also other 4,800 chemicals which could effectively promote tumor or co-carcinogens causing cancer related to lungs, nasal cavities, kidney, liver, nasal sinuses, oesophagus, stomach, and uterine cervix among others (WHO, 2002; Hoffmann, Hoffmann, & El-Bayoumy, 2001). In line with this, the harmful chemicals present in cigarette smoking include elements like 210Pb, 210Po, and Uranium (Khater et al., 2008). Although there is a significant difference in the type of tobacco used in cigarettes and hookahs, Khater et al. (2008) revealed that smoking moassel in hookahs can produce a wide-range of radioactive toxic elements which includes high concentration of 238U, 234Th, 226Ra, 210Pb, 210Po, 232Th, and 40K.
Exclusive hookah smokers receive high concentration of carbon monoxide up to 1.79 mg per 1000 ml of hookah puff as compared to 1.06 mg for each 45 ml cigarette puff (Monn et al., 2007). It means that cigarette smokers receive much higher concentration of carbon monoxide as compared to those individuals who smoke hookahs. Since hookah smoking uses water, some of the harmful chemicals react with the components of water through the process of chemical combustion and distillation under low temperature (Baker, 2006). As a result, substances like HCN or NO3 becomes less irritant on the part of the human body. This makes hookah smoking three times less concentrated as compared to smoking cigarettes (Monn et al., 2007).
Cigarette and hookah smoking contains carbon monoxide (Chaouachi, 2007). Since high concentration of carcinoembryonic antigen (CEA) is the major cause of transforming the cancer cells into malignant (Juang et al., 2000), it is possible to conclude that smoking cigarettes or hookahs can cause a person to develop cancer even though the CEA levels receive out of smoking hookah is lower as compared to cigarette smoking (Sajid et al., 2008).
In comparison between non-smokers and ex-smokers, the mRNA and protein expression of CEA is high in the normal lung tissue of tobacco smokers (Ohwada et al., 1995). Although the levels of CEA presence in hookah smoking is lower than smoking cigarettes, the fact that hookah smoking contributes to the increase in the CEA level in exclusive hookah smokers’ body does not exclude them from increasing the possibility that they would develop lung cancer in the long-run (Funk-Brentano et al., 2005).
References
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