Hookah and Human Health: Health and Social Risks of Hookah in Saudi Arabia

Department of Health Sciences

Health Professions Education

Prospectus

Table of Contents

Section Page

1. Introduction3

Description of the Local Problem3

Rationale of the Local Problem and Purpose of the Study5

2. Review of Literature6

Hookah Usage6

Health Risk8

Research Question(s)11

3. Description of Proposed Research Methods and Procedures11

Methods11

Procedures11

References12

Hookah and Human Health: Health and Social Risks of Hookah in Saudi Arabia

Section 1

Introduction

Description of the Local Problem

One should note that there are different means for smoking tobacco throughout the world. One of them is the use of hookahs. A hookah is defined as a water pipe designed for smoking the flavored tobacco. It is also known as shisha, argilah, goza, or hubble-bubble. The hookah requires the use of the flavored tobacco in order to give it a different taste from that of a cigarette (Chaouachi, 2009).

Cobb et al. (2010) argue that the use of hookah has substantially increased over the last two decades in the world. The tendency is particularly evident among the youth aged from 18 to 25 years. The high level of the hookah smoking has also led to the establishment of bars where smoking is the most popular activity. The research shows that a large number of hookah smokers think that smoking tobacco through hookah poses less risk than smoking it through other means including cigarettes.

According to Ahmed et al. (2011), medical experts have found that a single shisha session might be as dangerous as smoking 200 cigarettes at once. It is explained by the fact that cigarettes contain more than 4000 chemicals and toxins. Furthermore, smoking increases the health risks around the world (Almohrej, Altraif, Tamim, & Fakhoury, 2014). In the United States, about 2,242 online shops sell hookah tobacco and related products. Moreover, approximately 175 hookah lounges and cafes can be found only in California. It is important to underline that in Los Angeles, most of the cafes are located near universities and college campuses (Hanna, O’Connell, & Woo, 2014). However, the popularity of hookah smoking is larger in Middle Eastern countries than in the United States (Griffiths, Harmon, & Gilly, 2011).

Rationale of the Local Problem and the Purpose of Study

Rationale of the Local Problem. The rationale for the study is the observation that nations of the Middle East experience a high level of hookah use. Its effect in Saudi Arabia is worse than in the USA because of the easy access to hookah in every region. The health risks associated with hookah smoking also influenced the choice of the local problem. Saudi Arabia has a high rate of the health and social risks associated with smoking hookah. It have forced the government to introduce effective prevention measures and prohibit the use of hookah in the country (Baboor, Alnazzawi, Abu-Hammad, & Dar-Odeh, 2014). Cigarettes pose a significant health threat to smokers and non-smokers. However, hookahs are more perilous than cigarettes (Chaouachi & Sajid, 2010). In Saudi Arabia, smoking in public places has been prohibited since 2004. However, the country occupies the fourth position in importing tobacco worldwide. Moreover, the tobacco consuming (including hookah smoking) has led to the economic loss. The loss accounts for approximately 20.5 billion dollars for the last ten years (Almohrej, Altraif, Tamim, & Fakhoury, 2014).

There are different health and social risks related to the hookah smoking. The former ones, which are associated with hookah smoking in the short term, include raising the blood pressure and heart rates of smokers. It puts smokers at a high risk of developing such conditions as cardiac arrests and strokes (Ben, 2009). Also, hookah smoking results in damaging the major arteries of the body that results in the limited supply of blood to the brain (Mirjana, Steven, & Zang, 2010). In addition, the water pipe usage contains the same toxicants as cigarettes, including drug nicotine, cancer causing, pulmonary disease, as well as acute intoxication caused by the carbon monoxide (Eissenberg, 2013). Furthermore, hookah smoking is directly connected with the adverse pregnancy outcomes, especially a low birth weight (Hanna, O’Connell, & Woo, 2014).

The Purpose of the Study. The purpose of the study is to develop an education Reference Judie for the Saudi Arabian hookah smoker. The Reference Judie will help to understand the risks of hookah smoking. It will help to substantiate the claims regarding the rate of risks associated with hookah smoking in the country. Since the previous researches have already identified some risks caused by the hookah use, the study aims at determining the level of these risks. The ways of becoming addicted to hookah will also be the central focus while the developing the education Reference Judie.

Section 2

Review of Literature

Hookah and Human Health: Health and Social Risks of Hookah in Saudi Arabia

Section 2

Review of Literature

Hookah Usage

Definition of Hookah. The notion of hookah should be comprehended as a waterpipe used to pass charcoal heated air through tobacco and through a water-filled chamber (Chaouachi, 2009). The synonym of hookah, shisha, specifically constitutes for the particular sort of tobacco that is used in hookah. Its peculiar characteristic features are moistness and stickiness as a result of being soaked in the extract of molasses or honey. There are also other names of this type of tobacco, for instance, narghile, goza, arghileh, or hubble bubble (Chaouachi, 2009). Shisha is also characterized by variety of flavors, which are usually fruit ones, whereas exotic scents include caramel, cinnamon, mint, and other extraordinary options (Eissenberg, 2013).

History. Hookah is an ancient tradition that has been deeply rooted in the culture of many countries, especially in the Eastern part of the world (Chaouachi, 2009). Smoking hookah has been traditional related to Middle Eastern, Asian, African, Indian, and Turkish cultures for more than 500-year-old (Griffiths, Harmon, & Gilly, 2011 ).

India and Middle East. According to Ray (2009, p. 1319). “Hookah smoking has been practiced for over 400 years.” The court of Emperor Akbar started using and popularizing the habit of hookah smoking (Ray, 2009).

The first hookahs are regarded as primitive and simple in comparison with the modern ones. The basis for the first hookahs was a coconut shell and a tube with a so-called ‘head’ attached (“Hookah Smoking: A Growing Threat to Public Health”, n.d.). Moreover, it is very important to highlight that the initial tobacco for smoking via hookahs was not a contemporary mixture of shisha and fruit, but some time for hashish and opium in India (Ray, 2009).

The art of making hookah became more popular, and it is relevant to emphasize the fact that masters of hookah were treated with significant respect at that time as far as the procedure was very complicated and required special skills and knowledge. The hookah rooms were situated in the coffee houses and cafes (Ray, 2009).

It is essential that there was no difference in terms of sex, and both male and female representatives smoked hookah in India (Ray, 2009). Hookah started in India, then, smoking hookah extended to Persia and the Parisians were called it Narghile. Then it spared to Turkey, and Ottoman Empire at the early of 17th century. Later, hookah practice extended to North Africa and the middle of the Middle East (including Saudi Arabia) and it was called shisha (the glass bottle) (Ray, 2009).

Europe. The hookah has been practicing in Europe since the British came to India at 1950s, and some of them smoked the hookah for a fashion way until the other form of fashion smoking came and replaced it (Ray, 2009). At the 1990s, hookah smoking spread from West Asia, northern Africa, and South East Asia to parts of Europe, and Russia. The spread of hookah was there because of the immigrants from West Asian origin and their restaurants that offer the hookah (Ray, 2009).

The United States of America. The phenomenon of hookah became popular in the 1990s to be fashionable as cigars smoking were (Sterling & Mermelstein, 2011). Though, the level of significant popularity slightly lowered with the course of time, and the issues of harm hookah may cause to a smoker’s health started being taken into consideration. Actually, contemporary investigations into the issue from different angles identified obvious harm that regular smoking of shisha causes to human health, namely, cardiac arrests and strokes, damage cause to the major arteries of the human body, contribution to the development of cancer, pulmonary disease ((Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012).

Health Risk

Cardiac Arrests and Strokes. Any kind of tobacco (especially when it is used regularly and in a big amount) subsequently causes heart diseases. The phenomenon of hookah also belongs to this list as far as it also reduces blood flow to the heart and at the same time often appears to be a reason for high blood pressure (Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012). Moreover, it impacts blood vessels, and it is also considered to be a way to the stroke (Selim, Fouad and Ezzat, 2013). According to Aslam, Saleem, German and Qureshi (2014, p.1), “Many studies report that a mean increase in systolic and diastolic blood pressure and heart rate of shisha smokers is observed after shisha smoking.”

Cancer. Cancer may be also considered to be one of the horrible consequences of tobacco use in general and regular hookah smoking in particular (Eissenberg, 2013). According to the article “An Emerging Deadly Trend: Waterpipe Tobacco Use” (2007), “Waterpipe tobacco smokers are exposed to cancer-causing chemicals and hazardous gases such as carbon monoxide. Waterpipe users are also exposed to nicotine, the substance in tobacco that causes addictive behavior” (p. 1). The aspect of addictive quality is a crucial one as many young people consider hookah to be less harmful than traditional cigarettes (Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012). The same tendencies are supported by the work “Hookah Smoking: A Growing Threat to Public Health” (n.d.) provided by the American Lung Association.

According to contemporary investigations, one course of hookah is equaled to 200 cigarettes that have been smoked at a time. Hence, smokers tend to smoke hookah regularly, and such experience increases the probability of cancer development in the future. It is an alarming tendency as 54,4% of student respondents to the survey conducted by Rahman et al. (2012) have the experience of smoking hookah, and the addictive potential of the smoking habit is also very high and needs proper and timely intervention (Morris, Fiala, & Pawlak, 2012).

Pulmonary Disease. The session of smoking hookah is dangerous for lungs as far as the smoker of hookah inhales larger amount of nicotine in comparison with those who smoke cigarettes, which can cause pulmonary disease (Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012).. The tobacco that is used for hookah smoking is usually heated by means of charcoal or wood cinders. This aspect is also very dangerous as potentially harmful chemical elements such as metals and carbon monoxide are released in this process (Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012). The same data is supported by Ondov and Seltzer (2010).

Negative Pregnancy Outcomes. Hookah smoking is strongly prohibited for pregnant women. Moreover, it is not recommended in the period when a woman is taking birth control pills because it may result in strokes and development of heart disease and complications (or even anomalies) in the embryo (Rahman, Chang, Hadgu, Salinas-Miranda, & Corvin, 2012). The child may have difficulties with the breathing process after the birth, which may cause development of serious respiratory diseases as well as low birth weight (Chaouachi, 2009).

Damaging of the Major Arteries of the Body. The process of damaging the major arteries and its intensity as well as threat to health depends on the amount of the tobacco that has been smoked and regularity of the habit (Selim, Fouad, & Ezzat, 2013). The major arteries become gradually clogged as a result of permanent hookah smoking habit (Selim, Fouad, & Ezzat, 2013).

Social risk

Image.

Laws.

Peer pressure.

Smoker Knowledge, behavior

Education

Health.

Social.

Reference Judie.

Section 3

Description of Proposed Methods and Procedures

The Research Question(s)

Research Methodology

The method used for this paper was developmental.

Procedures

Assumptions.

Limitations.

Rationale.

Inclusion criteria.

Exclusion criteria.

Search procedures.

Libraries used. There was one library used. The ( The name of the university library) was used for this project.

Search engines and databases used. There were two databases used. The databases were PubMed and EMBASE.

Search terms.

Boolean strings.

References

Ahmed, B., Jacob P., Allen, F., & Benowitz, N. (2011). Attitudes and practices of hookah smokers in the San Francisco Bay Area. Journal of Psychoactive Drugs, 43(2), 146-152.

Almohrej, O., Altraif, S., Tamim, H., & Fakhoury, H. (2014). Will any future increase in cigarette price reduce smoking in Saudi Arabia? Annals of Thoracic Medicine, 9(3), 154-157.

Baboor, A., Alnazzawi, A., Abu-Hammad, O., & Dar-Odeh, N. (2014). Unconventional materials and substances used in water pipe (narghile) by smokers in central western region of Saudi Arabia. Saudi Medical Journal, 35 (8), 890-893.

Ben, S. H. (2009). The narghile and its effects on health. Part I: The narghile, general description and properties. Revue de Pneumologie Clinique 65(6), 369-75.

Chaouachi, K. (2009). Hookah (shisha, narghile) smoking and environmental tobacco smoke (ETS). A critical review of the relevant literature and the public health consequences. International Journal of Environmental Research and Public Health, 6(2), 798-843.

Chaouachi, K., & Sajid, K. M. (2010). Cancer risks of hookah (shisha, narghile) tobacco use require further independent sound studies. International Journal of Cancer, 127(7), 1737-1739.

Cobb, C., Ward, K. D., Maziak, W., Shihadeh, A. L., & Eissenberg, T. (2010). Waterpipe tobacco smoking: An emerging health crisis in the United States. American Journal of Health Behavior, 34(3), 275-285.

Eissenberg, T. (2013). Tobacco smoking using a waterpipe (hookah): What you need to

know. AANA Journal, 81(4), 308-313.

Griffiths, M., Harmon, T., & Gilly, M. (2011). Hubble bubble trouble: The need for education about and regulation of hookah smoking. Journal of Public Policy & Marketing, 30(1), 119-132.

Hanna, M., O’Connell, A., & Woo, M. (2014). Hookah smoking among young adults in southern california. Nursing Research, 63(4), 300-306.

Kamal, C., & Mohammad S. K. (2010). A critique of recent hypotheses on oral (and lung) cancer induced by water pipe (hookah, shisha, narghile) tobacco smoking. Medical Hypotheses, 74(5): 843-846.

Mirjana, V., Steven, D., & Zang, E. (2010). Doses of nicotine and lung carcinogens delivered to cigarette smokers. Journal of the National Cancer Institute (Journal of the National Cancer Institute, 92, 106-111.

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Selim, B. G., Fouad, H., & Ezzat, S. (2013). Impact of shisha smoking on the extent of coronary artery disease in patients referred for coronary angiography. Retrieved from http://www.anakarder.com/sayilar/95/buyuk/647-654.pdf

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