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May 26, 2015

Why is Shisha (hookah) smoking on the rise?

The Canadian Charger

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While anti-smoking campaigns have helped reduce cigarette smoking amongst young people in Canada, Shisha (hookah) smoking is increasing in this same age group, according researchers with the Propel Centre for Population Health Impact at the University of Waterloo.

A recent study by the Propel Centre, which analyzed data from the national 2012-2013 Youth Smoking, found that nearly one in four high school students have smoked a hookah, also known as a water pipe.

The Youth Smoking Survey 2012/2013 was administered to 27,404 Canadian grades 9–12 students attending schools in nine Canadian provinces representing 96 per cent of the Canadian population.

The study also found that smokers have an 18 per cent higher probability of using a hookah than non-smokers, and students with more spending money have significantly higher odds of hookah use compared with those with no spending money.

Dr. Leia Minaker, a scientist at the Propel Centre for Population Health Research, who conducted the study, funded by the Canadian Cancer Society, said her research team found that hookah use amongst Canadian youth has been significantly increasing over time.

“We found that among grades 9-12 students in Canada ... Fourteen per cent of grades 9-12 students have tried hookah, and that number is almost one-quarter (23 per cent) among high school seniors. Boys have a higher chance of using hookah than girls,” Dr. Minaker said.

Meanwhile, few national tobacco surveillance systems address hookah use. Results of the Propel Centre study suggest that tobacco use surveillance systems should include alternate tobacco product use since excluding certain types of other tobacco products underestimates prevalence estimates of tobacco use.

The tobacco used that has been soaked in honey or molasses – is the product smoked in a hookah. Dr. Minaker said, recently the tobacco industry has been adding other manufactured flavours to the tobacco.

“The tobacco industry uses fun and fruity flavours to entice youth to try tobacco products. You can now get flavoured shisha in Canada called “Scooby Snack,” “Baby Doll” (which apparently tastes like Double Bubble gum), and Orange Soda. I think most Canadians recognize that those are all child-friendly flavours.”

She cited the increasing trend of adding manufactured flavours to Shisha and using these flavours to market the product as a major reason why hookah smoking is becoming more popular amongst young people. 

Moreover, a lot of people think hookah smoking is not as harmful as smoking cigarettes. The Propel Centre study found that among students in grades 9-12 in Canada, 38 per cent believe that hookah is less harmful than cigarettes.

But Dr. Minkaker said this is another misconception.

“When people smoke hookah, the smoke bubbles up through the water in the pipe. The smoke is cool and less harsh than cigarette smoke, especially if it’s flavoured. Many people mistakenly believe that the water filters the smoke, but all the toxic chemicals remain in the smoke that the user breathes in.”

She added that not only are the toxic and cancer-causing components in cigarette smoke are also in hookah smoke, but they may be in even in bigger amounts.

Due to the co-use of cigarettes and hookahs and the simultaneous increase in the use of hookahs and the decrease in the use of cigarettes, the Propel Centre's report suggests that governments should consider how to limit non-traditional tobacco use amongst young people.

There is a small but growing number of municipalities in Canada that have prohibited hookah smoking in restaurants, bars, cafes, patios and even outdoors on municipal property. A couple of Canadian provinces have prohibited hookah smoking in public places, but cigar and hookah bars may be exempt.

Dr. Minkaker also denounces the justification that hookah smoking is “part of our culture” so it should be accepted.

“Hookah is an ancient form of tobacco smoking, and it’s done in a traditional, Middle Eastern pipe. People who oppose hookah restrictions in public places might say, 'Hookah smoking is our traditional cultural activity', which is true. It is a cultural activity that is actually banned in several of the countries where it has strong, traditional roots. Several countries have banned indoor hookah smoking, including Lebanon, Turkey, and parts of Saudi Arabia and India. But more importantly, even if those countries hadn’t banned it, the cultural activity argument isn’t great – there are a lot of things that are allowed in other countries that are not allowed in Canada – take cigarette smoking in workplaces, for example!”

The Canadian Cancer Society reports lung cancer as the leading cause of cancer death in Canada. It is estimated that 85 per cent of lung cancer cases are related to using tobacco products.

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