It was surprising in Sacramento to go to a food and music festival held in the courtyard of a local church and see a hookah bar section set up right next to the picnic tables where food was being eaten. Yet hookah smoking and the ethnic community attending the church were a familiar scenario. The only people smoking the hookah were young males, but the smoke stench wafted around the people eating the food they bought from the stands, even in the outdoors environment on church grounds. The smell of smoke was overpowering to those sitting at tables within a few feet of the hookah smokers.
From the holistic health perspective, with water pipes or hookahs gaining popularity, scientists today described a step toward establishing their health risks. In a study that they said provides no support for the notion that hookahs are safer than cigarettes, they reported that hookah smoke and tobacco contain lower levels of four toxic metals. It was part of the 246th National Meeting and Exposition of the American Chemical Society (ACS), being held this week in September 2013.
Why aren't oxygen bars the preferred practice with college-age kids instead of water pipes? With water pipes or hookahs gaining popularity in the United States and other countries, scientists today described a step toward establishing the health risks of what has been termed "the first new tobacco trend of the 21st century."
In a study that they said provides no support for the popular notion that hookahs are safer than cigarettes, they reported that hookah tobacco and smoke contain lower levels of four toxic metals than cigarette tobacco and smoke. "Any form of smoking is dangerous, and our studies on toxic metals in hookah smoke are taking the first steps toward the necessary animal and human studies that will establish a clearer picture of the relative dangers of hookah and cigarette smoking," explains Joseph Caruso, Ph.D., who led the study, according to the September 8, 2013 news release, Toward understanding the health effects of waterpipe or 'hookah' smoking. "It is very difficult to compare hookah smoking with cigarette smoking because they are done so differently."
Dr. Caruso, who led the study, explained that water pipes use specially prepared tobacco, sometimes called shisha — a moist, gooey concoction that may include molasses, honey and flavoring agents
Burning embers or charcoal heat the shisha, producing smoke that bubbles down through a container of water and into a long hose-like tube with a mouthpiece for inhaling.
Caruso and colleagues, who are with the University of Cincinnati, think that the lower levels of arsenic, lead, cadmium and chromium they detected in hookah smoke are not due to filtering of the smoke through water. That's part of the basis for the popular belief — disputed by the U.S. Centers for Disease Control and Prevention, the American Lung Association and other authorities — that hookah smoking is safer than cigarettes. Rather, it seems that shisha itself may contain lower levels of those metals, since Caruso's team did not detect excess amounts of those metals in the hookah water. See, "Hookah smoking is new trend among teens | abc7.com."
Other differences in hookah vs. cigarette smoking complicate any interpretation of the health implications of the lower levels of toxic metals in hookah smoke, noted Caruso and graduate student Ryan Saadawi, who presented on the research at the meeting
Studies have shown, for instance, that a typical hour-long hookah smoking session involves 200 puffs, while an average cigarette is 20 puffs. The World Health Organization estimates that an hour-long hookah session is equivalent to smoking 5-10 packs of cigarettes. However, many people who smoke shisha smoke less frequently than cigarette smokers.
"All of these things make hookah smoking different from cigarette smoking, and it also makes it difficult to compare the two, which is partly the reason why there are so few studies on the topic," says Saadawi, according to the news release. Caruso and Saadawi studied unsmoked shisha, as well as shisha smoke, with a sensitive instrument called an inductively coupled plasma mass spectrometer. They also removed the additives from the shisha and found little difference before and after, thus the tobacco is the likely source of the metals, they said. Whether the smoke went through the water in the hookah also didn't affect the metal levels.
You can access live audio and video of the event and ask questions at the ustream site
Total analysis in hookah tobacco formulation and hookah tobacco smoke
Various studies have been performed on cigarette, cigar, and pipe tobacco while virtually no studies have been performed on hookah tobacco. It is well documented the former tobacco is known to contain toxic metals such as As, Cd, Cr, and Pb. However, little is known about the metal content in hookah tobacco. Hookah has been popular in the Middle East and surrounding regions for ages and its use is emerging rapidly in Western cultures making it imperative to study.
Microwave assisted digestion in combination with ICP-MS was utilized to elucidate the toxic metal content in an array of different brands/flavors of hookah tobacco formulations as well as hookah tobacco smoke. A water extraction was done on the hookah tobacco formulation to remove water soluble glycerin, molasses/honey, colorants and flavorings. Polycyclic aromatic hydrocarbons were extracted from hookah tobacco smoke using an organic solvent and analyzed by HPLC florescence detection.
Also see another site, "What Kids Who Don't Eat Vegetables Look Like When They Grow Up." (Nick Mom). Kids eat what the see their family eating first and then their friends. And if they see their friends smoking hookah pipes, they're more likely to join in the process. Should churches (including the various ethnic churches where hooking smoking is familiar in the culture) holding festivals also have a hookah bar on the premises, such as in the church courtyard or on the church grounds to raise funds if the smokers are mainly college-age youth?
The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 163,000 members, ACS is the world's largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.
More youth from families where the tradition is to go into a room or garage and smoke water pipes are continuing the habit, even investing in opening more hookah bars
There have been numerous other studies on health and hookah smoking. You may wish to check out the news release based on recent studies, or the news release, More smoke water pipes -- family habits significant. College students are rapidly picking up the habit. But smoking in any form is bad for lung functions.
A new study published in the journal Respirology reveals that water pipe smoking, such as hookah or bong smoking, affects lung function and respiratory symptoms as much as cigarette smoking. Most users of water pipes and many physicians believe that smoking through a water pipe filters out the toxic components of tobacco and is considerably less harmful than smoking cigarettes.
Led by Mohammad Hossein Boskabady, MD, PhD, of Mashhad University of Medical Sciences, researchers set out to compare lung function and respiratory symptoms among water pipe smokers, deep or normal inhalation cigarette smokers, and non-smokers. Three groups of smokers, including 57 water pipe smokers, 30 deep inhalation cigarette smokers (S-DI), and 51 normal inhalation cigarette smokers (S-NI) were identified and studied. In addition, 44 non-smokers were studied as a control group.
Respiratory symptoms increase from smoking
A questionnaire was administered to assess the prevalence and severity of respiratory symptoms and lung function tests performed on smokers and control subjects using a spirometer. Results showed an increased prevalence and severity of respiratory symptoms among water pipe smokers and cigarette smokers. Similar effects of water pipe smoking and deep inhalation cigarette smoking on respiratory status were found.
Wheezing was present in 23% of water pipe smokers, 30% in S-DI, and 21.6% in S-NI. Chest tightness was present in 36.8% of water pipe smokers, 40% in S-DI, and 29.4% in S-NI. Cough was present in 21% of water pipe smokers, 36.7% of S-DI, and 19.6% of S-NI.
Wheezing and tobacco use coughs
Wheezing, chest tightness, and cough only occurred in non-smokers 9.1%, 13.3% and 6.8% respectively. "Our study is the first report regarding the importance of the method of cigarette smoke inhalation with respect to effects on the respiratory system," Boskabady concludes, in the news release, Water pipe smoking has the same respiratory effects as smoking cigarettes.
"Our findings reveal that there were profound effects of water pipe smoking on lung function values, which were similar to the effects observed in deep inhalation cigarette smokers." Water pipe smoking is similar to smoking cigarettes in the effects seen on the lungs.
The number of people smoking water pipes is rising dramatically throughout the world
A large proportion of new users are young, and many believe – contrary to facts – that water pipe smoking is less dangerous than cigarettes. Research into why people start smoking water pipes is under way at Uppsala University. Use of water pipes (also called "hookah" and "narghile") is on the rise, according to a number of studies conducted in Europe and North America. Anti-smoking campaigns typically focus on cigarettes and even, to some extent, snuff but rarely provide information about the negative effects associated with hookah use.
"Many adolescents and adults believe that hookah use is less dangerous than cigarette smoking," says Bengt Arnetz, Professor of Social Medicine at Uppsala University and Professor of Occupational and Environmental Medicine at the Wayne State University School of Medicine, according to the news release, More smoke water pipes -- family habits significant. "Some fail to understand that hookah use involves tobacco. In fact, smoking a hookah entails much greater exposure to carbon monoxide and other dangerous and carcinogenic substances in tobacco smoke than does smoking cigarettes."
Arnetz, in collaboration with various colleagues, has conducted a series of studies focusing on hookah smoking. One study, published in the journal Nicotine & Tobacco Research, involved investigating factors associated with increased likelihood of hookah use. Such studies have been conducted for many years in connection with cigarette smoking but are comparatively rare when it comes to hookah smoking.
Young people follow in their father's, mother's and sibling's smoking habit footsteps
One study conducted in Michigan determined that 26 per cent of the 800 participating subjects engaged in hookah use. Researchers found that the likelihood that a person engaged in hookah use was more than eight times higher if the father in the household smoked a hookah, seven times higher if the mother did so and 20 per cent higher if a sibling did so. More generally, men and young people constituted risk groups in connection with hookah use. The risk factors applied equally to people currently engaged in hookah use and those who had previously been so engaged but had stopped.
Arnetz and his colleagues are now planning comparative studies of hookah smoking in Sweden and the United States. They are also interested in investigating the spread of hookah use among adolescents and the effects of socio-economic and stress factors on smoking behavior. The knowledge in question is important from the standpoint of designing future preventative strategies.
The CDC reports a heavy increase in smoking among mental patients
Smoking is increasing among mental patients, persons with various addictions to drugs, alcohol, food, or strange objects eaten such as dirt or drywall chips, or anything not regular food, and people from countries where tobacco use is a popular past time for men and some women, for example, Middle Eastern and Southeast Asian immigrants and their American-born children.
The latest Centers for Disease Control and Prevention (CDC's) research published in the government's publication, "Vital Signs" shows cigarette smoking is a serious problem among adults with mental illness. More needs to be done to help adults with mental illness quit smoking and make mental health facilities tobacco-free, according to the CDC article, "Smoking Among Adults With Mental Illness."
The name used by the CDC in the article was 'Janice.' The character Janice is not drawn from any one person, but is a blend of the experiences of many smokers with mental illness. And Janice has suffered from mental illness for most of her life. She had depressive disorders starting in adolescence, and was admitted to a mental health facility for a time when her symptoms became severe.
While there, she began smoking because many other patients were doing it, and she wanted to fit in. She noticed that the staff didn’t seem to mind patients smoking, and sometimes even used cigarettes to reward good behavior. By taking medication for depression and carefully following her treatment plan, Janice has been able to live a more productive life. She graduated from college and now is able to maintain a job. But she hasn’t been able to give up smoking, despite repeated attempts.
More people with mental illness smoke than people without that disorder
Despite overall declines in cigarette smoking in the United States, more people with mental illness smoke than people without mental illness. And just like many others who smoke, many people with mental illness will get sick, become disabled, or die early from smoking-related diseases.
The latest Vital Signs from CDC notes that many adults with mental illness who smoke want to quit, can quit, and will benefit from proven stop-smoking treatments. It’s true that some people with mental illness face issues that can make it more challenging to quit, such as low income, stressful living conditions, and lack of access to health insurance and health care. All of these factors make it more challenging to quit. But that doesn’t mean that smokers with mental illness can’t benefit from the same proven treatments as anyone else. Read the full MMWR Vital Signs issue to find out more.
Smoking Prevalence is Much Higher Among People with a Mental Illness
Nationally, nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness, and 36% of these people smoke cigarettes. In comparison, 21% of adults without mental illness smoke cigarettes. (Mental illness is defined here as diagnosable mental, behavioral, or emotional conditions and does not include developmental and substance use disorders.)
You can read more about smoking prevalence among people with mental illness in the Vital Signs Report. There are other troubling statistics from the report:
- 31% of all cigarettes are smoked by adults with mental illness.
- 40% of men and 34% of women with mental illness smoke.
- 48% of people with mental illness who live below the poverty level smoke, compared with 33% of those with mental illness who live above the poverty level.
What Contributes to Higher Smoking Prevalence in this Population?
While many mental health providers and facilities have made progress in reducing smoking in their facilities and among their patients, others are just now beginning to address tobacco use. Because they are more focused on treating the mental illness of their patients, some providers and facilities may not consider smoking to be a problem, or ignore it.
Smoking can cause unique issues for people with mental illness. Nicotine has mood-altering effects that put people with mental illness at higher risk for cigarette use and nicotine addiction.
However, recent research has shown that adult smokers with mental illness—like other smokers—want to quit, can quit, and benefit from proven stop-smoking treatments. These treatments need to be made available to people with mental illness and tailored as needed to address the unique issues this population faces.
What Can Be Done to Reduce Smoking Among People with Mental Illness?
Mental Health Professionals:
- Find out if patients smoke. Sometimes patients aren’t asked whether they smoke when beginning mental health treatment.
- If they do smoke, offer to help patients quit by providing proven quitting treatments, including referring them to the government's Smoke Free website, or other resources. There's a toll-free phone number listed on the CDC Smoke Free website. It means you can become free of smoking, quit smoking, not that you can get free 'smokes.' The answer most people want to find out is how to quit smoking.
- Make quitting tobacco part of an approach to mental health treatment and overall wellness. Mental health professionals should be especially aware of the behavior changes that may occur when withdrawing from nicotine, and should make sure that their patients are aware of them. Medicines used to treat mental illness may need to be monitored and adjusted for people with mental illness who are trying to quit tobacco use.
Mental Health Facilities:
- Include tobacco cessation treatments as part of an overall mental health treatment strategy.
- Make mental health facilities and campuses completely tobacco-free (no use of any tobacco product by anyone anywhere inside or outside at any time).
- Call attention to and stop practices that encourage tobacco use (e.g., providing cigarettes to patients, allowing smoking as a reward, selling tobacco products on site, and allowing staff to smoke with patients).
Success Stories: Rochester, New York and Austin, Texas
Daryl Sharp, Associate Dean for Faculty Development and Diversity in the School of Nursing at the University of Rochester, developed a nurse-managed program in Rochester, New York, that provided intensive tobacco dependence interventions for clients through a university-based mental health outpatient facility. The program, which ran from 2006 to 2009, included a variety of interventions, and program nurses worked with the treatment staff to support the integration of tobacco dependence treatment into clients’ recovery plans.
The program doubled the proportion of people who were tobacco-free for at least 7 days, from 8.1% to 16.5% at 1 year, and reduced the average number of cigarettes smoked by participants from 21.6 to 13.5 per day. The program was even more successful among those who were moderately to highly nicotine dependent.
Clients, clinic staff, and administrators all reported very positive impressions of the program, including an increased likelihood that when there was an intensive intervention readily available on site, that treatment staff would talk with their clients about stopping smoking. The Smoking Cessation Leadership Center Web site—associated with the University of California, San Francisco—has additional information, including resources focusing on tobacco dependence treatment for people with mental illnesses and substance use disorders.
In another success story, officials with the Austin-Travis County (TX) Integral Care (ATCIC) program sought to change the culture by implementing a Tobacco Cessation Initiative (TCI), making all of the agency’s mental health facilities tobacco-free. They also treated patients and staff who were addicted to nicotine, and implemented nicotine prevention measures.
The Tobacco Free Workplace policy implemented in February 2011 prohibited consumption of all tobacco products on ATCIC property and resulted in a significant drop in smoking rates among staff and patients. According to Dale Mantey, Tobacco Cessation Coordinator for ATCIC, TCI's curriculum has been widely replicated statewide and has contributed significantly to Texas’s progress toward achieving its goal of making all state mental health facilities tobacco free.
Support to Quit
For free quit support, call the phone number listed on the CDC's Smoke Free line. Also check out the site, "How to Quit Resources." This number routes callers to their state quit lines, which provide free support and advice from experienced counselors, a personalized quit plan, self-help materials, the latest information about quitting medications, and more. Specific services vary from state to state. Also see the CDC's Smoking & Tobacco Use Web site.
Quitting services and resources are also available online in English and in Spanish. These Web sites provide free, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit tobacco use.