Shisha: 200 times more harmful than cigarettes?

In Singapore, smoking the water pipe shisha has become a trendy pursuit for local youths hanging out in Middle Eastern-themed cafes on Haji Lane. It is usually shared between friends and is an enjoyable and relaxing experience. But here's the shocking truth — a single session of smoking shisha is the same as smoking 200 cigarettes, warn health experts.
Shisha is a glass-bottomed water pipe in which flavoured tobacco is covered with foil and roasted with charcoal. The tobacco smoke then passes through the water chamber and is inhaled deeply and slowly.
"Most shisha smokers are unaware of the health risks involved," observes associate professor Loo Chian Min, senior consultant and head of the Department of Respiratory & Critical Care Medicine, Singapore General Hospital (SGH). "Some youths don't even realise that there's tobacco involved and so they don't regard shisha as smoking."

Misconceptions about shisha smoking
Unlike cigarette smoking, which is always portrayed negatively in the media, the harmful effects of shisha smoking are not as well known. "Cigarette boxes sold in Singapore carry mandatory health warnings but you don't see similar warnings at shisha joints," Loo points out.
For a start, shisha is often smoked in a social gathering, in the intimate ambience of a comfortable cafe. It has none of the negativity associated with cigarette smoking.
Also, shisha boasts natural fruit flavours such as apple, lemon, orange and melon. So those who are not in the know tend to associate shisha with being fruity and healthy. Some may even see it as a safer alternative to cigarettes.

How harmful is it?
But shisha smoking is far from benign.
Shisha smoke is often laced with carcinogens or cancer causing substances. Regular smoking of shisha may lead to cancer of the lungs, mouth, stomach and oesophagus. This is on top of health conditions like impaired pulmonary function, heart disease and reduced fertility.

Related article: Are you having trouble conceiving?
According to recent research by the World Health Organisation (WHO), it is estimated that a smoker inhales half a litre of smoke per cigarette, while a shisha smoke can take in anything from just under a sixth of a litre to as much as a litre of smoke per inhalation.
Meanwhile, experts at the London-based Department of Health and the Tobacco Control Collaborating Centre have found that one session of smoking shisha resulted in carbon monoxide levels spiking to at least four times more than the amount produced by one cigarette.
Sharing a shisha pipe might also expose you to infections such as herpes and tuberculosis. "That's because the water pipe may be a breeding ground for bacteria," explains Loo.

Related article: 10 tips to quit smoking
However, while many health experts agree on the harmful effects of shisha smoking, there are those who say that its long-term effects have not been properly researched. Also, they claim that shisha smoke is actually 30 times less concentrated in certain chemicals than cigarette smoke.
"Despite these contradictory viewpoints, shisha smokers should keep in mind that it is not as harmless an activity as it seems," advises Loo.

The perils of second-hand smoke
Even if you're not smoking shisha, just sitting with your friends at the same table exposes you to dangerous second-hand smoke.
Breathing in this less-than-desirable smoke means that you face an increased risk of health conditions like:

• Rhinosinusitis, an inflammation of the nose or sinuses
• Asthma
• Coughing and sore throat
• Cancer
• Heart disease

So if you don't smoke shisha, it may be better if you didn't hang around a shisha lounge. And if you do smoke shisha, it may be time to quit.

This article was written by Jaclyn Lim for Health Xchange, with expert input from the Department of Respiratory & Critical Care Medicine, Singapore General Hospital.

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