Shisha … lethal ‘Killer’ wrapped in flavours

• It Contains 36 Times More Tar, 15 Times More Carbon Monoxide, 70 Percent More Nicotine — Sowemimo
• Risk Of Spreading Of Oral Infections Very High— Ikpe
Penultimate Tuesday, the former mayor of New York, Michael Bloomberg, declared his foundation’s desire to spend $160m to battle youth vaping, while American President, Donald Trump equally made public plans to ban flavoured cigarettes in order to “innocent children.”

Trump’s announcement was sequel to the death of six persons., who had used vape pens and e-cigarettes in a country where, according to Deborah Arnott, chief executive of Action on Smoking and Health, almost 2, 500 children under 18 years of age try their first cigarette every day, and where more than 400 end up becoming daily smokers.

Last Tuesday, the death toll in the United States rose to seven, and at least a further 450 people are being treated for vaping-induced lung diseases, many of which are presenting with chest pain, shortness of breath, coughing, fevers vomiting and fatigue.

In announcing the death of the seventh victim of vaping, a 40-year-old man from California, who battled a “severe” lung disease for several weeks, Dr. Karen Haught, the Tulare County public health officer, said: “With sadness, we report that there has been a death of a Tulare County resident suspected to be related to severe pulmonary injury associated with vaping.”

Since the first vaping-linked death was announced last month in Illinois, after a patient suffered a “severe respiratory illness” after vaping, the spike in the number of deaths has steadily risen, with states banning the life-threatening pastime one after the other.

Vape pens and e-cigarettes may be rare in Nigeria, but their equally dangerous cousin, shisha is burrowing its way deeper in to the country and by that token, emerging a prevalent public health challenge in some major cities in the country.

Unfortunately, as with many other lesser evils that steal into the country and grow strong enough to seize it by the jugular, health authorities appear to be attacking it with kid gloves.

In fact, more than one year ago, specifically in June 2018, the Federal Government called on the police and all other government agencies to enforce the ban on flavoured tobacco products including shisha.

The Minister of Health, Prof. Isaac Adewole, while addressing a press conference in Abuja to mark the 2018 world No Tobacco Day said: “Let me stress that the ban on tobacco products with characterising flavours is still in place and the ban includes shisha because it has flavour. I, therefore, urge the Consumer Protection Council (CPC) and the law enforcement agencies to intensify arrest of defaulters.”

The Director-General of the CPC, Mr. Babatunde Irukera, who was also at the briefing said a committee had been set up to look into the issue of Shisha and other matters and further recommendations would be made soon.He said, “Recently, the Standards Organisation of Nigeria, which is responsible for creating the national industrial standard, convened a technical committee meeting with respect to the tobacco standard and the subject of shisha was discussed like any other tobacco products.

“And the new industry standards are undergoing the process now so it is not an illegal product now, but soon the SON will come up with what the final standard will be,” he added. Shisha smoking is basically the use of pipes to smoke tobacco and other substances by ancient Africans and Asians. Over the past four centuries, this habit has migrated to different parts of the world, taking up different names in the process. For instance, it is called “narghile” in East Mediterranean countries, including Turkey and Syria; “shisha” and “goza” in Egypt, and some North African countries. In India, it is called “hookah.”

Even though North Africa, Eastern Mediterranean and South East Asian regions play host to traditional water pipe smokers, discotheques, nightclubs and sundry places where youths and adolescents gather, have become veritable catchment areas for new shisha smoking converts.

However, since the Federal Government called on the police and other government agencies to enforce the ban on Shisha and other flavoured tobacco, not much has been achieved in the area of enforcing the ban, or curtailing its use in public places. Right now, shisha smoking is not only appealing to many more people, it is also becoming popular in major cities.

Findings reveals that factors responsible for the rising use of the toxic pastime include, smoking to experience its stimulating effect or for experimentation, smoking for pleasure, or the perceived safety of shisha when compared with cigarette smoking.

Internationally, the annual mortality from tobacco use is estimated to be about five million, and it accounts for one in every five male deaths and one in 20 female deaths of those over the age of 30. But with the this emerging trend, it is projected that by 2030, the annual tobacco deaths will rise to 10 million if the current smoking patterns is sustained, especially in most low-income countries. It is in the light of this that there is a very strong need for an immediate response from policy providers towards curtailing the spread of this killer diet.

The President/Medical Director of Barn Medical Doctors Mission, a non-governmental organisation (NGO) Dr. Barnabas Herbert is particularly dusturbed over the gross misconception by most people that the use of shisha is less harmful to the body.He insists that nothing could be farther from the truth: “I have encountered very popular arguments that shisha smoking is not as harmful, if at all, when compared to other smoke types. However, the fact remains that shisha exposes any user to the potential harmful effects of tobacco smoke, as they contain basically the same components, such as carbon monoxide, and therefore, has similar health risks known to be associated with cigarette smoking.

“The water in shisha does not filter out these components as many pro users have suggested. Now, regardless of the claims surrounding its use, the tobacco smoke in shisha still delivers nicotine, a highly addictive substance. Considering the length of exposure users usually experience during each smoking cycle, it is certainly not out of place to say that, people who use shisha are exposed to the toxins in the smoke longer than if they smoked cigarettes,” the medical practitioner said.

Herbert added: “Therefore, while some individuals believe that smoking shisha is safe, and presents a better alternative to social (tobacco) smoking, it is expedient at this point to make it clear that believers of the myth are prisoners of wrong ideas as shisha does not have any health benefit and poses significant health risks to not just the primary users, but also victims of second hand smoke. Finally, in order to reduce the risks of destroying the organs of respiration (lungs) and other vital organs of the body, it is best if people avoid smoking tobacco products generally, and that includes shisha.”

Kikelomo Sowemimo, a pharmacist with Anchor University, Lagos State, who describes shisha or hookah is an instrument for vapourising flavored tobacco, cannabis or opium, whose vapour or smoke is passed through a water basin before inhalation, explained that “shisha contains 36 times more tar, 15 times more carbon monoxide, 70 percent more nicotine and other harmful chemicals than cigarettes.

She added that shisha, according a to research published in the journal of the Royal College of Physicians is identified as a “potential public health threat.” “Shisha smoke contains high levels of polycyclic aromatic hydrocarbons (known to be carcinogenic), volatile aldehydes (which have been found to cause various respiratory disorders and leukemia). Elevated blood levels of carbon monoxide have been found in shisha smokers. The carbon monoxide binds to haem in the blood, thereby reducing supply of oxygen to the body. This may cause loss of consciousness, headaches, shortness of breath etc.

Sowemimo continued: “Shisha smoking increases risks of hepatitis, herpes and tuberculosis from sharing of shisha mouth piece. There is also the risk of lung, bladder and oral cancers. Shisha smoking has also been found to cause weight gain, which is a risk factor for many diseases, such as type two diabetes mellitus. Shisha smoking can be addictive. It is worthy to note that water is not a filter for the toxic chemicals found in shisha. In fact, the presence of water will encourage the growth of microorganisms as microorganisms grow better in moist environment.

“Cleanliness of shisha pipes is usually called to question as the inside of the pipes are usually difficult to clean. There is no safety even in tobacco-free shisha. Sometimes, the so-called tobacco free shisha contain even more toxins than the tobacco containing shisha. Shisha may smell fruity, making it look like the proverbial gold-less glitter,” she concluded.

Also of great concern to the Chief Executive Officer (CEO) of MRI Medic Consulting Ltd, Dr. Ronald Kelechi Ikpe, is the capacity of the pipes to spread oral infections effectively.

“People who smoke shisha typically share the same mouthpieces and this predisposes them to the risk of spreading oral infections like oral herpes.  Shisha smokers are exposed to a lot of harmful chemicals that can even lead to cancer, heart diseases, lung disease, amongst others. This is largely due to the fact that shisha is primarily tobacco.”

While also corroborating Sowemimo that shisha increases the carbon monoxide levels to more than eight times the normal and this keeps them at same risk as smokers of cigarettes, he added that increased carbon monoxide levels can lead to carbon monoxide poisoning.

He listed long-term health effects of shisha to include chronic bronchitis, heart disease, coronary artery disease, and periodontal disease. There is also the danger of addiction, in this case, nicotine addiction because shisha delivers nicotine at even higher levels than a regular cigarette.

For those willing to keep of smoking, Ikpe said: “There is what we call nicotine replacement therapy, where the individual is given prescription nicotine and it is gradually tapered down. There are nicotine patches and gums, which one can use and gradually reduce the dose. In addition to this, there are also prescription non-nicotine stop-smoking medications. Generally, smoking is not to be encouraged as it predisposes one to diseases like lung cancer, oral cancers, gastric cancers, esophageal cancers, especially smoking of tobacco.”

For those contemplating taking up the habit, a medical officer at the Fich Medical Centre, Benin City, Edo State, Dr. Udomoh Esemokha warned that, “shisha or hookah is not a replacement for cigarette; it has no health benefits and is not better than cigarettes. In fact, it is worse, and the fruity flavor in hookah is not Vit C, but something that can cause impotence. Shisha can cause heart attacks, lung infections, miscarriages, strokes and can also weaken the smoker’s immune system.

“In addition to all these, it can cause the smoker’s skin to age rapidly, in addition to having heavy metals, such as arsenic and lead in their systems. It is also difficult to say exactly how much smoke or toxic substances that smokers are exposed to in a typical shisha session because people smoke it for much longer periods of time than they smoke a cigarette, and in one puff of shisha, smokers inhale the same amount of smoke as they would get from smoking a whole pack of cigarette,” Esemokha said.He added: “The average shisha-smoking session lasts an hour and research has shown that in this time you can inhale the same amount of smoke as from more than 100 cigarettes.”