The increasing awareness of adverse effects of tobacco has led some people to look for alternate ways to satisfy their nicotine craving. There has been a wide acceptance of Shisha, especially among the youth, due to a common belief that it is safer than cigarette. It is believed that the water, through which the smoke passes, filters the toxic components, rendering the smoke less harmful than cigarette smoke. On the other hand, many studies have shown that Shisha smoke contains much higher concentrations of those toxic materials that make cigarette smoke harmful. Some researches on waterpipe smoke have shown high concentrations of carbon monoxide, tar, nicotine and heavy metals as compared to cigarette smoke.
While smoking, a cigarette smoker takes 8 to 12 puffs over 5-6 minutes, inhaling a total of 500-600 ml of smoke. On the other hand, a waterpipe session typically lasts for 30-60 minutes. The smoker takes 50-200 puffs inhaling 500 ml of smoke in each puff. Thus about 50,000 ml of smoke is produced by a single session of Shisha smoking.
Shisha smoking involves burning flavored tobacco, known as molasses, using coal. When an individual breathes in from the mouthpiece, air is pulled through the apparatus into the tobacco and heated by the coal to produce smoke. As a result, the smoke contains components from both the tobacco and coal. These include polycyclic aromatic hydrocarbons (PAH), volatile aldehydes, CO, nitric oxide (NO), nicotine, furans and nanoparticles.
Both tobacco-containing and tobacco-free molasses contain high levels of PAH, a carcinogenic compound. These high levels are caused mostly due to the combustion of coal.
Smoking shisha is associated with three main detrimental health effects: cardiovascular damage, infection and cancer formation. Much of the morbidity and mortality associated with shisha smoking can be attributed to impairment of the cardiovascular system.
In conclusion, there is substantial confusion regarding the health effects of smoking shisha by healthcare professionals and consumers. Interestingly, recent studies have concluded that shisha smoking leads to significant exposure to PAHs, volatile aldehydes, CO, NO, nicotine, furans and nanoparticles. These agents have a wide range of effects ranging from cancer formation to respiratory disorders. Furthermore, smoking shisha also carries a cardiovascular risk, leading to a significant acute increase in blood pressure, heart rate and CO levels. Finally, a statistically significant association between smoking shisha and the development of lung cancer has been reported, mainly driven by exposure to carcinogens present in both the tobacco and coal.
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