In a smoke-filled room in Lahore, Pakistan, a small group of teenagers pass a `shisha’ (water pipe) round a table. Strawberry essence has been added to the tobacco, making a fruity aroma. “We come to this café at least once a week to share a `shisha’,” said Zeeshan Ahmed, aged 16.
“Our parents don’t mind us smoking `shisha’ and it is not dangerous,” said Fyza Imad, also 16.
Shisha smoking has become fashionable over the last decade in Pakistan. The misconception that it is harmless, a belief shown to be widely held among `shisha’ users, means that young people and their parents are largely unaware of the health risks.
“I play sports and would never smoke a cigarette because it harms the body and you get cancer, but `shisha’ is quite safe,” Hasan Sheeraz, 20, told IRIN at another restaurant where he and a friend were both puffing away.
Among those affected by the current craze are an increasing number of young women, especially in urban areas.
The growth in `shisha’ smoking has been rapid. A 2008 survey of 450 students in Karachi found that 64.2 percent of males and 37.9 percent of females had smoked a `shisha’ at least once in their lifetime; 77.3 percent of males and 33.3 percent of females smoked a `shisha’ regularly.
“When something becomes fashionable… it is very hard to change the trend. Peer pressure and the need of the young to do something new all play a part in this,” said Salim Khan, 50, the father of two teenage sons. He said he had explained the risks of `shisha’ smoking, but “very few parents are aware of these and… we have a growing problem.”
More harmful than cigarettes
Medical experts warn that the `shisha’ can be more harmful than cigarettes. “Smoke from a `shisha’ contains hundreds of potentially dangerous heavy metals like arsenic, cobalt, chromium and lead. Under normal `shisha’ use the smoke produced from a single pipe use contains approximately as much nicotine and tar as 20 cigarettes,” said Javaid Khan, a chest physician at Aga Khan University Hospital in Karachi. He warned that apart from lung and other cancers, “additional dangers not encountered with cigarette smoking are infectious diseases resulting from pipe sharing [especially TB] and the frequent addition of alcohol or psychoactive drugs to the tobacco.”
Photo: Tariq Saeed/IRIN
|SYoung Pakistanis are unaware of the risks of shisha smoking|
Young sportsman Sheeraz said he knew of people who added narcotics to their shisha, and accused some of the restaurants of turning “a blind eye".
In an interview with Medical News Today, an online health news service, Christopher Loffredo of the Georgetown University Medical Center warned: “People who use these devices [water pipes] don’t realize that they could be inhaling what is believed to be the equivalent of a pack of cigarettes in one typical 30-60 minute session… because such a large quantity of pure, shredded tobacco is used.”
A 2007 article in the Journal of the Pakistan Medical Association recommended a number of steps should be taken, including:
- `Shisha’ should be subjected to the same regulations as cigarettes and other tobacco products.
- It should contain health warnings.
- Restaurants should inform their clients of the actual contents of `shisha’.
- Media should be involved in creating awareness against the hazards of `shisha’ smoking
According to the World Health Organization (WHO), Pakistan’s population of 160 million includes 22-25 million tobacco smokers; 36 percent of adult males and 9 percent of adult females smoke. About 60,000 people die annually from tobacco-related diseases in the country.