High risk shisha smoke
Waterpipe smoking carries the same risks as smoking including
cancer, respiratory and heart disease despite it being seen as healthier,
according to new joint report from Public Health England and ADPH.
The report Waterpipe smoking (shisha) in England The
public health challenge also found that ‘high quality’ studies are
needed into the health effects of shisha smoking. However, available research
recommends reducing waterpipe use, especially regular use.
It quoted British Heart Foundation data that found the number of
shisha bars in the UK had risen by 210 per cent from 179 to 556 between 2007
and 2012. This is a huge rise, and other research indicates that waterpipe use
is a growing concern in certain areas and sub groups such as in BME
However, nationally its use is not prevalent and so currently
represents a ‘negligible’ public health risk. But the report recommended its
use must be monitored and action taken if it emerges as one. By monitoring
waterpipe use in their areas local authorities can identify where and in whom
waterpipe use is a public health threat.
Dr Andrew Furber, president of the Association of Directors of
Public Health said in the report’s foreword: ‘Tobacco use is likely to be the
major preventable contributor to ill health and health inequalities in most if
not all local authority areas. Although smoking cigarettes will make up the
bulk of this, it is important to address other forms of tobacco use, which are
more common in certain communities.
‘Waterpipe smoking (shisha) is one such use. The populations where
this is most commonly used are the same communities which are at higher risk of
diseases such as heart attacks and stroke from other causes, such as genetic
predisposition or diet. It is therefore important that local tobacco control
strategies take this form of use into account.
‘Clearly any public health programme needs to be sensitive to
local cultural context. However not to take action where there is a proven
threat to health is to do a disservice to those who will lose loved ones to
tobacco related disease.’
Waterpipe smoking is subject to UK smoke free legislation that
prohibits smoking in all enclosed public places and workplaces. Yet, the report
highlighted challenges to local authorities in enforcing tobacco and health and
safety regulations in relation to shisha premises and recommended that all
relevant agencies work collaboratively.
This approach, said the report, could include the education of
businesses alongside robust enforcement.
It also found several studies indicating that smokers perceived
waterpipe smoking to be less harmful, less addictive, and more socially
acceptable than regular cigarettes. This is likely to be wrong and this
misperception is also likely to contribute to its use.
The report noted an increased risk of infectious disease and a
risk of carbon monoxide poisoning due to the constant heating of tobacco by
The report suggested that local authorities could consider
interventions to raise awareness of the health risks of its use, especially
among current waterpipe smokers and young people.
It also recommended that standardised questions should be used in
surveys of local areas so that the data yielded could be compared nationally.
Where action is taken to reduce waterpipe use, the report urges that best
practice be shared in the relevant peer-reviewed journals.
National data shows that waterpipe smoking, up to twice per month,
in the general population is very low at 1 per cent.
Young adults are more likely than older adults to have tried
waterpipe smoking. However, current use is still low at around 2 per cent in 18
to 24 year olds. In 11-15 year olds, less than 1 per cent, and among 16-18
year, less than 3 per cent, say they smoke at least once a month.
In BME groups, waterpipe smoking is higher – almost 7 per cent
among Asian/Asian British.