Bye, bye Hookah, at least for a while

posted on: Apr 22, 2020

Hookah smoking is considered to be fun, especially when done in small groups. While waterpipe smoking has a worldwide presence, it is usually associated with Middle Easterners and even more so, Arabs. Here we look at hookah use among Arab American youth, among others. In the context of COVID19, we also are reminded of the issues of tobacco smoking generally.

A brief history of hookah smoking

Controversy exists over whether the use of the hookah first started in India or Persia. In any case, following its invention in the 15^th century, this water pipe quickly spread to Turkish society and then to the Arab world. The hookah goes by many different names around the world, including shisha, nargeela, ghallyan, and hubble-bubble. The name hookah itself derives from the word huqqa, meaning pot or jar or cavity or hollow. It is a Hindustani word, but of Arabic origin. Hookah smoking at first used tobacco named Ajami, which was strong but flavorless. Waterpipe smoking initially had a high status attached to it, and was smoked mainly by royalty and diplomats. Now, the hookah is smoked around the world, including, of course, in the U.S.

Hookah use among Arab American youth

Given that the world is heavily engrossed in dealing with the COVID-19 virus, it is particularly relevant to raise the topic of hookah tobacco smoking among Arab Americans. First, however, let’s look at the more pleasurable aspects of smoking in general for Arab American adolescents. In a study compiled by the American Journal of Health Behavior, a sample of adolescents reported their reasons for choosing to smoke were that it’s about “being cool, hanging out with friends, [getting] easy accessibility to cigarettes and feeling good after smoking…” They added, however, that “one of the main barriers to smoking cessation was having friends who smoke…”

Somewhat in contrast to individual cigarette smoking, waterpipe tobacco smoking is characterized as a pleasurable experience when being shared with others. Thus it is used in some Arab and other Middle Eastern countries as a way of socializing the young, mostly young men. The hookah is thus part of a process that makes people feel comfortable with one another. Among Arab Americans studied in the above research, a community-based convenience sample of 458 adult Arab-American hookah smokers was selected. Averaging an age of around 28 years, these men and women started tobacco use as young adults in private homes or hookah lounges. While some individuals started hookah at 18 years of age, often simultaneous with cigarette smoking, the study noted that women began smoking hookah later than men.

A recent U.S. Department of Health and Human Services (H&HS) study of tobacco use among Arab American adolescents in the Detroit area, one of the largest Arab American communities, found that recently, hookah bars and cafes were becoming more popular, especially among college students and teens. From 2013-2014, hookah use among middle and high school students almost doubled.

Health issues surrounding hookah and other tobacco use

The above research showed that “the nicotine content in hookah smoke is equivalent to a smoker that smokes 200-300 cigarettes a day, demonstrating a very high potential for addiction.” Astonishingly, hookah smokers expose themselves to 100-200 times the volume of smoke compared to a cigarette, thus making hookah much more harmful than cigarettes. This is the case despite a myth surrounding hookah smoking, which is that it is safer than cigarettes “because the smoke passes through water to filter out all the ‘bad stuff.’ However, research has shown that hookah smokers receive more carbon monoxide (CO), nicotine and smoke than cigarette smokers.” Also, because of the amount of tobacco puffed through the hookah, smoking time is increased over cigarette smoking, the depth of inhalation of smoke processed through water is increased and, thus, smokers are inhaling higher levels of toxin.

H&HS has established a relationship between the COVID19 pandemic and smoking in general. First, tobacco use can aggravate the risk of more serious symptoms of COVID19, especially since it is primarily a respiratory disease. As a UN World Health Organization (or WHO) study reported, “Smoking is already known to be a risk factor for many other respiratory infections, including colds, influenza, pneumonia, and tuberculosis. The effects of smoking on the respiratory system make it more likely that smokers contract these diseases, and in a more severe form. Smoking is also associated with increased development of acute respiratory distress syndrome, a key complication for severe cases of COVID-19, among people with severe respiratory infections.

Use of hookah and risk of infection transmission

As most of us probably know, waterpipe smoking is most often practiced in groups, with the hose being passed from person to person. A typical hookah session can go on for ¾ to an hour-long, but may also continue for several hours. Furthermore, the hose is usually reused by the next customer, exposing him or her to harmful microorganisms. The WHO has reported that waterpipe mouthpieces have been implicated in outbreaks of pulmonary tuberculosis and a related infection called Helicobacter pylori. This latter illness, along with the hepatitis C virus, was found in Egypt to be linked to hookah smoking. According to the WHO, the list of waterpipe-transmitted diseases is a long one.

The link of hookah use to various illnesses has led many Middle Eastern countries to ban its use. Especially given the easy transmission of COVID19, the WHO reported that Kuwait, Pakistan, Qatar, and Saudi Arabia have banned the use of hookah in public places, including cafes, hookah bars or restaurants. Furthermore, the WHO recommends the complete ban on the use of water pipes and even if its use continues at home, the mouthpiece should be changed between individual users.

This report on the hookah applies to many more people than just Arab Americans since the hookah is used by many who are neither Arabs nor Middle Easterners. It, like the story of COVID19, is not a user-friendly story. It is a reminder that we all need to be diligent in this era of a worldwide pestilence. So, if in the future we return to using this highly sociable mode of personal bonding with friends and acquaintances, let’s be attentive to the possibilities it poses for disease transmission as well as the destructive role of nicotine. Yes, that may take the fun out of smoking via this clever, but odd contraption, but in this strange time of social and physical distancing, it might make us think twice about how we do our puffing.

References:

“Smoking Behavior in Arab Americans: A Systematic Review,” America Journal of Health Behavior, September 2015

Data and Statistics: Fact Sheets, U.S. Department of Health and Human Services., Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Smoking and Tobacco Use

“Tobacco and waterpipe use increases the risk of suffering from COVID-19,” The World Health Organization

John Mason, PhD., who focuses on Arab culture, society, and history, is the author of LEFT-HANDED IN AN ISLAMIC WORLD: An Anthropologist’s Journey into the Middle East, New Academia Publishing, 2017. He has taught at the University of Libya, Benghazi, Rennselaer Polytechnic Institute in New York, and the American University in Cairo; John served with the United Nations in Tripoli, Libya and consulted extensively on socioeconomic and political development for USAID and the World Bank in 65 countries.

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