Harmless hookah is anything but...

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The hubbly-bubbly has a fashionable and sociable image but many smokers do not know that it increases the risk of oral cancers. Picture: Terry Haywood

Every couple of days, Thato*, an 18-year-old student, smokes a hookah pipe, also known as a “hubbly-bubbly”, oka pipe or water pipe, with his friends.

“Smoking the hookah pipe is normal for us. I don’t do it every day, but I know a few people who do it regularly, maybe even once a day. It’s a chance for us to socialise and relax. I don’t like cigarettes, so the hookah is cool for me,” he says.

Sergio Henriques says the attraction for him is it is “a social thing to do” and an option for “non-smokers”.

“People enjoy the different flavours of tobacco you put in them, and let me tell you, there are a lot. Last time I checked there was a Red Bull flavour. It leaves a better taste in your mouth than cigarettes, and you can exhale a great plume of smoke which some people find quite entertaining. You can also accessorise your hubbly by selecting various sizes and designs of bases, along with the head and pipes,” he says.

Groups of people smoking a hookah pipe are an increasingly common sight in South Africa. The biggest fans of the “hubbly” are young adults between 18 and 28, typically seen sitting in circles and passing it around.

The flexible pipe leads to a colourful, water-filled glass chamber that looks quite exotic, harking to the hookah’s origins, believed to be Indian or Persian. What is prepared and smoked is flavoured, molasses-based tobacco known as “shisha”.

A man loads a hookah with apple-flavoured tobacco, one of many varieties of flavours. Picture: Andrew October

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But hookah smoking is a growing health hazard and most people who do it aren’t even aware of this. Many of these smokers consider the hookah to be safer than cigarettes, but it’s been found that smoking a single hookah pipe can give you as much nicotine as 10 cigarettes.

That the sensation is reported to be “less irritating” than cigarette smoking – thanks to the smoke bubbling through the water, where it is diluted and cooled – doesn’t make it less harmful.

Paediatrician Dr Kuban Naidoo, who completed a Master’s research study this year titled “Factors associated with hookah pipe use among undergraduate students at the University of the Witwatersrand”, found that among his sample of more than 800 students, more than half had smoked the hookah at least once.

“My study highlighted the significant use of the hookah pipe among Wits students, and my prediction is that while the prevalence of hookah smoking is higher among the youth in other countries, South Africa is catching up.”

Naidoo explains that the hookah ritual is “quite new” here, and there is also no clear distinction between cigarette smoking and hookah use as yet, whereas abroad, where anti-smoking campaigns have made a huge impact, hookah smokers have often never touched a cigarette and, like Henriques, consider themselves “non-smokers”.

The real worry, however, is that hookah smokers in SA are becoming younger and younger, also in line with the trend overseas.

Youngsters increasingly smoke the hubbly-bubbly under the misconception that it is innocent fun. Picture: Mathieu Dasnois

Mathieu Dasnois

“We can anticipate a significant increase in schoolchildren smoking the hookah, though not cigarettes,” Naidoo says.

This resonates with the findings of a 2010 study carried out by the SA Medical Research Council in five deprived areas of Joburg. It found not only “surprisingly high” rates of hookah smoking among children as young as 12, but that a significant percentage of them added marijuana and/or alcohol to the tobacco.

Professor Andre van Zyl, head of the department of periodontics and oral medicine at the University of Pretoria, says that when he gave a talk at two private schools recently, he was “astonished to hear that the children smoke with their parents from as young as eight years old”.

“The kids swamped me with questions, admitting that they smoke hookahs. Some said they were desperate to stop as they were addicted,” Van Zyl said.

“The teachers confirmed this and informed me that it was a serious problem for them. It did confirm to me that this is a much bigger problem than we think.”

One of the signs of addiction to the hookah, says Naidoo, is smoking it alone at home, a practice common among established hookah smokers.

“You do take in significant amounts of nicotine, and the adolescent is more biologically sensitive to nicotine – that is, it takes less of it to make them dependent. And once there’s addiction, there are all the usual symptoms associated with cigarette addiction – tremors, agitation, mood swings,” he says.

Hookah smokers also face the same risks as those of cigarette smokers – diseases like oral cancer, respiratory and heart diseases, and pregnancy-related complications.

Indeed, American studies have found that due to frequent puffing, deep inhaling and the length of the smoking session, hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke.

Also, while cigarette smokers typically take between eight and 12 puffs of a cigarette over five to seven minutes, hookah-smoking sessions typically last 20 to 80 minutes, during which a smoker may take between 50 and 200 puffs.

In 2005, the World Health Organisation stated that a “hookah smoker may inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes”.

The Medical Research Council has found that because the hookah pipe is shared, it could be a major contributor in the transmission of diseases such as tuberculosis, viral hepatitis and oral herpes infection.

“We need to sit up and take notice of these facts, to disabuse people of the notion that hookah smoking is safe,” says Naidoo.

“American researchers have called this the second global tobacco epidemic since the cigarette, so we need to push the health message much harder if we’re to reverse the hookah smoking trend in SA.”

That it has gained almost a “cultural” status, endorsed even by some parents, presents a big challenge, however.

There are a number of “hookah lounges” in our cities, restaurants or bars where patrons can rent hookahs and buy shisha to smoke. And because anti-smoking legislation addresses only cigarette smoking, hookah smoking escapes these restrictions, promoting the innocuous image it has developed.

“The PR around hookah smoking gives the impression it is pleasant, socially attractive and harmless. I’ve even seen shisha tobacco being sold in sweet shops,” says Naidoo. “But the fact is that it is just as dangerous as cigarette smoking. And parents should do something about it.”

The question you should ask as a parent, Naidoo suggests, is: “Would I allow my 12-year-old daughter to smoke cigarettes?

“Consider your answer, because it amounts to the same thing.” - Cape Argus

*Not real name

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