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Hookah parlours

  1. 1. F.Y.B.Com Div.: C Name Roll No Sign Neelam Mankani 332 Ashlyn Mascarenhas 334 Siddharth Mataliya 335Hookah Parlour - Smoker’s heaven Submitted to: Mr. Mani Iyer 1
  2. 2. Index:Sr. No. Sub- Titles Page no. 1. Hookah is really not that cool… 4 2. Global expansion of hookah 8 3. What is hookah…? 10 4. History of hookah 12 5. Prevalence 16 6. What is a hookah parlour…? 20 7. Opening a hookah parlour 22 8. Why hookahs have become so popular..? 25 9. Hookahs compared to cigarettes 28 10. High risk of hookah use 30 11. Attitudes, awareness & misconceptions 32 12. Hookah ban in Mumbai 35 13. Conclusions 37 14. Recommendations 39 15. Bibliography 43 2
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  4. 4. Hookah is really not that cool…The fluffy cushions, colourful drapes and coloured sheesha are enticing enough. Ganglygroups of youngsters don‘t mind collecting money — just enough for an hour‘s worth offlavoured smoke. It‘s fun, it‘s cool and well, it‘s ‗exotic‘ to group-smoke from a singlehookah. And many believe it is better than the stick. Right ? Wrong. As much as it soundslike a fun pastime activity, doctors warn that it is ―even more harmful than smoking acigarette.‖ Now, don‘t go lighting that butt, doctors maintain it is a killer as well.Less than a week after the world celebrated World No Tobacco Day, DNA spoke toyoungsters to find out what they think of their ‗cool hookah habit‘. No doubt, most felt it wasas harmless as a friendly Labrador. But, Dr Pratima Murthy, Professor of Psychiatry andChief, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences(Nimhans), points out that the health risks attached to hookah smoking ―are no lessdetrimental than those of cigarettes. Any type of smoking reduces appetite. It also killscertain nutrients in the body, which are essential for the immune system. Loss of appetitemay result in weight loss,‖ she says.The tobacco in a hookah pipe is no less toxic, and the water in the hookah does not filter outthe toxic ingredients in the tobacco smoke. Hookah smokers may actually end up inhalingmore tobacco smoke than cigarette smokers do because of the large volume of smoke theyinhale in one smoking session.―I like hookah mainly because of the flavour,‖ says Anu Phillip, a young animation student.―I think it is very safe and does not have any tobacco in it, I don‘t think it would cause anyharm to me,‖ she states.Don‘t be so sure. Doctor‘s point out that like cigarettes, hookah smoke contains high levels oftoxic compounds including tar, carbon monoxide, heavy metals and carcinogens. And waterdoes not filter out these toxins.And while youngsters, girls and boys, are happy forming smoke rings, parents are blissfullyunaware of their child‘s new fascination. ―In my class, many girls hang out at hookah parlousand cafés. It has peer acceptance but our families still forbid it strictly,‖ says Atreyee BharunDas, a student who‘s doing her graduation. 4
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  6. 6. When asked why she smokes a hookah, Meghana Abraham, a student, said, ―there‘s noreason why I smoke it. It‘s just something I like to do.‖ A sentiment echoed by many others.However, there may be some good news, if you term it that. Dr Murthy says: ―Hookahsmoking is safe for passive smokers as the smoke does not affect them. But with cigarettes,the smoke affects both passive and active smokers.‖But, when an hourly smoking session costs Rs400, who would want to remain passive? Manyyoungsters go in groups to split the costs. ―I like different flavours and it‘s not too expensive.I have friends whom I can share with,‖ says Raghunandan Iyengar, an animation student,who says he is aware of the problems that it can cause but insists that he‘s ―not a regulartobacco smoker.‖ 6
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  8. 8. Global expansion of hookah:The recent global expansion of hookah use by youth and young adults to smoke tobaccoposes a new challenge for the tobacco control community. Currently, it is estimated thatworldwide, 100 million people use a hookah to smoke tobacco every day. The past decadehas seen a dramatic rise in the popularity of hookah smoking among young people living inthe Middle East, Southwest Asia, Africa, Europe, Canada, and the U.S. The growingpopularity of hookah use among U.S. teens and adults is evidenced by media reports and therecent rapid proliferation of hookah establishments (bars, cafes, or restaurants) in large citiesand near college campuses. Hookahs and the tobacco mix used to smoke them are easilyavailable.Teens and young adults are susceptible to hookah use because of their tendency toexperiment with new things. In the U.S., young people already have the highest rates ofcigarette smoking of all age groups (Centers for Disease Control and Prevention [CDC],2006a, 2006b). As CDC reports, in 2005, 24% of adults aged 18 to 24 and 23% of high-school students smoked cigarettes. If they start smoking tobacco at an early age they are morelikely to become addicted to nicotine than those who start later and those using hookahs maywell transition to cigarettes as their addiction becomes stronger. Also, the tobacco industrymay see the growing popularity of hookah use as another opportunity to target a populationthat has already provided them with a valuable market for their current products. 8
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  10. 10. What is hookah…?Hookahs come in a variety of designs, sizes, materials and colors, but typical hookahs havethe following components:  A bowl where the tobacco is placed and heated, usually with burning embers or charcoal.  A vase or smoke chamber which is partially filled with water.  A pipe or stem connecting the bowl to the vase by a tube that carries the smoke down into the water.  A hose with a mouthpiece through which the smoke is drawn from the vase.As the smoker inhales, the tobacco smoke is sucked down from the bowl and then bubbles upthrough the water into the air of the smoke chamber and then through the hose to the smoker.The water in the vase cools the smoke and filters out some of its tar and particulates.At the end of a smoking session, the dirty water is thrown away and the hookah vase refilledfor the next user or users.Most smoking sessions last from 45 to 60 minutes but they can continue for several hours.While hookah is the most common word used among English speakers, other terms usedinclude narghile or nargile, goza, ghalyun, and hubble bubble.Hookahs are made with single hoses or three or more of them connected to the base formultiple users. Hookahs are made with a variety of materials and come in a variety of colors.Many of them have been made into works of art by skilled craftsmen in India, Iran, Turkey,and the Middle East. 10
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  12. 12. History of hookah…One of the oldest and deep rooted traditions in Turkey is the Nargile (Hookah), with bothmen and women finding great pleasure in smoking the water pipe. The hookah started awhole new culture which endured for many, many years. Even today the hookah givesenjoyment to a special breed of smokers. The original hookah came from India, but it wasrather primitive as it was made out of coconut shell. Its popularity spread to Iran and then tothe rest of the Arab world.But it was in Turkey that the hookah completed its revolution, and did not change its style forthe last few hundred years. The hookah became a very important part of the coffee shopculture, finding its popularity in Turkey around the time of Murat the IVth, 1623-40. The joythat the smokers received from this very simple yet beautiful smoking apparatus wasunbelievable. Rules were created even for lighting the pipe, and if a professional smoker sawanyone lighting it the incorrect way, the culprit would be told in no uncertain term "Doyourself and the sacred hookah a favor and put out the coals by blowing into it."Not all tobaccos qualified for usage in the hookah, and only the dark tobacco imported fromIran found favor with the hookah user. This tobacco was washed several times before use asit was extremely strong. Only oak charcoal was used to be placed on the top of the tobacco.Some professional hookah smokers used certain fruit, like sour cherries or grapes in theirgovde just to enjoy the motion it created in the water. Other people enjoyed addingpomegranate juice or rose oil to their water for added flavor. The hookah smoker hatedanyone lighting their cigarettes on their hookah fire because they felt it disturbed the rhythmof the burning charcoal.The hookah was so popular and fashionable with the elite ladies of the 19th and the beginningof the 20th century, that it became the in thing to be photographed with a hookah. If youwanted to be the hostess with the mostest the hookah was a must for popular afternoon teaand intellectual gatherings. Unfortunately like most wonderful things from the past, thehookah suffered a decline with the availability of the cigarettes. But still today, one is able tofind a special type of smoker that would only find their enjoyment from smoking the hookah. 12
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  14. 14. They were designed to smoke opium, and hashish. The hookah made its way from the PersianKingdom to other parts of the Persian empire which also included India, Pakistan,Afghanistan, much of Middle Asia and Arab parts of Northern Africa.Today the Hookah is a smoking pipe used worldwide. The practice of adding strong flavors isa relatively recent one but has grown in popularity in the past 20 years. 14
  15. 15. Table no (1) Age distribution of Hookah or Shisha smokersTable no. (2) Distribution of Hookah users based on occupation 15
  16. 16. Prevalence:Most of the data on hookah use prevalence are from Middle Eastern studies. Results from arepresentative sample of these studies indicate that  19% of 635 young Egyptian teenagers had used hookahs.  41% of 388 Israeli schoolchildren aged 12 to 18 years smoked hookahs, and 22% of these users smoked every weekend.  Of 587 Syrian university students, 63% of the men and 30% of the women had ever used hookahs: currently, 26% of the men and 5% of the women still used them.  Among 1964 Lebanese university students in a 2001 survey, 31% of the men and 23% of the women used hookahs weekly.  57% of men and 69% of women in a national survey of 4,000 Kuwaiti government workers had used hookahs at least once.  The percentage of American University of Beirut students who had ever used a hookah rose from 30% in 1998 to 43% in 2002.Prevalence data on hookah use in the U.S. are limited to a survey of 1671 teens (mostly Arab-American) aged 14 to 18 years and living in Michigan. Among study partipants, 27% hadused hookahs and the percentage of users increased from 23% at age 14 to 40% at age 18.Hookah users were twice as likely as non-users to be smoking cigarettes as well and that theodds of experimenting with cigarettes were eight times as high for anyone who had ever useda hookah as for non-users. In this country, the use of hookahs has become increasinglywidespread with the growing numbers of Arab immigrants and Arab-Americans andincreasingly popular among youth and young adults in the general population.Two surveys of 300 students each conducted in 2005 and 2006 by Breathe California,Sacramento, found that during the first year, 45% of the students had used hookahs during thepast two months. In 2006, 40% of the students were at events where hookahs were used andof these, 58% used hookahs during the past 6 months.In the spring of 2007, campus professionals and national young adult tobacco control expertswere interviewed about their perception of hookah use and youth and young adults. Mostinterview participants reported growing numbers of middle school, high school, and college 16
  17. 17. Table no. (3) Distribution of Hookah smokers based on educational level 17
  18. 18. students smoking with hookahs in their communities and across the country. Also reportedwere a proliferation of hookah bars and growing numbers of students smoking hookahs withfriends inside or outside their residence halls, in their apartments or houses. Hookahs havebecome a common topic of conversation among students.The majority of smokers in this study (34.3%) were of the age group 35-44 years (Table 1).About half of the water-pipe users in the study were businessmen (46.3%) followed byskilled labourers (23.6%) (Table 2).Majority of the Hookah smokers (75.2%) were having either secondary school or collegeeducation (Table 3). 18
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  20. 20. What is a hookah parlour…?Hookah lounges are commercial establishments where groups of people gather to smoke froma hookah pipe. Some hookah lounges are business modeled as such from their inception.Others are cafés or other establishments to which the element of hookah smoking was addedlater. Hookah lounges of all sorts have become popular in parts of Europe and North Americain the last decade.Considered a unique and acceptable way to socialize with friends, especially among youngpeople, hookah lounges are springing up close to college campuses and in other communitiesall over. Hookah lounges are mostly found in college towns and urban areas and are regardedby some as a novel and chic way to socialize and embrace multiculturalism. Some people ofMiddle Eastern or South Asian extraction consider them a continuation of their own culturaltraditions. 20
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  22. 22. Opening a hookah parlour:Believe it or not, opening a hookah bar can be very easy if you invest your time and money ina solid hookah business plan. For starters, you will need to know where you will get yourstartup capital and where you want your business located. Like so many other things, locationis key for your hookah business. Additionally, you will want to have a good idea of what ahookah business is all about—in other words, you should be an aficionado of the practice.You will want to be knowledgeable about the varieties of hookah tobacco and have a goodidea of the atmosphere you are trying to create at your bar or lounge. As you iron out thedetails of how to start a hookah bar, you‘ll want to include what type of drinks your bar willserve and you‘ll also want to know what you‘re looking for in your employees. Finally, youwill want to be prepared for the hard work and long hours you may need to dedicate to yourbusiness when you first open, though it‘s a good bet your hookah bar will take off when yourcustomers start talking about how great your lounge is.There will be a chance in the early stages of your business that your days will start late andyour nights will be long. Beyond that, you will have to spend your days ordering from yoursuppliers—alcohol, tobacco, food—booking entertainment like DJs or singer/songwriters,hiring and managing employees, and ensuring your business records are in the black.Eventually, you may be able to hire a bar manager who will take care of orders and bookings,and an accountant to keep your books, but in the beginning you will want to have your handsin all the pots. During prime operating hours, your staff will take over most of the duties andyou will just watch your business in action.About the Customers:Customers at a hookah bar will be interested in enjoying a bar or lounge atmosphere with theadded entertainment of sharing tobacco from a hookah pipe. Though not all customers willwant to partake in the smoking or drinking, they will be interested in being part of the sceneyour business has created.What You Need to Start: A great location and space for a bar/lounge A cool name for your business 22
  23. 23. A business license and insuranceAn alcohol permitStartup capital to invest in real estate and bar materialsEmployees who fit your business criteriaEntertainment possibilitiesAdvertisement capabilitiesFinancial-tracking software 23
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  25. 25. Why Hookahs have become so popular…?Major reasons for the growing popularity of hookah use worldwide since the 1990s includethe introduction of a flavored tobacco mix, the mushrooming of hookah establishments,aggressive marketing, and media hype about this new trend.Introduction of Flavored Tobacco:In the early 1990s, Egyptian tobacco companies introduced ―Maassel‖, a specially preparedmixture containing sweetened fruit flavors and mild aromatic smoke which has helped toattract new hookah users worldwide known as ―shisha‖ in the U.S., consists of about 30% ofcrude cut tobacco fermented with about 70% of honey, molasses, and the pulp of differentfruits. It provides a pleasant aroma when heated slowly with burning charcoal and comes in avariety of flavors including apple, strawberry, rose, mango, cappuccino, banana, peach,lemon, orange, mint, and licorice. Currently, most hookah smokers around the world useMaassel rather than the traditional tobacco mix because it is more flavorful and makes theprocess of water pipe preparation simpler because users do not need to moisten, shape, anddry the tobacco before use, as with other kinds of tobacco like Ajami.Hookah Bars, Cafes, and Restaurants:Hookah bars, cafes, and restaurants have become popular social gathering places for youngsmokers and their friends and their numbers have increased dramatically in recent years. Inthe U.S., the estimated number of these establishments now ranges from 300 to 1,000.Directories listing hookah bars and cafes in large cities and the States are posted on theInternet and these places are touted in the media. Hookah bars, cafes, and restaurants lurecustomers through advertising in college/university and local newspapers, radio stationspopular among young people, and by emphasizing exotic aspects of Middle Eastern culture intheir décor, furnishings, music, and displays of a variety of colorful, finely crafted hookahs.These places especially appeal to some college students under the age of 21 because they donot serve alcoholic beverages. 25
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  27. 27. Aggressive Marketing:Multiple enterprises have sprung up in the U.S. and Middle East to take advantage of abooming business fueled by aggressive marketing of hookahs, hookah accessories, andMaassel. For example, in Bahrain, revenues from hookah tobacco exports to other Middle-Eastern countries increased by 9% to about $25 million from 1995 to 1996. Most of the―shisha‖ imported to the U.S. comes from companies in the United Arab Emirates, Jordan,Egypt and Saudi Arabia. The owner of the Florida-based website SouthSmoke.com recentlyreported that the demand for hookahs was at an all-time high and that sales were highest inCalifornia, Arizona, New York, Texas, and Virginia. A Detroit wholesaler also made morethan $1 million in sales the previous year to tobacco shops, hookah cafes and stores acrossthe country and predicted that sales would triple in the coming year. Many businesses havedeveloped websites to advertise their hookah products, e.g. Southsmoke.com,hookahkings.com, hookah-hookah.com, fumari.com, and egyptiandreams.co.uk.To attract customers, these businesses offer a variety of hookahs for sale, e.g., EgyptianHookahs, Sheik Hookahs, Rotating Hookahs, and Modern Hookahs or give these productsexotic names like ―Scheherazade,‖ ―Syrian Queen,‖ and ―Queen Nefertiti.‖ Fumari claimsthat its hookahs and shisha deliver a pure experience and are made for durability. Otherwebsitespromote hookah use as chic and elegant (hookahculture.com) or as part of a unique lifestyle(insidehookah.com) and hookahs as objects of religious veneration (sacrednarghile.com).Media Hype:The media (radio, satellite TV, and the press) has also helped to boost the global expansion ofhookah use by glamorizing this practice. Newspaper reporters depict hookah use as new,trendy, and safe for college students and other young people, although some of them do warnabout its potential health effects. Articles in campus and local newspapers generally promotehookah use. 27
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  29. 29. Hookah compared to cigarettes:While many hookah smokers may consider this practice less harmful than smoking cigarettes,hookah smoking carries many of the same health risks as cigarettes. Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke. Due to the mode of smoking—including frequency of puffing, depth of inhalation, and length of the smoking session—hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke. A typical 1-hour-long hookah smoking session involves inhaling 100–200 times the volume of smoke inhaled from a single cigarette. Hookah smokers are at risk for the same kinds of diseases as are caused by cigarette smoking, including oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility. Hookah smoking is NOT a safe alternative to smoking cigarettes. 29
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  31. 31. Health risk of hookah use:Assessing the specific dangers of hookah use is challenging because some users also smokecigarettes; the extent to which it is harmful likely depends on the duration and frequency ofuse, and there is wide variation in the content of the different brands of hookah tobacco.Constituents of Hookah Smoke:Despite these challenges, studies provide ample evidence that hookah smoking is not a safealternative to cigarette smoking. Hookah smoke has been found to contain highconcentrations of carbon monoxide (CO), nicotine, ―tar‖, and heavy metals. Also, commonlyused heat sources like charcoal or wood cinders may increase health risks because theyproduce such toxicants as CO, metals, and carcinogens. These risks may be increased byusing quick-burning charcoal which likely emits more CO than the charcoal traditionally usedin the Middle East.Health Effects:Health problems identified by researchers in the Middle East, China, and India include lung,oral and bladder cancer, and cancer of the esophagus and stomach, heart disease andrespiratory problems. Other health risks include nicotine dependence and infections liketuberculosis, herpes, and hepatitis which can be transmitted through the sharing of the samemouthpiece — a common custom in many cultures.Health Risks for Children:Women using hookahs during pregnancy may expose their unborn children to low birthweight, low Apgar scores and respiratory distress.Children exposed to secondhand smoke (SHS) from hookahs at home may suffer fromrespiratory ailments and also from similar problems as children whose families smokecigarettes, e.g., ear and upper respiratory infection, asthma and sudden infant deathsyndrome. 31
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  33. 33. Awareness, Attitudes & Misconceptions:Lack of public knowledge about these potential health hazards has led to the widespreadmisconception that hookah smoking is safe. Studies conducted in Egypt, Israel, and Syriahave found that in general, people know little about its health effects and believe that it is lessharmful than cigarette smoking. Another study of 576 pregnant women in Beirut and itssuburbs found that 25% had smoked hookahs during their pregnancies which suggest thatthese participants may not have known about the harmful fetal effects of their behavior.Another common misconception among hookah users is that they will not suffer any adverseconsequences if they smoke occasionally rather than daily like most cigarette smokers. Yeteven occasional users could be harmed because they probably inhale a lot of smoke full oftoxic substances during smoking sessions that typically last for 45 minutes to over an hour.Lack of knowledge, attitudes, and misperceptions about hookah use among college studentsand other young people is a major concern.A lack of awareness about the dangers of hookahs may also help to explain permissiveattitudes toward teen children and/or young women using them in some parts of the MiddleEast. For example, in several Eastern Mediterranean countries, researchers found cases ofteenage children being allowed to smoke with hookahs, of some families even sharing ahookah after meals, and of a greater tolerance of women using these water pipes thansmoking cigarettes.Hookah use is promoted by much of the media, hookah retailers, and hookah bars/cafes as anenjoyable and safe social activity for college students and other young users. Some collegestudents prefer hookah smoking over other kinds of recreation because it offers a cheaper andsafer alternative to taking drugs or bar-hopping and the potential problems associated withthese activities. 33
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  35. 35. Hookah Ban in Mumbai:Now, patrons at restaurants won‘t have to be irked by the occupants of the next table smokinghookah, while they enjoy their food, as the Brihanmumbai Municipal Corporation (BMC) hasbanned hookah parlours in the city.This decision was upheld by the Bombay high court and it has directed the state governmentto notify other corporations and municipal councils to implement the same circular.As per the affidavit filed by Dr Anil Bandiwadekar, executive health officer, of thecorporations states that on July 1, 2011, a circular has been issued incorporating terms andconditions of the Cigarette and Other Tobacco Products (Prohibition of Advertisement andregulation of Trade and Commerce production Supply and Distribution) (COTPA), Act.Under condition 35, ―The licensee shall not keep or allow to keep or sell or provide anytobacco or tobacco related products in any form whether in the form of cigarette, cigar, bidis,or otherwise with the aid of pipe, wrapper or any other instrument in the licensed premises.‖The division bench of Chief Justice Mohit Shah and Justice GS Godbole, accepted thecircular in totality and refused to alter it. The bench said, ―On the last date of hearing of thepetition, we had directed the BMC to incorporate the conditions of the COTPA act andaccordingly it has been done.‖The court added that, ―It would record its reasons of not interfering with the circularseparately but directed the state government to direct other municipal corporation andcouncils in the state to implement and incorporate similar changes in the license issuing rulesof eateries within one month.‖The orders were passed during the hearing of a petition filed by an NGO ―Crusade AgainstTobacco‖ alleging that hookah parlours were selling tobacco products, including hookahs, tominors and are also violating several other rules prescribed under the Act.According to the PIL, none of the restaurants have separate smoking and non-smokingsections. This exposes non- smokers to second-hand smoking and is a clear violation of theprovisions of the Act. It further said that the Supreme Court has banned smoking in publicplaces after observing that a non-smoker cannot be compelled to be a victim of air pollution. 35
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  37. 37. Conclusions:Hookahs have been used for at least 400 years to smoke tobacco but their recent popularityamong teens and young adults in the U.S., the Middle East, Europe and other parts of theworld represents a global public health challenge.Major reasons for this trend include the introduction of flavored tobacco (Maassel), the rapidrise in the number of hookah establishments, aggressive marketing tactics by businesses, andnewspaper articles and other media touting hookah smoking as fashionable, trendy, and safe.Although studies have identified serious health problems associated with hookah use andexposure to its secondhand smoke, most people seem to be unaware of these dangers. Hookahuse is widely viewed as a safe alternative to cigarette smoking rather than a potential healthhazard. In fact, for young people, hookah use may represent initial stage of later addictionand the transition to cigarettes.Clean indoor air legislation has been passed in several countries and a number of States in theU.S. In this country, however, hookah bars have managed to get exemptions from these lawsin most of the States. These establishments not only continue to operate, but new onesliterally ―spring up overnight‖ in large cities and near college campuses. Their mode ofoperations compounds the problems associated with hookah use.Since hookah bar owners tend not to ask their young customers for any identification, theyoften end up serving minors. Also, they make up their own concoctions to smoke with thehookahs they rent. Since Maassel is not regulated like cigarette tobacco, hookah bar ownerscan claim their mixtures contain little or no tar or nicotine or are tobacco free. BreatheCalifornia had some of the mixtures made up by Sacramento.Hookah bars tested in a lab and found that they did indeed contain tobacco. Also, hookah barowners are not required to sterilize or replace the mouthpieces of their hookahs, thusexposing customers to the risk of contracting infectious diseases from sharing hookahs withothers. 37
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  39. 39. Recommendations:To address these challenges, the following recommendations have been drawn:Conduct more research on hookah smoking among youth andyoung adults in India and other countries where hookah use israpidly rising:Additional research on hookah use will provide the scientific basis for assessing themagnitude of this health problem, convincing users and others that it is not safe anddeveloping prevention, cessation, and policy strategies that will stop it from becoming aglobal epidemic.Future studies should be conducted to:  Collect ongoing prevalence data each year on hookah use prevalence among youth and young adults to assess trends over time to assess the magnitude of the problem.  Identify and describe knowledge, attitudes, and perceptions about hookah use and its safety as compared to cigarette smoking to learn why young people smoke hookahs.  Monitor key marketing strategies to provide the basis for counter-marketing efforts.  Assess the health risks of hookah smoke and smoking to build on the knowledge gained from the research already conducted in the Middle East and other parts of the world.  Facilitate the development, implementation, and evaluation of cessation products and programs to help users to quit.Surveys have been developed to collect prevalence and other data, e.g., a nationwide campussurvey. However, questions on hookah issues can also be added to existing surveys. Nationalprevalence data would be available if questions could be added to such annual surveys as theYouth Tobacco Survey and Behavioral Risk Factor Surveillance System.9 39
  40. 40. Develop, support, and expand health education to enhanceknowledge, change attitudes, and correct misperceptions abouthookah use and its effects:More health education campaigns and materials are urgently needed to raise public awarenessof the health risks of hookah use and dispel the myth that it is safe. Educational programs areespecially important for middle-, high-school, and college students as well as for theirparents, health professionals, pregnant women, and people who are exposed to SHS fromhookahs. Others who need to know more about the health risks of hookahs include theadministrators, staff, and faculty of schools, colleges, and universities as well as public healthofficials and policymakers.Suggestions for educational activities, programs and/or materialswere to:  Use peer educators to conduct classroom and other kinds of presentations because the peer-to-peer model is more effective than using older adults for these activities.  Engage students and other young people in the conversation, encouraging them to identify the risks of hookah use and healthy alternatives.  Collaborate with students on hookah use prevention campaigns. For example, staff and students should construct a huge hookah bulletin board highlighting its health risks and correcting myths about its safety and are taking them around the campuses in the colleges.  Include information about hookah use in health promotion presentations.  Present information on hookah-related health risks to staff at student health centers and assist them in adopting the practice of asking their patients about hookah use, educating them on the risks, and encouraging users to quit.  Conduct more presentations on hookah issues at local and national conferences.  Make use of the media, e.g., writing articles or letters to the editor and placing ads in campus and local newspapers to ―spread the message.‖ 40
  41. 41. Mobilize to change or strengthen policies to reduce hookah use andits harmful effects:Many countries and a number of countries need policies to eliminate exposure to secondhandsmoke. However, hookah bars can continue to operate in those places that have clean indoorair legislation by claiming that they are retail tobacco establishments or operate astobacco/cigar bars or lounges. Tobacco control advocates and others need to mobilize to closethese loopholes by educating policymakers on the health risks of hookah use and urging themto change the law.10Other policies that would reduce the harmful effects of hookah smoking include requiringhookah bars to ask all customers for their I.D.‘s to prevent minors from buying or smokingtobacco on their premises and ensuring that they provide plastic, disposable mouthpieces ornozzles to prevent the transmittal of infections among users sharing the same waterpipe.Also, policies to reduce cigarette smoking may also prove effective in curtailing the use ofhookahs.These policies include imposing marketing restrictions, prohibiting misleading labeling(e.g., contains 0 mg of tar), placing warning labels about health risks on the products, andregulating the tobacco content of Maassel. Taxation of this tobacco mix may also reduce theappeal of hookah smoking for young people.Collaborate with others to share experiences, information, andresources:Several survey participants emphasized the need for greater inter-organizational collaborationacross the country linking local and national groups working in tobacco control.Collaboration would enable individual groups to better address hookah use sharedinformation, tips, resources, and key lessons learned. Programs that are culturally appropriateand engage the target populations—especially teens and young adults, their parents, andcommunities—may ultimately prove to be the most successful approach in combating thisemerging global epidemic. 41
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  44. 44. Thank You 44