Smoking and Waterpipes

Types of Smoking, Quick Facts, Smoking Cessation and Impacts on Health – Sheesha

“You are stronger than your addiction”

Introduction

In an era marked by increasing awareness of the detrimental effects of smoking on our health, the efficacy of smoking cessation strategies is of great significance. Numerous studies have demonstrated the effectiveness and success rates of various pharmacological and behavioral interventions, and different strategies have been proposed to optimize successful implementation. Tobacco causes health problems across all ethnicities, but the way people from different ethnic backgrounds use tobacco varies considerably. As we battle the global tobacco epidemic, it is important to better understand how to support individuals looking toward a smoke-free life.

Facts- Adult smokers in the UK

In the UK, in 2022, 12.9% of adults now smoke; 14.6% of men and 11.2% of women, which equates to around 6.4 million people in the population. 4 In 2022, adult smoking rates by each country in the UK were (ASH, 2023):

England: 12.7%
Wales: 14.1%
Scotland: 13.9%
Northern Ireland: 14.0%

Since 2011, the largest fall in smoking prevalence has been among 18- to 34-year-olds. Those aged 25 to 34 years continued to have the highest proportion of current smokers (16.3%, around 1.4 million people). In the UK, more than 1 in 5 (22.8%) people in routine and manual occupations smoked, compared with less than 1 in 10 people (8.3%) in managerial and professional occupations.

In England, 10.4% of mothers were smokers at the time of delivery in 2019-20.

Smoking

Smoking is when you inhale and exhale smoke from burning plant material that’s rolled into a wrapper (cigarette). Smoking cigarettes is the most common way of using tobacco in the UK.

There are various forms of smoking which include cigrattes, waterpipes commonly known as Shisha and smokeless tobacco i.e. Naswar, Paan, Ghutka etc.

What is actually a cigarette?

Commercially produced cigarettes are made up of (Cleveland Clinic, 2024):

Plant material. In tobacco cigarettes, this is dried and processed tobacco (Nicotiana tabacum) leaf stems.
A rolling paper wrapper.
Filter (cigarette butt). The filter traps larger bits of the partially burned tobacco while smoke travels through it into your mouth.

Impacts of Cigarette on Health

Cigarette smoke contains thousands of toxic chemicals that harm almost all organs in the body and are linked to numerous cancers, stroke, heart disease, and lung disease.

Waterpipes (shisha, hookah, narghile, hubble bubble)

Waterpipes have traditionally been used to smoke tobacco in the Middle East. However, there has been a recent global resurgence of waterpipe smoking and in recent years ‘shisha bars’ have become particularly popular among young people from ethnic minority groups in the UK (ASH/YouGov Smokefree GB Survey, 2019). Waterpipes are mostly used to smoke tobacco. Herbal mixtures are also commonly used and although these do not contain nicotine and so are not addictive, smoking herbal shisha is similarly harmful to health as smoking tobacco shisha, yielding similar levels of toxicants such as carbon monoxide, nitric acid and tar (Shihadeh A et al, 2012).

Impact of Shisha on Health

The most widespread misconception among shisha users worldwide is that smoking shisha is less addictive and dangerous than smoking cigarettes. The UK has seen a 210% spike in shisha consumption since the smoking prohibition. The idea that the water that the smoke travels through before being consumed “filters out” the dangerous chemicals in the smoke has been reported by users. Despite the fact that shisha smoking has not yet been studied as thoroughly as cigarette smoking, what is known indicates that it carries many of the same risks as smoking cigarettes and may also pose certain special health risks. Along with other dangerous substances, it contains similar toxins and carcinogens that are known to cause cancer. Additionally, research showed that the blood was contaminated with heavy metals.

Generally, shisha, or hookah, has several harmful impacts on health. Here are some key points:

Tobacco Exposure: Shisha contains tobacco, which exposes users to nicotine and various toxic substances. This can lead to addiction and other health issues.
Respiratory Issues: The smoke produced from shisha contains harmful chemicals that can damage lung tissue and lead to chronic respiratory conditions like bronchitis and decreased lung function.
Cardiovascular Problems: Shisha smoking can increase heart rate and blood pressure, raising the risk of heart disease and stroke.
Cancer Risk: Long-term use is associated with an increased risk of cancers, particularly lung, oral, and throat cancers, due to the carcinogenic compounds in the smoke.
Infectious Disease Transmission: Sharing a hookah can increase the risk of transmitting infectious diseases, including respiratory infections and viruses.
Misconception of Safety: Many users mistakenly believe that shisha is less harmful than cigarettes, leading to prolonged and frequent use.
Secondhand Smoke Risks: Non-smokers exposed to shisha smoke can suffer from similar health risks, including respiratory problems and increased cancer risk.

Overall, while the social aspects of shisha use may seem appealing, the health risks are significant and should not be overlooked. The impacts of shisha on health can be classified as short-term and long term.

Short-term impacts on Health

Common cold
Chronic bronchitis
Headaches
Dizziness
Nausea

Long-term impacts on Health

Risk of lung cancer
Respiratory illness
Low birth weight in babies
Gum disease.

Is Shisha any safer than a cigratte?

In a shisha session (which usually lasts 20-80 minutes), a shisha smoker can inhale the same amount of smoke as a cigarette smoker consuming over 100 cigarette (British Heart Foundation).

Smokeless Tobacco

Smokeless tobacco refers to products that are consumed without being burned. Common forms include chewing tobacco, snuff, and dip. These products are typically placed in the mouth or nasal cavity, where nicotine is absorbed through the mucous membranes. While smokeless tobacco may seem less harmful than smoking, it still poses significant health risks, including addiction, gum disease, tooth decay, and increased risk of certain cancers, particularly in the mouth and throat.. Only products designed to be chewed or inhaled are legal in the UK (ASH, 2024).

Specific types of SLT include (ASH, 2024):

Naswar is a smokeless tobacco usually containing powdered tobacco, slaked lime and indigo. It is used by sniffing (nasally) or ‘dipping’ (placing a pinch under the tongue or in the cheek where it is stored.
Paan (also known as Betel quid) is commonly used in many Asian communities. It can be prepared in a variety of ways but usually contains sliced areca nut, slaked lime and catechu, wrapped in betel leaf. The resulting quid is then placed in the mouth and sucked or chewed for its psychoactive effects. Paan is itself not a tobacco product, but it is often mixed with tobacco as an auxiliary ingredient.
Gutkha is a mixture of tobacco and pan masala.
Khaini is dried tobacco and slaked lime.
Zarda is a moist or dry chewing tobacco mixed with a variety of colourings, spices, and perfumes.

Common Impacts of smoking on Health

Both smokers and secondhand smokers are at high risk for a variety of ailments due to smoking. Other essential organs are also impacted, in addition to the respiratory system. It is commonly known that smoking increases the risk of cancer and cardiovascular problems. Eighty to ninety percent of lung cancer deaths are related to cigarette smoking, which is the leading risk factor for the disease (Onwuzo et al., 2024).

Stroke
Diabetes
Cardiovascular diseases
Cancer

Other negative impacts on health include

Eye disease
Miscarriage
Erectile dysfunction
Fertility issues
Premature aging

Smoking cessation

Smoking cessation generally known as stop smoking or quit smoking is a process of discontinuing tobacco smoking.

Quitting smoking means breaking the cycle of addiction and fundamentally rewiring the brain to stop craving ‘Nicotine’ (Fletcher, 2023).

Strategies for Smoking Cessation:

Smoking cessation can be a challenging but incredibly rewarding journey. Here are some strategies that can help:

Set a Quit Date: Choose a specific day to quit and stick to it. This gives you time to prepare.
Identify Triggers: Recognize situations, people, or feelings that make you want to smoke and develop a plan to avoid or cope with them.
Seek Support: Share your goal with friends and family or consider joining a support group. Counseling can also be beneficial.
Consider Nicotine Replacement Therapy: Products like patches, gum, or lozenges can help ease withdrawal symptoms.
Prescription Medications: Talk to a healthcare provider about medications that can help with cravings and withdrawal.
Develop Coping Strategies: Find alternatives to smoking, such as exercise, deep breathing, or engaging in hobbies.
Stay Busy: Keep yourself occupied with activities that distract you from cravings.
Celebrate Milestones: Acknowledge your progress and reward yourself for milestones, whether it’s a day, a week, or a month smoke-free.
Learn from Relapses: If you slip up, don’t get discouraged. Analyze what happened and use it as a learning experience.
Stay Motivated: Remind yourself of the benefits of quitting, such as improved health, saving money, and feeling better overall.

What happens when you quit smoking?

Quitting smoking triggers a series of physical and mental changes in your body, often leading to both immediate and long-term health benefits. Here’s a general timeline of what happens when you quit (Medical News Today):

Timeline after you Quit Smoking

Within Minutes to Hours

Heart Rate and Blood Pressure: Your heart rate and blood pressure begin to drop toward normal levels.
Carbon Monoxide Levels: The level of carbon monoxide in your blood decreases, allowing oxygen levels to improve.

1 to 3 Days

Nicotine Withdrawal: You may start experiencing withdrawal symptoms, such as irritability, cravings, anxiety, and difficulty concentrating.
Taste and Smell: Your senses of taste and smell may begin to improve.

1 to 2 Weeks

Respiratory Improvements: Your lung function starts to improve, and you may notice less coughing and shortness of breath.
Circulation: Blood circulation improves, making physical activities easier.

1 to 9 Months

Coughing and Sinus Congestion: Coughing and congestion decrease, and your lungs begin to repair themselves.
Energy Levels: You may feel more energetic as your body heals.

1 Year

Heart Disease Risk: The risk of coronary heart disease is cut in half compared to that of a smoker.

5 Years

Stroke Risk: Your risk of stroke can drop to that of a non-smoker after 2-5 years.

10 Years

Cancer Risks: The risk of lung cancer decreases significantly, and your risks for other cancers (like mouth, throat, and esophagus) also diminish.

Long-Term

Overall Health Benefits: Quitting smoking can lead to a longer life, reduced risk of chronic diseases, improved quality of life, and enhanced physical fitness.

While the journey can be challenging, many find that the benefits far outweigh the struggles. Support, whether from friends, family, or cessation programs, can make a significant difference in successfully quitting.

“Remember why you wanted to quit in the first place, and hold onto that reason.”

References

ASH. (2023). ASH Fact Sheet October 2023. https://ash.org.uk/uploads/Facts-At-A-Glance-Fact-Sheet.pdf?v=1697723952

ASH Fact Sheet. (2024). Tobacco and ethnic minorities [Report]. https://ash.org.uk/uploads/Tobacco-and-Ethnic-Minorities-Fact-Sheet-v3.pdf?v=1712223258

Fletcher, J. (2023, December 22). What happens after you quit smoking? https://www.medicalnewstoday.com/articles/317956#timeline

Onwuzo, C. N., Olukorode, J., Sange, W., Orimoloye, D. A., Udojike, C., Omoragbon, L., Hassan, A. E., Falade, D. M., Omiko, R., Odunaike, O. S., Adams-Momoh, P. A., Addeh, E., Onwuzo, S., & Joseph-Erameh, U. (2024). A review of smoking cessation Interventions: efficacy, strategies for implementation, and future directions. Cureus. https://doi.org/10.7759/cureus.52102

Professional, C. C. M. (2024, June 18). Smoking. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/17488-smoking