Emerging Trend of Waterpipe use in Saudi Arabia

Abstract

Annually the tobacco epidemic kills more than 5 million people globally, one person die prematurely every six seconds in the world. In the Kingdom of Saudi Arabia about 30,000 people die every year because of smoking associated diseases. ⁽¹⁾

The waterpipe (WP) is known in different cultures with different names as Shisha, Hubble-bubble, Hookhah, Goza and Nargghile etc. It is centuries old tobacco use method which is witnessing a worldwide surge in popularity. Water pipe is widely used in Middle East , Northern Africa and in some parts of Asia and it is  gaining popularity in some Western countries .In some Arab countries less stigma is associated with water pipe than cigarette smoking.⁽²⁾

Many factors have contributed to recent waterpipe wide spread use, including sweetened and flavored waterpipe tobacco, its reduced harm perception, the thriving café culture & restaurants.  The passage of smoke through water is one of the reasons for common misperception that waterpipe use is less harmful than cigarettes. Actually health effects are influenced by type of tobacco, frequency and duration of use, volume of smoke inhaled and other factors. ⁽³⁾

Water pipe smoking is gaining popularity particularly in Gulf region. Its  smoke contain harmful constituents which is linked to variety of life threatening conditions including pulmonary diseases, coronary heart diseases, cancers and pregnancy related complications.⁽⁴⁾ Approximately three quarters of female university students in Egypt prefer smoking tobacco via a water pipe than smoking cigarettes because they believe it is less harmful. Water pipe users are at greater risk as they are exposed to greater overall amounts of nicotine, carbon monoxide and other toxins.⁽⁵⁾

Waterpipe smoking has adverse effects on general health and predispose to oral cancers. A positive correlation between lip and buccal cancers and WP smoking is proved. ⁽⁶⁾

A study was carried out among 1,652 secondary students aged 15 -19 years of both genders in Al Hass region of Saudi Arabia. Water pipe was used by 53.9%. Of the regular water pipe smokers 20.7% smoked on daily basis and 23.8% on weekly basis. Primary motive of WP use were outing with friends, for company and to avoid boredom. ⁽⁷⁾

A similar study conducted among selected schools students (13 to 15 years age) of Al Kharaj region of Saudi Arabia indicates 20 percent students were current smokers and 16% were ex smokers; influence of friends and smoking in family were important factors among current smokers.⁽⁸⁾

Analysis of nicotine content of 13 commercial brands of waterpipe tobacco was carried out using gas chromatography at toxicology Laboratory; University of Jordan revealed that WP smokers are not at lesser risk  than cigarettes smokers in relation to nicotine dependence. The inability of water to trap significant amount chemical substances present in tobacco (especially nicotine), and danger of combustion of additives like; glycerine, honey, and other flavors could be important factors to extrapolate the damage resulting from waterpipe smoking. ⁽⁹⁾

A study revealed that the prevalence of WP smoking in school students in the Kingdom ranged between 12 to 30 percent, which generally rose up to 37% in university students. High proportion of water pipe smokers among students might possibly reflect high socioeconomic status as highly educated parents might consider WP smoking a modern standard of living. WP use is increasing among women of different age groups also, including 14 percent of school girls, 11 percent of female university students and 16 % of female doctors. Other community groups as military personnel 30.5 percent and 15 percent of rural and desert inhabitants. ⁽¹⁰⁾

Social acceptability, poor knowledge of water pipe related health hazards and certain socio demographic characters are favoring the increasing current trend of water pipe use in Saudi Arabia. There is an urgent need to promote multi-disciplinary health education activities at different age groups in order to prevent adolescent and younger age from all type of smoking especially current trend of WP smoking, and to help smokers to quit.

Prevention and cessation of WP includes discouraging adolescents and adults who have never smoked, expanding legislation on water pipe café and banning on pro-tobacco advertising and sponsorship, besides all indoor workplaces should be no smoking area. Raising community’s awareness, firm legislation, and high taxation on tobacco products may prove effective. Studies indicate nicotine patches, gums, and nasal sprays containing small doses of nicotine, hypnosis, acupuncture and providing medical support for those wishing to quit are effective measures. Public interventions including laws and regulations regarding smoking café and restaurant should be rigorously implemented. ⁽¹¹⁾