One session of shisha is like smoking 100 or more cigarettes

It is a cardinal sin for a man to leave the bar smelling of a strange strain of strawberries like a house girl who just discovered body lotion. GRAPHIC | NATION

What you need to know:

  • If you take a walk through an upmarket shopping mall in Nairobi on a weekend  or visit clubs in Mombasa and Kisumu, you are likely to find teenagers in shisha lounges.
  • Thanks to aggressive marketing, which says some brands do not contain tobacco, many of these youngsters believe it is not just fashionable, but also harmless.
  • The situation is likely to get worse as the economy improves and more young people have money to spend on leisure.

Stacy Wangui, 25, knows the dangers of smoking tobacco-laced shisha only too well, but she just can’t  resist smoking the stuff. “I know a puff is like smoking 100 cigarettes or so. It can affect a woman’s fertility and cause many diseases, but why do we still drink alcohol yet we know it damages our liver?” asks the young mother rhetorically, shrugging her shoulders. 

“I don’t know how many times I inhale it, I take countless puffs because by the time I’m smoking shisha, I am usually semi-buzzed, anyway. Shisha is fun, it’s the new thing. I do it every two weeks with my friends because sometimes we are broke but if we had the money, we would do it every weekend,” she adds.

Ms Wangui and her friends consider smoking shisha in one of Nairobi’s upmarket shopping malls or in the house an  ideal way of  bonding over the weekend and although it’s tobacco-laced, she says it’s not like smoking a cigarette.

“Shisha is flavoured and does not smell like tobacco. It is not like holding a cigarette stick. Smoking cigarettes is so unattractive,” she says, as she mimics holding a cigarette with a sneer.

Ms Wangui says a friend of hers recently bought a shisha bong (or hookah) so for a night of hubble-bubble, all they need to do is buy the tobacco, flavours, a paper foil and coal, all of which are easily available in Nairobi. Once they have everything, they can inhale the night away.

“My 16-year-old brother taught me and my five friends how to smoke shisha to get a buzz. We draw on it and hold the smoke until the bong is passed around. I get a buzz when I deprive my brain of oxygen, then when I exhale, my brain feels refreshed.  It makes me feel hyped,” she offers.

RISKING CANCER

But Wangui and her friends are not the only ones who have taken up shisha smoking. It is a growing trend among the youth.

A reveller enjoys smoking Shisha at Abbysinia shisha joint in Nairobi on 11th April 2013. PHOTO | ANN KAMONI | FILE

“If you take  a walk through an upmarket mall in Nairobi on a weekend, or visit clubs in Mombasa and Kisumu, you are likely to find teenagers in shisha lounges, says Dr Peter Waweru Munyu, a pulmonologist and critical care specialist at the Aga Khan University Hospital.

The hip-hop generation wants to appear to have money, and one of the ways they express themselves is by buying expensive brands of cigarettes and smoking fine cigars from Havana, he says. 

Because they are young impressionable, it means more and more young people, especially educated women, are taking up shisha smoking. The misconception among these young people is that smoking shisha is less harmful than smoking cigarettes.

“Young women think shisha smoking is fashionable, but shisha has the same effects as cigarettes and can also alter the functioning of the brain,” says Prof Gerald Yonga, a consultant cardiologist and chairperson of the Kenya Cardiac Society.

Indeed, a research by the World Health Organisation, estimates that the volume of smoke inhaled in an hour-long shisha session is equivalent to smoking between 100 and 200 cigarettes.

On average, a cigarette smoker  inhales half a litre of smoke per cigarette, while a shisha smoker can take in anything from just under a sixth of a litre to a litre of smoke per inhalation.

Dr Munyu warns that when burnt, the tobacco, charcoal or coal used produces tar, which is known to have very high risks of  causing cancer. 

“It can cause cancer of the lungs, tongue, pancreas, trachea, bronchus, intestine, kidney, colon, rectum, mouth, lips, throat, and also increases the risk of heart disease,” he says.

The pulmonologist says the marketers of shisha are giving people a false sense of safety, marketing some of it as smokeless, yet it is still dangerous.

CONTAGIOUS DISEASES

A Reveller smokes Shisha at Carnivore grounds in Nairobi during the 54th edition of Blankets and wine on August 3,2014. PHOTO | GERALD ANDERSON | FILE

“Smokeless yet one is drawing in smoke? It might be possible to have  tobacco-less shisha, but these are business people. They would like to get as many people hooked to it so that the business grows. Although they might not lace it with tobacco, they can use other addictive drugs whose long-term effect on the lungs doctors don’t know yet,” Dr Munyu warns.

On average, smokers lose 15 years of life, according to statistics from the anti-drug abuse agency, the National Authority for the Campaign Against Alcohol and Drug Abuse (Nacada).

Smoking shisha, like smoking cigarettes, causes low sperm count, with men who smoke ending up having weak or no erections. It also leads to impotence at a young age, infertility in women and contributes to premature ageing.

“It’s very easy to tell a young woman who smokes. Her skin ages and loses its glow, and her lips become dark. She stops looking as nice as she would want to to,” says Dr Munyu, who also runs a clinic at the Aga Khan University Hospital that helps people quit smoking.

Sharing of the shisha tips also poses health risks as a smoker can easily transmit a disease to his or her colleagues. At the high-end clubs, everybody gets their own shisha tip but as they get drunk, few or none remember to change the tip every time the shisha pot goes round.

“A person who has already taken six beers changing a tip? Picture this; it can happen at the beginning of the shisha session, but they will stop at some point. Even among  those who smoke in high-end clubs and lounges, the shisha pipe moves from one person to another without them changing the tip. Diseases like tuberculosis can be spread through the sharing of tips,” says the pulmonary diseases specialist.

As the popularity of shisha smoking for recreation continues to grow among young adults, doctors warn that the habit could push up the number of tobacco smokers and drug users, even as the country fights to reduce smoking.

Rustic Bistro Shisha lounge. April 14, 2014 PHOTO | JEFF ANGOTE | FILE

Tobacco kills one out of two long-term users, or one person every six seconds globally. And as the country’s economy continues to grow, with more people  having disposable income to spend on luxuries like shisha and cigars, more Kenyans are likely to die from tobacco-related illnesses.

About 2.5 million Kenyan adults currently use tobacco (smoking and/or smokeless tobacco) according to the 2014 Global Adult Tobacco Survey, Kenya.  Most of the current smokers started smoking between the ages of 20 and 24, while others were initiated between the ages of 17 and 19. But these figures could be higher as more teenagers take up shisha and cigar smoking.

ENJOYED AT HOME

According to Euromonitor International, a market research firm, the tobacco industry in Kenya has seen a rapid shift in terms of consumer behaviour and trends.

While the sale of cigarettes continues to decline due to higher prices and general public awareness campaigns against tobacco, the use of flavoured tobacco (shisha) and electronic cigarettes is on the rise. 

Shisha lounges and bars are popping up in major towns in the country, with event planners offering it in  a variety of flavours at parties.  In the major towns, shisha smoking has become an integral part of partying. Even at alcohol-free parties, you will have shisha.

Smokers also buy the shisha bongs and make it at home. A bong costs anything from Sh4,000 to  Sh15,000 and includes hiring a shisha maker, buying the bong spare parts, shisha pens, pipes, coal and flavours. All these can be delivered to your doorstep.

All this is happening against the backdrop of an intense war against  tobacco use, with tougher laws. Last year, for instance, Nacada, in conjunction with the Ministry of Health, banned 19 shisha flavours found to contain bhang, heroin and cocaine.

But Dr Munyu says that is not enough. “We need to recognise that my sister, brother or child can be caught up in smoking and join the government in the fight,” he says.

New delivery systems of drugs through spiked juices, marijuana-laced cakes, biscuits, chocolates are also hampering the fight to curb tobacco and drug use, which is already burdening the healthcare system.

The situation is not helped by the behaviour parents who, according to Dr Munyu,  re setting wrong examples for their children. 

“It’s very hard to tell a child not to smoke if he sees his father or mother smoking cigarettes. In most cases, they will steal and smoke their parents’ cigarettes because smoking looks trendy,” he says

In addition, says Dr Munyu, “Young adults also have the wrong role models in society. Events such as the Masaku Sevens or “Shisha Celebrity Queens” are splashed all over the media. Although cigarette makers or shisha lounges might not actually advertise the stuff, the social media is doing the job for them,” he says.

MORE TOXIC

Dr Peter Waweru Munyu, a senior instructor, pulmonologist and critical care specialist at the Aga Khan University Hospital, uses a diagram in the Smoking Cessation Clinic to explain damages caused by tobacco to the lungs. PHOTO | COURTESY | AKUH

Smoking shisha is just as bad as smoking cigarettes

Shisha smoking is believed to have originated in Persia, Turkey, or India. It involves using a glass-bottomed water pipe in which flavoured tobacco is covered with a paper foil and roasted using charcoal or coal.

The tobacco smoke passes through a water pot before it is inhaled. With guava, apple, strawberry or mint flavour, the tobacco tastes smoother and smells sweet.

Shisha smoking is taking root fast in Kenya among young people in urban areas, with many bars setting up lounges for hookah lovers.

For about Sh500 to Sh800, two to five friends can get a shisha pot to share, compared with a packet of cigarette with 20 sticks, whose price ranges between Sh100 and Sh150, depending on the brand.  

Many smokers go for shisha thinking it is not as harmful as cigarettes. However, the tobacco is no less toxic inhaled via a hookah pipe, and the water in the hookah does not filter out the toxic ingredients in the smoke,” says Dr Munyu. Indeed, experts say the water is mainly for cooling the smoke.

While research on hookah smoking is in its early stages, the little  evidence available shows that it poses dangers such as the following:

  •  Hookah smokers actually inhale more tobacco smoke than cigarette smokers do because of the large volume of smoke they inhale in one smoking session, which can last as long as an hour.

  •  An hour-long hookah smoking session involves some 200 puffs, while smoking an average cigarette involves 20 puffs.

  •  The amount of smoke inhaled during a typical hookah session is about 90,000 millilitres, compared with 500–600 millilitres inhaled when smoking a cigarette.

  •  Unlike cigarettes, hookah smoke also contains by products of charcoal or wood cinder combustion, which can increase heart disease-causing agents. Hookah smoke contains high levels of toxic compounds including tar, carbon monoxide, nitric oxide, heavy metals and cancer-causing chemicals (carcinogens). In fact, hookah smokers are exposed to more heart disease-causing carbon monoxide and smoke than are cigarette smokers.

  •  High levels of benzene, a chemical in crude oil and gasoline, were found in hookah smokers and non-smokers in a US survey of people who attend social events where the water pipes are used. Benzene exposure is a known risk factor for leukaemia. There are no safe levels of benzene exposure.

  •  As with cigarette smoking, hookah smoking increases the  risk of getting many cancers including those of the lungs, mouth, throat, bladder and oesophagus.

  •  Hookah smoking delivers about the same amount of nicotine as cigarette smoking, leading to tobacco dependence. Shisha users are likely to graduate to using cigarettes and other drugs.

  •  Hookah smoke poses dangers associated with second-hand smoke. Second-hand smoke from hookahs can be a health risk for non-smokers. It contains smoke from the tobacco as well as smoke from the heat source (for example charcoal) used in the hookah.

  •  Sharing the hookah’s waterpipe can increase the risks of contracting communicable diseases such as tuberculosis and hepatitis.

  •  Babies born to women who smoke water pipes every day while pregnant weigh less at birth than babies born to non-smokers.

  •  Babies born to hookah smokers are also at increased risk of respiratory diseases.

  •  Shisha smokers are just as much at risk of reduced lung function and respiratory diseases as cigarette smokers.

  •  Shisha smokers are at risk of decreased fertility.

Source: Dr Munyu/CDC Statistics