Hookah facts for kids
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A hookah (Hindustani: حُقّہ (Nastaleeq), हुक़्क़ा (Devanagari), IPA: [ˈɦʊqːa]; also see other names), shisha, or waterpipe is a single- or multi-stemmed instrument for heating or vaporizing and then smoking either tobacco or flavored tobacco (often muʽassel). The smoke is passed through a water basin—often glass-based—before inhalation.
The major health risks of smoking tobacco through a hookah include exposure to toxic chemicals, carcinogens and heavy metals that are not filtered out by the water, alongside those related to the transmission of infectious diseases and pathogenic bacteria when hookahs are shared. Hookah and waterpipe use is a global public health concern, with high rates of use in the populations of the Middle East and North Africa as well as in young people in the United States, Europe, Central Asia, and South Asia.
The hookah or waterpipe was invented by Abul-Fath Gilani, a Persian physician of Akbar, in the Indian city of Fatehpur Sikri during Mughal India; the hookah spread from the Indian subcontinent to Persia first where the mechanism was modified to its current shape and then to the Near East. Alternatively, it could have originated in the Safavid dynasty of Persia, from where it eventually spread to the Indian subcontinent.
Despite tobacco being considered a taboo when the hookah was first conceived, its use became increasingly popular among nobility and subsequently widely accepted. Burned tobacco is increasingly being replaced by vaporizing flavored tobacco. Still the original hookah is often used in rural South Asia, which continues to use tumbak (a pure and coarse form of unflavored tobacco leaves) and smoked by burning it directly with charcoal. While this method delivers a much higher content of tobacco and nicotine, it also incurs more adverse health effects compared to vaporizing hookahs.
The word hookah is a derivative of "huqqa", a Hindustani word, of Arabic origin (derived from حُقَّة ḥuqqa, "casket, bottle, water pipe"). Outside its native region, hookah smoking has gained popularity throughout the world, especially among younger people.
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History
In the Indian city of Fatehpur Sikri, Roman Catholic missionaries of the Society of Jesus arriving from the southern part of the country introduced tobacco to the Mughal emperor Akbar the Great (1542–1605 AD). Louis Rousselet writes that the physician of Akbar, Hakim Aboul Futteh Ghilani, then invented the hookah in India. However, a quatrain of Ahlī Shirazi (d. 1535), a Persian poet, refers to the use of the ḡalyān (Falsafī, II, p. 277; Semsār, 1963, p. 15), thus dating its use at least as early as the time of the Shah Ṭahmāsp I. It seems, therefore, that Abu’l-Fath Gilani should be credited with the introduction of the ḡalyān, already in use in Persia, into India. There is, however, no evidence of the existence of the water pipe until the 1560s. Moreover, tobacco is believed to have arrived in India in the 17th century, until then another substance was probably smoked in Ahlī Shirazi's quatrain, perhaps through some other method.
Following the European introduction of tobacco to Persia and India, Hakim Abu’l-Fath Gilani, who came from Gilan, a province in the north of Persia, migrated to Hamarastan. He later became a physician in the Mughal court and raised health concerns after smoking tobacco became popular among Indian noblemen. He subsequently envisaged a system that allowed smoke to be passed through water in order to be 'purified'. Gilani introduced the ḡalyān after Asad Beg, the ambassador of Bijapur, encouraged Akbar I to take up smoking. Following popularity among noblemen, this new device for smoking soon became a status symbol for the Indian aristocracy and gentry.
Modern development
Instead of copper, brass and low-quality alloys, manufacturers increasingly use stainless steel and aluminium. Silicone rubber compounds are used for hookah hoses instead of leather and wire. New materials make modern hookahs more durable, eliminate odors while smoking and allow washing without risks of corrosion or bacterial decay. New technologies and modern design trends are changing the appearance of hookahs. Despite the obvious benefits of modern hookahs, because of high production cost and lack of modern equipment in traditional hookah manufacturing regions, most hookahs are still produced with older technologies.
Operation
The jar at the bottom of the hookah is filled with water sufficient to submerge a few centimeters (an inch or two) of the body tube, which is sealed tightly to it. Deeper water will only increase the inhalation force needed to use it. Tobacco or tobacco-free molasses are placed inside the bowl at the top of the hookah. Often the bowl is covered with perforated tin foil or a metal screen and coal placed on top. The foil or screen separates the coal and the tobacco, with the foil and the tobacco reaching maximum temperatures of 450 and 130 degrees Celsius (850 °F and 270 °F) respectively. These temperatures are too low to sustain combustion and considerably lower than the 900 degrees Celsius (1700 °F) found in cigarettes. A larger fraction of the smoke condensates of the hookah are produced by simple distillation rather than by pyrolysis and combustion, and as a result, would tend to carry considerably less of the pyrosynthesized compounds found in cigarette smoke.
As a result of suction through the hose, a vacuum is created in the headspace of the water bowl sufficient to overcome the small static head of the water above the inlet pipe, causing the smoke to bubble into the bowl. At the same time, air is drawn over and heated by the coals. It then passes through the tobacco mixture where due to hot air convection and thermal conduction from the coal, the mainstream aerosol is produced. The vapor is passed down through the body tube that extends into the water in the jar. It bubbles up through the water, losing heat, and fills the top part of the jar, to which the hose is attached. When a user inhales from the hose, smoke passes into the lungs, and the change in pressure in the jar pulls more air through the charcoal, continuing the process. Vapour that has collected in the bowl above the waterline may be exhausted through a purge valve, if present. This one-way valve is opened by the positive pressure created from gently blowing into the hose.
Health effects
Exposure to toxic chemicals
Tobacco smoke contains toxic chemicals, including carcinogens (chemicals that cause cancer). Water does not filter out many of these chemicals. The toxic chemicals come from the burning of the charcoal, tobacco, and flavorings. These chemicals can lead to cancer, heart disease, lung disease, and other health problems. The toxic chemicals include tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons (PAHs; e.g., benzo[a]pyrene and anthracene), volatile aldehydes (e.g. formaldehyde, acetaldehyde, acrolein), benzene, nitric oxide, heavy metals (arsenic, chromium, lead), and carbon monoxide (CO). Hookah smoking also increases the amount of carbon monoxide (CO) in a person's body to eight times their normal level. Compared to smoking one cigarette, a single hookah session exposes users to more carbon monoxide and PAHs, similar levels of nicotine, and lower levels of tobacco-specific nitrosamines. By inhaling these chemicals, hookah smokers are at increased risk of many of the same health problems as cigarette smokers. An average hookah smoking session smokers inhale 100–200 times more smoke inhaled smoking a single cigarette.
Exposure to pathogens that cause infectious diseases
When people share a hookah, there is a risk of spreading infectious diseases such as oral herpes, tuberculosis, hepatitis, influenza, and H. pylori. Using personal disposable mouthpieces may reduce this risk, but does not eliminate it.
Short-term health effects
Carbon monoxide (CO) in hookah smoke binds to hemoglobin in the blood to form carboxyhemoglobin, which reduces the amount of oxygen that can be transported to organs including the brain. There are several case reports in the medical literature of hookah smokers needing treatment in hospital emergency rooms for symptoms of CO poisoning including headache, nausea, lethargy, and fainting. This is sometimes called "hookah sickness". Hookah smoking can damage the cardiovascular system in several ways. Its use elevates heart rate and blood pressure. It also impairs baroreflex control (which helps to control blood pressure) and cardiac autonomic functioning (which has many purposes, including control of heart rate) Hookah use also acutely harms vascular functioning, increases inflammation, and harms lung function and reduces the ability to exercise.
Long-term health effects
Current evidence indicates hookah causes numerous health problems. Hookah smoking is associated with increased risk of several cancers (lung, esophageal, and gastric), pulmonary diseases (impaired pulmonary function, chronic bronchitis, and emphysema), coronary artery disease, periodontal disease, obstetrical and perinatal problems (low birth weight and pulmonary problems at birth), larynx and voice changes, and osteoporosis. Many of the studies to date have methodological limitations, such as not measuring hookah use in a standardized way. Larger, longitudinal studies are needed to learn more about the long-term health effects of hookah use and of exposure to hookah smoke. Oral health is also affected, notably dental and periodontal status
Effects of secondhand exposure to hookah smoke
Secondhand smoke from hookahs contains significant amounts of carbon monoxide, aldehydes, PAHs, ultrafine particles, and respirable particulate matter (particles small enough to enter the lungs). Studies have found that concentrations of particulate matter in the air of hookah bars were in the unhealthy to hazardous range according to the U.S. Environmental Protection Agency standards. The air in hookah bars also contains significant amounts of toxic chemicals, including aromatic hydrocarbons, carbon monoxide, nicotine, and trace metals. The concentrations in the air of all these toxic substances are greater than for cigarettes (for the same number of smokers per hour). During a typical one-hour hookah session, a user expels into the air 2-10 times the amount of cancer-causing chemicals and other harmful chemicals compared to a cigarette smoker. No studies have examined the long-term health effects of exposure to secondhand hookah smoke, but short term effects may include experience respiratory symptoms such as wheezing, nasal congestion, and chronic cough.
See also
- Bong
- Electronic hookah
- Health effects of tobacco
- Incense
- One-hitter (smoking)
- Thuoc lao
- Chillum (pipe)
- Pipe smoking
