Abstract

Hookahs are water pipes that are used to smoke specially made tobacco mixtures that come in a wide variety of flavors. They usually work by passing charcoal-heated air through the tobacco mixture and ultimately through a water-filled chamber. A user then inhales the smoke through a tube and mouthpiece. The youngsters of today mistakenly believe that smoking hookah or shisha are less harmful than smoking a regular cigarette because the tobacco is filtered through water. Sadly there is no scientific evidence for this statement. Unlike cigarette tobacco, the hookah tobacco is colorfully packed and sold in different flavors like apple, mint, cherry, chocolate, coconut, licorice, cappuccino, watermelon & candy which appeals the youngsters and convinces them to think, it's not as harmful as smoking a cigarette. Well, it’s like consuming a “sugar coated poison” and also many people smoke hookah in lounges, clubs & cafe, so it is perceived to be a social activity which is harmless & safe. The other shocking & dangerous side of this story is most of the tobacco marketed to hookah users does not carry a health warning, leading to the misperception that it is not harmful for the health. Hookah smoking is associated to Lung, bladder, stomach, esophageal and oral cancers. It also leads to Heart disease and other serious conditions, such as lung diseases and carbon monoxide poisoning.It also leads to Heart disease and other serious conditions, such as lung diseases and carbon monoxide poisoning.

Keywords

Introduction

A common misconception about hookah is that it is not addictive, or at least not as addictive as cigarettes. Many hookah blends are lower in nicotine than cigarettes, but studies have found that users may be getting just as much nicotine as cigarette smokers. This is because hookah smokers are exposed to more smoke. They tend to sit around the water pipe for longer than 30 minutes at a time, and sometimes for several hours. A daily hookah session of an average length equates to smoking 10 cigarettes a day, enough to get hooked. Some experts also believe that hookah addiction is more complex than simply getting hooked on nicotine. The mix of chemicals in hookah tobacco blends can lead to more complicated addictive behaviors. The social and relaxing atmosphere around the hookah smoking section can also add a psychological element to the addiction. A user can become dependent on that sense of relaxation at the end of the day and on the social interaction that comes with it [9].

4. Hazardous health effects & diseases caused by hookah smoking

Hookah smoke has high levels of harmful chemicals. These include tar, carbon monoxide, heavy metals and cancer-causing chemicals called carcinogens. In fact, hookah smokers are exposed to more carbon monoxide and smoke than are cigarette smokers. As with cigarette smoking, hookah smoking is linked to Lung, bladder, stomach, esophageal and oral cancers. It also leads to heart diseases and other serious conditions, such as lung diseases and carbon monoxide poisoning. Nicotine is an addictive drug that can have lasting damaging effects on adolescent brain development and has been linked to a variety of adverse health outcomes for the developing fetus. Short-term hookah use is associated with acute health effects, including increased heart rate and blood pressure, reduced pulmonary function, Mouth irritation, Labored breathing, Increased asthma attacks, Coughing, wheezing and Carbon monoxide intoxication. Hookah smoke poses dangers linked to secondhand smoke and hookah smoking by pregnant people is linked to low birth weight babies. Using an unclean pipe or sharing a pipe with other smokers is risky. It could raise your chance of getting a disease such as: The flu, Tuberculosis, Herpes, Hepatitis COVID-19. For kids and teens, the dangers of hookah become even more severe. Although some hookah products are made with tobacco-free nicotine, they can still increase mood swings, irritability, anxiety, depression and learning difficulties [10].

5. The emergency need for awareness campaigns to educate the public on Hazards of Hookah smoking

Hookah smoking is now a serious health threat especially for adolescents. Implementation of planned interventions & regular health campaigns can help reduce hookah smoking and reduce the lack of awareness level in the society which has lead to a monumental rise in consumption of hookah especially by children. Hookah smoking among young people and adolescents is now a public health concern. Tobacco use is the fourth risk factor contributing to the global burden of disease and has created health, social and economic problems in the world [11].  Smoking has killed 100 million people in the 20th century, and if the current trend continues, it can cause 1-billion deaths in the 21st century, and by 2030 the related deaths are expected to be more than 8million over a year, with more than 80% of all deaths occurring in low-income and developing countries (World Health Organization, 2013) [12]. Dehdari et al., 2012 reported that many people mistakenly think that hookahs are harmless or are less harmful compared with cigarette smoking, while in many cases hookahs are more harmful [13]. Berg et al., 2015 et al explained hookah smoke contains more than 4000 different chemicals substances, most of which are produced during the burning process and include more than 40 carcinogens, including hydrocarbons and heavy metals  [14]. Hookah smoking predisposes people to diseases such as oral cancer, lung, decreased respiratory function, reduced fertility and cardiovascular disease, because of its high concentration of carbon monoxide, nicotine, tar and heavy metals. Martinasek et al., 2011 said that, the use of a common oral tube facilitates the spread of infectious diseases such as respiratory infections, tuberculosis and digestive diseases [15]. Sadeghi et al., 2019 explained the prevalence of hookah smoking in some areas is higher than cigarette smoking. Around 100 million people smoke hookah every day [16]. Minaker et al., 2015 analyzed Today, the phenomenon has become widespread amongst youth, and has become popular in such a way that hookah has become a social phenomenon [17].The governments all over the world, public & private agencies, NGO's & the civil societies has to formulate campaigns to bring in awareness among the public to destroy this hookah monster.

6. The role of Ban Hookah Campaign in convincing the Government of Haryana for passing the Law for Banning Hookah

The "BAN HOOKAH" campaign organized by "MEDFIT INDIA MOVEMENT under the team work of Dr.J.C.Balachandar, Shiv Swaroop Singh, Saanvi Agrawal,  Dr.S.Irshad Ahamed, Dr.A.Ayeshamariam, B.C.Aditya Jeyeachandran and Dr.M.Jayachandran was effective in reducing the hookah smoking habits by increasing the awareness level in the society and improving the constructs of the protection motivation theory among the youth through hoardings all over the state, leaflets in the daily newspapers, social media campaigns, talks & lectures in schools & colleges on the harmful health effects of hookah smoking and breaking the myth around the normalization of hookah smoking. The protection motivation theory, which was used as the key ingredient of the ban hookah health campaign, is one of the theories about protective behaviors that was introduced by Rogers in 1975 [19] and since then has been adopted to predict and intervene in health behaviors [18]. This theory suggests that the acceptance of a recommended health behavior is the result of an individual’s motivation for self-protection. Rogers suggested that fear can affect protection motivation through self-efficacy, response efficiency, response costs, perceived susceptibility and perceived severity  [19].The protection motivation theory provides an important social cognitive description of protective behaviors. This theory involves two stages: Threat Appraisal (perceived susceptibility, perceived severity and rewards)and Coping Appraisal (perceived self-efficacy, response efficiency and perceived cost). These two stages lead to motivation and behavior [20], they also worked on Community-based health promotion which is a comprehensive, systematic and coordinated approach aimed at constructing proper community norms through education and community organizations [21]. The unique features of community-based programs are that it targets the entire community at many levels and has many educational components and encourages public participation [22]. The community-based educational campaigns aimed at conveying messages about a specific behavior in the target group like saying no to hookah or quitting hookah smoking. Through Health campaigns they invite people and authorities for participation and attract their attention to collective interests and benefits [23]. Through the ban hookah campaign they were successful in convincing the government of Haryana in passing a law which banned the hookah in the state of Haryana and also embraced and acknowledged the harmful health effects of hookah smoking through the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Haryana Amendment Bill, 2024, [24] with major efforts put in by Dr.Amit Kumar Agrawal IAS, the additional principal secretary to the chief minister of Haryana, who played an instrumental role in bringing the governments attention towards this hookah monster.

CONCLUSION

Tobacco is a preventable cause of morbidity and mortality worldwide. In recent years, hookah use increased mainly as an alternate tobacco smoking method, under the assumption of it being “less harmful” . Lately, as also noted by the American Heart Association statement, hookah has been considered a global threat—in part—due to the high increase of its use, in addition to the deleterious effects it has on human health. Smoking hookah may look glamorous to some, but it’s every bit as addictive as cigarette smoking — and maybe more harmful. But that hasn’t stopped this ancient pastime from seeing a revival among high school and college students. The fruity smell of flavored tobacco attracts young people, misleading them to believe hookah is a safe way to smoke tobacco. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which will lead to more severe negative health effects. Hookah bars and lounges, where a communal hookah is placed in the center of each table, are also popular among college students and young adults. The social atmosphere surrounding hookah creates confusion about its safety. The truth, however, is that the danger of hookah is just as real as that of other tobacco products leading to deadly diseases and needs a ban all over the world. This was the principal reason behind launching the "BAN HOOKAH CAMPAIGN" and this also clearly proves banning hookah smoking is inevitable to safeguard the health status of the youth population/citizens along with creating an awareness against the disease causing effects of hookah smoking. By passing a law banning hookah smoking, the government of Haryana has sent a loud & clear message to the public on the harmful & dangerous effects of hookah smoking and this deserves a big round of applause. The state of haryana has set an universal precedent by rightly banning it. FINALLY, THE TIME HAS COME FOR THE GLOBAL BAN OF HOOKAH.

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