May 2014, Volume 64, Issue 5

Letter to the Editor

Shisha...... modern society killer

Muhammad Sikander Ghayas Khan  ( Riphah College of Rehabilitation Science Lahore, Riphah International University, Lahore. )
Nameeka Shahid  ( Student, Riphah International University, Lahore. )
Qurrat-ul-Ain  ( Final Year MBBS Student, Dow University of Health Science, Karachi. )

Madam, throughout the world people are becoming more aware of their health and more inclined towards healthy living and eating. However in Pakistan people do not give due importance to health and indulge in habits which can be damaging as, shisha smoking. With the help of your journal I would like to elaborate on different abstracts taken from different health journals stating the severity of this issue.
Water pipes (shisha) are the first new trends of the 21st century.1 According to World Health Organization (WHO), an average pipe smoking of around one hour is almost equal to smoking of 200 cigarettes.2 Research shows that it affects two vital organs: Lungs and Heart adversely.1 We cannot overlook the infectious diseases like Herpes Simplex and Hepatitis A and many more which can be caused by sharing the same pipe.3,4 Also children who are exposed to such environment have an increased risk of getting lung disease like asthma and sudden infant death syndrome.5,6 The latest trend is the addition of alcohol and psychoactive drugs which make its use even more dangerous.5 The cafe owners argue on the base of a myth that the water in the base of the shisha works as a filter so the smoke inhaled is not bad but the reality is that water does not filter out cancer causing chemicals.7
According to Chairman of Niche Tobacco Advisory Group in Manchester "There\'s a misconception that shisha is not as bad for you as cigarettes, because tobacco is flavoured and passes through water first, but the carcinogen and nicotine are still there. So a regular shisha smoker can expect to be at risk to the similar health problems that cigarette smokers face, whether that\'s respiratory, heart disease or cancer."8
All the research done clearly shows that Shisha is addictive, hazardous and responsible in building up toxic levels of indoor air pollutants.2 The social nature of this type of tobacco use needs serious steps to be taken by the Government and health authorities to ensure public health and also protect passive smokers.9
Dear Madam we as a nation need to wake up to the hazardous nature of shisha smoking and its ever increasing trend. Though the research in this field is limited but still the findings so far are not positive and are enough to take serious actions.


1. Min Sohn R, Kawkab Shishani B, Ayako Okada R, Froelicher ES. Approaches to Smoking Cessation in a Cardiovascular Population.In: Dornelas Ellen A. (ed.) Stress Proof the Heart. Part II.1st ed. New York: Springer, 2012; pp 345-72.
2. Sharma Acharya E. Assessment of nicotine dependence and its demographic correlates among African American smokers. [thesis]. United States: University of Maryland; 2008.
3. Frequently Asked Questions About Hepatitis C. Public Health Agency of Canada. (Online) updated 2012 (Cited 2013 Dec 24). Available from URL:
4. All about Hepatitis. Australia: Goverment of Western Australia Department of Health, Public Health & Clinical Services. (Online) (Cited 2013 Dec 24). Available from URL:
5. Healthy Homes - Indoor Air Quality. University of Nebraska Cooperative Extension. (Online) (Cited 2013 Dec 24). Available from URL: secondhandsmoke.htm.
6. Asthma and Indoor Air Quality in the Home. California: developed by Community Action to Fight Asthma (CAFA). (Online) (Cited 2013 Dec 24). Available from URL: scehsc/pdfs/Tobacco%20Smoke.pdf.
7. Khan N, Iftikhar S, Siddiqui MU, Padhiar AA, Affanulhaq S. Effect of age and gender on the knowledge, attitude and practice of shisha smoking among medical and dental students of Karachi, Pakistan.J Dow Uni Health Sci 2010; 4: 107-12.
8. Qureshi H. Smoking shisha: how bad is it for you? Guardian News and Media Limited or its affiliated companies. (Online) 2011 (Cited 2013 Dec 30). Available from URL: society/2011/aug/22/shisha-smoking-how-bad-is-it.
9. Hipple B, Lando H, Klein J, Winickoff J. Global teens and tobacco: a review of the globalization of the tobacco epidemic. Curr Probl Pediatr Adolesc Health Care 2011; 41: 216-30.

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