Shisha: Truth Behind Smokescreens

For many NYU Abu Dhabi students, their first encounter with shisha occurred in the UAE. Many others have smoked shisha previously, either as a result ...

Nov 2, 2013

For many NYU Abu Dhabi students, their first encounter with shisha occurred in the UAE.
Many others have smoked shisha previously, either as a result of being part of communities or cultures where shisha smoking is common or because of the rising popularity of shisha in Europe, the Americas and other regions around the world.
Even so, shisha has managed to remain enigmatic and simultaneously ubiquitous. Whether in the hands of hipsters in Williamsburg, The Mission or in the corners of harem and café scenes in Orientalist paintings, shisha has occupied a space as a known-unknown accessory for a while. This status and the unique nature of the waterpipe have given rise to rampant misconceptions about the health effects of smoking shisha.
Sophomore Lucia Salem recently decided to quit smoking shisha after she discovered that her initial perception of shisha was uninformed.
“Shisha [seemed] harmless … and it tastes good so it doesn’t feel like it’s bad for you,” said Salem.
Because shisha is disassociated from the perceptions many hold of smoking, a variety of misconceptions exist about its health effects. Smoking is understood as something that burns the throat, feels painful or otherwise is directly connected to harm. Many uninformed beliefs surround shisha, from the idea that shisha is flavored and therefore cannot cause harm — and that it's not harmful if it doesn't feel odd or painful like the smoke of a first cigarette — to the idea that the water in the base of a shisha filters out carcinogenic or otherwise unpleasant chemicals from the smoke.
Aytunc Guler, a sophomore from Turkey, said that shisha has a different image than smoking.
“[Smoking shisha is not seen] as though you are smoking. It is seen like you are doing something very cultural,” said Guler.
This same sentiment is pervasive in general and not necessarily limited to cultures where smoking shisha originated.
If shisha smokers wish to make informed decisions on the activity, they should look beyond misconceptions, half-truths and the oft-mumbled, "One hour of shisha is equivalent to 20/40/100/200/X number of cigarettes" -- a line mentioned by both Salem and Guler. Instead, shisha smokers should turn to objective and unbiased medical studies to gain insight.
Unfortunately, studies on shisha remain scant and sometimes unreliable for a variety of reasons.  The shisha-hours-to-cigarettes claim is linked to a 2005 World Health Organization study that posited, “the waterpipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes.”
Critics called the findings “alarmist” and “ludicrous and anti-scientific.” The same study conceded that “there is surprisingly little research addressing tobacco smoking using a waterpipe given that there are many millions of current waterpipe smokers,” and lists a total of 12 general areas where research is needed.
Just as cultural appropriation of shisha in the West — by Iowa-farm-boys-turned-Brooklynites or the golden youth of any European city with a 19th century neo-classical city center — has a myriad of cultural and societal implications, so do studies originating from different areas of the world on the phenomenon of shisha. Studies from areas where shisha has been imbedded in the culture for centuries are more likely to return data and results that indicate that shisha is less detrimental than cigarettes or other forms of tobacco consumption.
A study completed at the university in Saudi Arabia found that shisha smoke contains 142 possibly harmful chemicals as opposed to around 5,000 in cigarette smoke. A study from Pakistan examining the difference between the carcinoembryonic antigen levels — indicators of the possibility of cancerous tumors — in shisha-exclusive smokers versus smokers of cigarettes found that these levels in shisha-exclusive smokers were significantly higher than those of non-smokers but nevertheless lower than those of cigarette smokers.
Countries without a tradition of shisha also seem to have their own xenophobic bias in relation to studies on shisha smoking. The United Kingdom's National Health Service website's only reference to shisha appears in a special subsection labeled "South Asian health" rather than in the "Stop smoking" category, and shisha is lumped in with paan and bidi. While not necessarily problematic, this could imply that the U.K. government views shisha smoking as something associated with immigrant and minority communities, ignoring its massive popularity among young people in general.
Even with the uncertainty amongst the scientific community and with the plethora of cultural and political issues inherent in many of the studies, a few things are certain about smoking shisha. According to the Center for Disease Control in the United States, “Water pipe smoking delivers the addictive drug nicotine and is at least as toxic as cigarette smoke.” Because “the tobacco is combusted,” as it is in smoking of any kind, it means that “even after it has passed through water, the smoke … contains high levels of toxic compounds, including carbon monoxide, heavy metals, and cancer-causing chemicals.” Smoking is smoking, which always means exposure to agents that cause “oral cancer, lung cancer, stomach cancer, cancer of the esophagus, reduced lung function, and decreased fertility … and heart disease.”
However, smokers such as Guler see smoking as part of his social routine and as a moment to come together with friends to chat and enjoy each other’s company.
“At the end of the day, you’re smoking something, so of course it’s not good for you … [but] kebab is harmful for you and you still eat it, shawarma is bad for you, but you still eat it,” said Guler.
Sam Ball is a contributing writer. Email him at
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