Water Pipe Tobacco Smoking Among Young Adults In Canada: A Health Concern

Why is this issue important?

Discuss About The Water Pipe Tobacco Smoking Among Young Adult.

Water pipe tobacco smoking has been increasing at an alarming rate in Canada. As per the Canadian Tobacco Use Monitoring Survey (CTUMS), WTS is used by 7% of teenagers aged 15 years, 14% of youth aged 15-19 and 28% of the young adults aged 20-25 ().  The use of the WTS has reached the concerning levels as it is extremely harmful for the health.  It implies for stringent regulations to decline the exposure of young people and children to the WTS. Thus document addresses the issue of the WTS in Canada and the impact of the issue on people due to greater selling of Hookah products at restaurants.  The document examines the existing regulatory framework in this regard to decrease the increasing prevalence of WTS. The issue is discussed explicitly with the available literature, including the research on this issue and its implications. The policies and regulatory framework marketing in other countries has also been discussed to determine its impact on the issue of WTS. The implications from the data are used for   recommending policies for Canada to curb the issue. The recommendations are also made for improving present strategies.  Lastly, the conclusion is drawn based on the discussion to decrease the use of WTS in teenage and young adults in Canada. 

In Canada, water pipe tobacco smoke is considered a health issue. Any product which contains tobacco should follow all the rules which are implicated for tobacco products. Even if it is WTS, Cigarettes or electronic cigarettes they must follow the regulation which are made for tobacco. The Canadian smoking frequencies are most reduced in civilization. As indicated by Canadian tobacco use monitoring survey (CTUMS) smoking pervasiveness is lesser than at any other time among Canadian grown-ups and youth (Hammal et al. 2013). In 2001, the Canadian smoker’s percentage was 22% which lower to 16% in year 2012. The everyday smoking rate of Canada is 12% that too they are smoking less cigarettes on regular bases.  In year 2001, 52% Canadian ever burned had stopped which expanded to 63% in year 2012. Overview demonstrated that only 7% of youngsters matured 15-17 are present smokers which down from 18% in the year 2001 (World Health Organization, and WHO Study Group on Tobacco Product Regulation 2015). The issue is important for its serious health implications and increase of health care cost on hospitals due to high prevalence of cancer.

What does research tell us

According to the World Health Organization, there are numerous type of water pipes used for tobacco inhalation, however the epidemiology of “hookah”, “Shisha” and “narghileh” has been increasingly covering the entire globe. Originally used in Indian, Africa and middle-east countries, the consumption has increased extensively throughout the world (more than 5 million frequent consumers) specifically in Russia, Vietnam and Syria in last 20 years (Ramôa, Eissenberg and Sahingur 2017). This water pipe tobacco device is divided into three sections with a head bowl, in which tobacco is placed, a body having water and a hose with a water pipe containing mouthpiece. In this setting, water pipes employ indirect heat to the tobacco containing bowl and then the user draws smoke down through the water body into their mouth, the watery solution carriers sugary molasses and with that some flavoring agents such as apple, banana, vanilla, orange and other flavors that attracts the users to consume such water tobacco (Cobb et al. 2011). Besides its taste, there is another factor that increases its popularity among younger generation. Further, it should be understood that while going through the water bowl, the smoke gets cooled and hence, even the first time smoker can inhale that cold smoke deeply in extensive amount into their lungs and rise of cancer patients.  

The cause of the increasing prevalence of the issue in Canada is the misconception among younger generation that this water pipe tobacco smoking has fewer side effects than the cigarette smoking and hence they use it in higher quantity for longer time (Middlekauff et al. 2014). But study proved that WTS has same highest nicotine exposure, 3.75-fold larger COHb (Carboxyhemoglobin- this detected in blood when carbon monoxide is inhaled) and 56-fold bigger gulped smoke volume. This finding says that WTS presents substantial risk of dependence, disease, and death Rammah et al. (2013).

The reason for spread is also the social acceptability of the product due to café and restaurant cultures where these products are served without any regulation Canada. Researchers has found that maximum of the first time smokers of water pipes enjoy with their family, friends and relatives and it is used a fun session in family gatherings (Middlekauff et al. 2014). The involvement of this in social gathering in Canada has originated from Middle East countries.  During Ramadan, young Muslim people are served with water pipe tobaccos after they break their fast. Further, introduction of different flavored hookahs has increased its consumption rate to a large extent in which the ratio of males and female are nearly equal (Maziak et al. 2014). Therefore, due to these above-mentioned reasons, the WTS has become one of the serious concerns in Canada.

Health complications

Researchers have been intensively focused to understand the effect of WTS on people using it as well to the passive smokers of the smoke. The world health organization, in a recent advisory against the WTS has explained the way it effects the health of consumers (El-Zaatari et al. 2015). The primary toxicant that can affect the health is nicotine that makes the consumers addicted to the product and increases their risk of lung, heart and kidney related disorders. The report from Maziak (2013) showed that WTS using is as danger as using cigarette smoking which may cause low birth weight, impaired pulmonary function, cardiovascular disease and severe systemic disease including malignancy. Whereas, Maziak (2013) determined that water pipe tobacco smoking can cause oral health problems like periodontitis, dry socket, premalignant lesions, and oral and oesophageal cancer. In a recent study done by Waziry et al. (2017) the researchers were determined to understand the effect of WTS on consumers and for that they conducted a systematic review. They found that the excessive smoking was related to COPD or respiratory diseases and starting from wheezers to bronchitis, the critical nature dependent on the duration and intensity of the smoking rate. This even causes gastro-oesophageal, bladder cancer, hepatitis c infection, gastric carcinoma, worse life quality and metabolic syndrome in extensive smokers (Primak et al. 2013).

It is a common conception related to hookah or water pipe smoking is that despite of presence of nicotine, it is easier to quit this smoking as it does not make people addicted. To understand the fact several researchers conducted researches. Giovino et al. (2012) also researched about this concern and for this, they chose a community, which has this habit in their roots and they are the Arab-Americans. They conducted this assessment in Texas where more than 40,000 Arab origin people reside. The researchers demanded self-participation form the locals and those data were collected who answered all the questions without any force. IT was found that from 340 responders of the community, only 27% showed willingness about quitting and within that only 30% were able to quit smoking.  in an another research article, more than 1700 students of Jordan having age group 15 to 25 were sked to fill a survey form and from the data collected in can be implemented that more than 68% students wanted to quit smoking however only 68% of them were able to do that with their strong will power (US Department of Health and Human Services 2014). Hence, it can be said that WTS also affects people by its addictive nature and due to that despite of many attempts, people were unable to stop using WTS and many of them tried to stop WTS but were unsuccessful. Water pipe-particular suspension programs that address one of a kind highlights of water pipe tobacco smoking which depends on its social centrality, social uses, and irregular utilize example and qualities and inspirations of clients who need to stop are required. Suggestions are given to move water pipe stop intercession advancement forward (McMillen et al. 2012).

Smoking cessation

In this examination, rats were presented to WTS by entire body presentation for a month, and results were contrasted with a control crowd presented just too outside air. We found that WTS encouraged obstructed short and long span memory loss. This result proves that WTS may disable intellectual capacity implying regulatory frameworks Alzoubi et al. (2015).

In Canada Tobacco Products Information Regulations (TPIR) is the primary law to require realistic wellbeing notices to be shown and ought to incorporate safety message containing data to enable individuals to stop smoking with exhibiting the poisonous emanation / constituent’s levels. Tobacco products labelling regulations is wellbeing related marks that must be shown on all tobacco items which likewise incorporate water pipe tobacco smoking. The Promotion OF Tobacco Products and Accessories Regulations prohibit the utilization of the expression “light” and “mild” on various tobacco items, retail shows and in addition on tobacco embellishments (World Health Organization, and WHO Study Group on Tobacco Product Regulation 2015).

In Canada they restricted the offer of tobacco items to youngster 18 years old or less and check identity card such as driving licence or passport for the age. Tobacco makers and shippers must furnish health Canada with yearly report which incorporates deals information, fabricating data, contains of tobacco, lethal constituents, toxic explore, undertaking activities. Smoking is not allowed when the person is sitting with children or youngster while driving (Hammal et al. 2013).

The Food and Drug Administration of the United States of America has also implemented several rules in the states so that the extensive use of this tobacco form can be regulated. It should be mentioned that there are more than 230,000 middle school students and more than 700,000 high school students consume it. The primary reason for such intense consumption is the availability of the product in different flavours which attracts most of the teenagers and younger people to consume it on daily basis (Khayatzadeh-Mahani et al. 2017). The primary step the FDA took in the year 2016 was, inclusion of this product in the tobacco containing products range so that while selling such products, company had to show the warning related to cancer. Further through this, the FDA regulated several steps such as manufacturing, import, packaging, labelling, advertising, promotion, sale and distribution of water pipe smoking related products, however it excluded products such as lighters, tong, and external burners which are important portions of hookah related products (Regmi et al. 2017).

After these, one more important regulation was implemented by the USA government which was related to parts and components of this water pipe smoking related products. These were regulated under different acts such as the Federal Food, Drug and Cosmetic act and regulated the flavouring agents, hose cooling attachments, the hookah or water pipe vessel, wood made charcoal, coconut shell and the electric heating system and the water filtration base additives due to which such flavoured smoke used to generate (Regmi et al. 2017). Besides these, to regulate the production of hookah jars and its retails, the FDA also regulated the manufacturing of the hookah jars, required nicotine by implementing warnings and advertisements, and their sale of hookah pipes. Importing costly hookah jars and attachments form other country was also regulated with excess taxation and if any violation occurred, then there was different FDA approved regulatory procedures using which violations can be reported to the respective authority (Khayatzadeh-Mahani et al. 2017).

In the United Kingdom, hookah has been banned by the government as it has much more harmful effects than that of the cigarettes. Before implementation of the legislation, a detailed investigation was carried out so that identification of the facts that affects the health of the consumers can be collected and utilized in the regulatory process (Goniewicz et al. 2012). The first regulation was related to the product labelling and hence, these products were included on the consumer protection act 1987. Further a set of secondary legislation was also implemented such as the tobacco products regulations 2002, a further amendment of this act in 2007, guidance related to warnings for tobacco products. Besides this, the government mandates the presence of warning signs on shisha and other hookah related products with messages such as tobacco kills and “smoking not only harms the consumers but everyone around” (Salvi 2016). Further, the authority for food and drug administration also specified that these products should contain a code or identification marking and it should also contain the date of production, the ingredients and the date and time of manufacturing so that while consumption, the consumer can understand the freshness of the product. In this context, the companies were also banned to use phrases such as ‘light’ and ‘moderate’ level of tobacco as minimal level of tobacco is also deleterious for health of the consumer (Jawad et al. 2016).

The regulation also banned the companies producing shisha and other hookah related products to use their trade mark, brand name and other famous representation as it can mislead the consumer to consume the product. Further, it also mentioned that all the used ingredient and their adverse effects should also be presented in the product label so that consumers can decide to consume it or not (Salvi 2016). Further in case of selling, advertisement and underage sales, the UK government was able to create a simple and strictly regulated legislation, that inhibited the sellers to sell their tobacco containing product to underage individuals, as per the Primary legislation: Children and Young Persons Act 1933 (as amended), further increased the taxes on such product so that production, manufacturing, selling and buying can be regulated and controlled (Goniewicz et al. 2012).

The regulations on water pipe smoking in Canada have resulted in many different outcomes, which have helped to increase awareness of the population towards the risks of smoking water pipes. From the example of these three countries, where the rate of water pipe tobacco smoking is at higher level, it can be understood that government is active and willing to control such products so that Youngers can be protected from addiction. The legislations have implemented a mandate to all outlets that provide water pipe smoking to properly label the products, which can enable the customers to understand the contents of the smoke, and how they can affect them. This can be helpful for the customer’s to make an informed choice, and also prevent incorrect information being given to them. This has also resulted in the reduction of smoking water pipes since the implementation of these policies in Canada by about 15%.

In USA, the regulation regarding the water pipes have shown better results, with the withdrawal of many businesses from this sector, and the subsequent reduction in the sales of water pipe smokes (reduction by about 25%). The legislation has also focused in the proper labeling of the products, and includes the adverse effects of the smoke from the water pipe on the health of water pipe smokers. The legislations have also focused on the effects of second hand smoking, thereby ensuring that the places offering the water pipe smoking or hookah are isolated from non smokers. This is an effective strategy in preventing the dangerous smokes to affect the non smoker’s health.

In the UK, the implementation of policies against the use of water pipes or hookahs has been the most effective, as the policies have helped the banning of hookahs. This is the most significant development in anti-smoking policies that helped top protect both the non-smoking as well as the smoking communities from the adverse effects of the hookah. This have consequently have led to the cessation of the use of hookahs in public places, as well as an overall reduction in the report of respiratory illnesses related to the use of water pipes. Additionally, the stricter laws also have helped to improve the awareness of the people against smoking hookahs, as the people became more aware of the adverse effects of hookah smoke on the lungs.

Conclusion

Water pipe tobacco smoking (WTS) is commonly known as hookah among young adults. It is a worldwide well-being peril that executes around five million individuals yearly. This is an old tradition which is followed in Eastern Mediterranean countries, the Middle East and parts of Asia. WTS is a mixture of wood charcoal, tobacco, Water and water pipe (it is an appliance which is used for inhale). In this assignment to understand the effect of water pipe tobacco smoking, three countries was chosen such as the United States of America, The United Kingdom and Canada and the rules and regulations of these in the context of Water pipe tobacco smoking was discussed. Further in the assignment, the implication of these regulation in maintaining the consumers behaviour and attitude towards consuming such products and the rate of decrease in the smokers has been incorporated so that the strength of the regulation can be assessed. Finally, a set of recommendations were provided so that the regulation and laws related to Water pipe tobacco smoking can be maintained.

References

Akl, Elie A., Mohammed Jawad, Wai Yim Lam, Rawad Obeid, and Jihad Irani. "Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review." Harm reduction journal 10, no. 1 (2013): 12.

Akl, Elie A., Swarna Gaddam, Sameer K. Gunukula, Roland Honeine, Philippe Abou Jaoude, and Jihad Irani. "The effects of waterpipe tobacco smoking on healthcare outcomes: a systematic review." International journal of epidemiology 39, no. 3 (2010): 834-857.

Alzoubi, Karem H., Omar F. Khabour, Eman A. Alharahshah, Farah H. Alhashimi, Alan Shihadeh, and Thomas Eissenberg. 2015. The effect of waterpipe tobacco smoke exposure on learning and memory functions in the rat model. Journal of Molecular Neuroscience 57 (2): 249-56.

Cobb, Caroline O., Alan Shihadeh, Michael F. Weaver, and Thomas Eissenberg. 2011. Waterpipe tobacco smoking and cigarette smoking: A direct comparison of toxicant exposure and subjective effects. Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco 13 (2): 78-87.

Cobb, Caroline, Kenneth D. Ward, Wasim Maziak, Alan L. Shihadeh, and Thomas Eissenberg. "Waterpipe tobacco smoking: an emerging health crisis in the United States." American journal of health behavior 34, no. 3 (2010): 275-285.

El-Zaatari, Ziad M., Hassan A. Chami, and Ghazi S. Zaatari. "Health effects associated with waterpipe smoking." Tobacco control 24, no. Suppl 1 (2015): i31-i43.

Giovino, Gary A., Sara A. Mirza, Jonathan M. Samet, Prakash C. Gupta, Martin J. Jarvis, Neeraj Bhala, Richard Peto et al. "Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys." The Lancet 380, no. 9842 (2012): 668-679.

Goniewicz, Maciej Lukasz, and Wioleta Zielinska-Danch. "Electronic cigarette use among teenagers and young adults in Poland." Pediatrics 130, no. 4 (2012): e879-e885.

Hammal, Fadi, Alyssa Chappell, T. Cameron Wild, Warren Kindzierski, Alan Shihadeh, Amanda Vanderhoek, Cong Khanh Huynh, Gregory Plateel, and Barry A. Finegan. "‘Herbal’but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafes where they are served." Tobacco control (2013): tobaccocontrol-2013.

Jawad, Mohammed, Andy McEwen, Ann McNeill, and Lion Shahab. "To what extent should waterpipe tobacco smoking become a public health priority?." Addiction 108, no. 11 (2013): 1873-1884.

Jawad, Mohammed, Elham Choaie, Leonie Brose, Omara Dogar, Aimee Grant, Elizabeth Jenkinson, Andy McEwen, Christopher Millett, and Lion Shahab. "Waterpipe tobacco use in the United Kingdom: a cross-sectional study among university students and stop smoking practitioners." PloS one11, no. 1 (2016): e0146799.

Khayatzadeh-Mahani, Akram, Eric Breton, Arne Ruckert, and Ronald Labonté. "Banning shisha smoking in public places in Iran: an advocacy coalition framework perspective on policy process and change." Health policy and planning 32, no. 6 (2017): 835-846.

Martinasek, Mary P., MPH, CHES, McDermott, Robert J., PhD, FAAHB, and Martini, Leila, MPH, MLS. 2011. Waterpipe (hookah) tobacco smoking among youth. Current Problems in Pediatric and Adolescent Health Care 41 (2): 34-57.

Maziak, Wasim, Ziyad Ben Taleb, Raed Bahelah, Farahnaz Islam, Rana Jaber, Rehab Auf, and Ramzi G. Salloum. "The global epidemiology of waterpipe smoking." Tobacco control (2014): tobaccocontrol-2014.

Maziak, Wasim. "The waterpipe: an emerging global risk for cancer." Cancer epidemiology 37, no. 1 (2013): 1-4.

McMillen, Robert, Jeomi Maduka, and Jonathan Winickoff. "Use of emerging tobacco products in the United States." Journal of environmental and public health 2012 (2012).

Middlekauff, Holly R., Jeanie Park, and Roya S. Moheimani. "Adverse effects of cigarette and noncigarette smoke exposure on the autonomic nervous system: mechanisms and implications for cardiovascular risk." Journal of the American College of Cardiology 64, no. 16 (2014): 1740-1750.

Primack, Brian A., Stephanie R. Land, Jieyu Fan, Kevin H. Kim, and Daniel Rosen. "Associations of mental health problems with waterpipe tobacco and cigarette smoking among college students." Substance use & misuse 48, no. 3 (2013): 211-219.

Rammah, Mayyasa, Farah Dandachi, Rola Salman, Alan Shihadeh, and Marwan El-Sabban. "In vitro effects of waterpipe smoke condensate on endothelial cell function: a potential risk factor for vascular disease." Toxicology letters 219, no. 2 (2013): 133-142

Ramôa, C. P., T. Eissenberg, and S. E. Sahingur. 2017. Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare. Journal of Periodontal Research 52 (5): 813-23.

Regmi, Kabindra, Dinesh Kaphle, Sabina Timilsina, and Nik Annie Afiqah Tuha. "Application of Discrete-Choice Experiment Methods in Tobacco Control: A Systematic Review." PharmacoEconomics-Open (2017): 1-13.

Salvi, Sundeep. "The Perils of Waterpipe or Hookah Smoking: Time for Action." (2016): 532-534.

US Department of Health and Human Services. "The health consequences of smoking—50 years of progress: a report of the Surgeon General." Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 17 (2014).

Ward, Kenneth D., Kamran Siddiqi, Jasjit S. Ahluwalia, Adam C. Alexander, and Taghrid Asfar. 2015. Waterpipe tobacco smoking: The critical need for cessation treatment. Drug and Alcohol Dependence 153 : 14-21

World Health Organization, and WHO Study Group on Tobacco Product Regulation. "Advisory note: waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators." (2015).