KARACHI, Oct 28: A research has found high prevalence of shisha smoking in medical students, with 76pc of them admitting that they are aware of the health hazards of the water pipe tobacco addiction.

The study was carried out by Arham Zavery, Faisal Qureshi, Arbab Riaz and Fatima Pervez, all students of the Dow International Medical College, under the supervision of Prof Javaid Khan of the Aga Khan University (AKU).

A total of 274 students — 59 female and 215 male — of two medical colleges in the city were interviewed for the study. Of them, it was found, 11 per cent female and 34 per cent male students were shisha smokers.

One fourth of the students said they smoked at shisha cafes, followed by 21 per cent at restaurants, four per cent said they smoked it at home, while the remaining students didn’t disclose the place where they smoked shisha.

Nearly half of them said that they took up smoking shisha under peer pressure, while 26 per cent of those interviewed also smoked other forms of tobacco, for instance, cigarette and cigars.


An overwhelming majority of the students (76pc) said they knew shisha contained tobacco though 14pc had doubts over its content and nine per cent categorically said shisha smoking did not involve tobacco.

Over 63pc students did not know that it was illegal to serve shisha in restaurants or cafes.

“Shisha smoking has become increasingly popular among the youth across the world though evidence suggests it is associated with many of the known risks of tobacco smoking, particularly cancer,” said Dr Prof Javaid Khan, chair of the National Alliance for Tobacco Control and a senior professor at the AKU.

According to Dr Khan, shisha has been known to the people of the subcontinent for the past four centuries as it was first introduced in this part of the world by a physician of Emperor Akbar as a safer form of tobacco use. However, he said, over the past few years, there had been a marked increase in number of shisha smokers in the country. “For youngsters, smoking shisha is enjoyable and fashionable as it symbolises a ‘modern’ way of life. “Many restaurants and cafes in major cities of Pakistan now offer shisha to their customers,” he said.

Citing data from his previous research on the same subject that involved university students of Karachi, Dr Khan said that 64.2pc of male and 37.9pc of female students had admitted smoking shisha at least once in their life.

The findings of yet another study that collected data from 71 institutions in six major cities of the country showed that the prevalence of shisha smoking was 20pc in youth, he said.

“These results show that the trend of shisha smoking has spread like an epidemic and is not confined to one major city but has spread all over the country,” he said, adding that this must be a matter of concern for the civil society and policymakers.

He said there were myths associated with shisha smoking that it was less dangerous than cigarette smoking because of ‘lower nicotine’ content. It was also not true that all tobacco toxins were filtered out by water in the pipe.

“These are all false perceptions. Patterns of waterpipe smoking may result in higher nicotine intake while there are many toxins which are not filtered out by the water at all,” he argued.

According to Dr Khan, the growing trend of shisha smoking has alarmed public health experts across the world and for the first time an international conference on waterpipe tobacco smoking was held in Abu Dhabi recently.

“The conference discussed for three days the rising trend of water pipe tobacco smoking in the world. A research done at a Syrian centre for tobacco studies was shared at the moot that showed that a single puff of shisha compared to a puff of cigarette released double the amount of nicotine and six times higher concentration of carbon monoxide,” he said.

He quoted Prof Alan Shihadeh of the American University of Beirut, who gave a presentation at the conference, as saying that an average session of water pipe smoking last between 30 and 45 minutes during which a shisha user inhaled up to 90 litres of toxins-filled air. The smoke from shisha, besides other toxic elements, contains hundreds of potentially dangerous heavy metals such as arsenic, cobalt, chromium and lead, he said.

Research on shisha use had shown that it could cause cancers of the esophagus, lungs, chronic obstructive lung disease, emphysema, low birth weight, asthma attacks and pneumonia.

“Additional dangers linked to shisha use are diseases resulting from pipe sharing and frequent addition to alcohol or psychoactive drugs. Shisha smoking can also transmit infections and viruses such as tuberculosis and herpes simplex according to one report,” he said.

Nicotine dependence, he said, might also result from repeated inhalation of tobacco smoke from shisha. Besides, there was some evidence that shisha use might also decrease sperm count in men.

“Children have an increased risk of developing lung infections, asthma and sudden infant death syndrome as a result of exposure to tobacco smoke,” he added.



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