The problem of smoking tobacco in form of cigarettes, and hookahs is a major concern among youths in relation to its adverse effects on health.

It is well-known fact that tobacco is one of the most widely used abused substances in the world because of the presence of a highly addictive major alkaloid stimulant—nicotine in it.  This nicotine abuse leads to the problem of adverse health effects including cancer, and pulmonary and cardiovascular diseases.

Hookah use among the present-day generation creates an alarming need considering its negative health effects.

Hookah smokers smoke at hookah lounges as well as in private homes.

Hookah tobacco (also known as waterpipe tobacco, maassel, shisha, narghile, or argileh) is a type of combustible tobacco that is smoked with a hookah (waterpipe).

Water-pipe tobacco smoking obsession has spread worldwide. Especially, the younger generation is besotted with mu’assel (shisha) and avidly use these for smoking. 

Flavors profiling in flavored hookah tobacco is an issue of increasing scrutiny for the health sector owing to its adverse effects on humans, especially being heated to produce smoke.

Tobacco smoke comprises a large number of chemicals and brand-specific flavors including hundreds of volatiles complex mixture attributed towards its toxicity and carcinogenic properties.

These additives added in commercial brands of mu’assel (shisha) imparts diverse taste with amusing aroma.

Hookah (water pipe) smoking is the inhaling of hookah tobacco smoke that has been generated by heating hookah tobacco with burning charcoal and passed through a partially-filled water jar.

The mechanism of hookah tobacco smoking is unique. First, the tobacco is heated indirectly with charcoal, then the smoke passes through a water bowl and finally is inhaled by the smoker through a rubber hose fitted with a mouthpiece.

Hookah tobacco products come in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon. 

Figure 1 - Hookah (water pipe) Smoking Apparatus

Harmful Effects of Flavored Hookah

Generally it is thought that smoking non–tobacco hookah is safe and does not cause toxicity but it is reported by researchers and scientists during their experimental studies conducted that even non-tobacco hookahs released smoke in the environment same like that of tobacco products. 

In all the flavoured products of tobacco, nicotine is the most potent and one of the most addictive drug present including hookah tobacco.

The concentration shows a variation although the average nicotine content ranges between 1.8–6.3% of 3.4 mg/g of tobacco depending upon the brand. 

In contrast to the misleading false ingredient statement ‘0.05% nicotine’ that is portrayed on most hookah tobacco packages, hookah smokers smoke 10–20 g of hookah tobacco head per one hookah smoking session which leads to an average amount from 36 to 126 mg. 

The major chemicals attributed to toxicity are fragranced ones, synthetically derived from petroleum smoking which leads to major health hazards.

The common signs of toxicity among youths involve cancer, birth defects, CNS disorders and allergic reactions. Some of these chemicals are addictive in nature for ex- menthol which increases the nicotine receptor density.

In fact, research shows that water pipe smokers may absorb even more of the harmful chemicals found in cigarette smoke because smoking sessions are typically longer.

A typical one-hour hookah session involves inhaling 100–200 times the volume of smoke from a single cigarette.

Hookah tobacco smoking has been associated with increased risk for lung and oral cancers, coronary heart disease, pulmonary disease, cough, respiratory problems, reduced lung function and decreased fertility.

The heating of charcoal not only creates smoke but also leads to the production of highly toxic gases like carbon monoxide, certain metals and other carcinogenic chemicals which can increase the risk of cancers and heart problems.

The burning of these flavoured items not only produces smoke but also releases a small amount of secondary smoke consisting of very fine particles spreading in the air and posing serious toxicity to persons present in the vicinity. 

Continuous Abuse Leading Problem Among Youths

The continuous and prolonged use of present-day well-known non-tobacco hookahs or flavoured hookahs is prevalent among youths and adults.

As per the data presented by National Adult Tobacco Survey (NATS) in the years 2013–2014, 20.2% of the youth population between the age group of 18–24 years used hookah ‘every day, ‘some days, or ‘rarely’.

The abuse of these items increased manifolds in the younger generation as per the report published on “Smoking and Tobacco Use” by the Centre for Disease Control and Prevention, United States as the studies show a vast increase between 22% to 40% from the past year.

There occurs a great upsurge in the abuse among youths aged from 19-30 years. The studies are not limited to this as the surveys conducted reveals a significant rise in hookah abuse i.e. nearly 1 in every 13 (7.8%) high school students in the United States had used a hookah to smoke.

Young adults who are not currently enrolled in college may also show similar behavior and risk perceptions as do college students who are abusing it.

Hence, the young population are at the apex of abusing these addictive substances due to a large number of factors including motivation, socialization and many more which may pose an alarming threat to their life.

Conclusion

Researchers and scientists according to a report published on the internet by Express News Service on 12th February 2021 state that present-day widely available substances in the form of herbal cigarettes, bidis, a blend of certain herbs rolled in tendu leaves etc. marketed with the tagline of ‘safety” and considered as a healthier alternative to traditional cigarettes are unhealthier and poses a serious risk to the user.

Usually, the packets of all the varieties of these flavored items of hookah do not contain any detail regarding the chemical constituents and other multiple flavoring additives.

The chemical constituents of these products is not been completely known to the users because the manufacturers remain silent about mentioning the chemical ingredients of the flavoring agents. 

The shortfalls in the measures owing to technical procedures for the identification of these additives are masking the data showing the presence of these carcinogenic flavored additives in such toxic herbal compounds and hookahs and thereby increasing the hazard potential for human health.

The need of the hour is to unequivocally establish a technique for chemical profiling of the flavouring additives using state of art.

Henceforth, directives must be taken by various state and central bodies and conventions must be made, policies must be framed to regulate tobacco products production in form of these FLAVORED HOOKAHS and their abuse, especially among youths to protect public health because “HEALTH IS WEALTH”