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Waterpipe Smoking in Public Places Measures for Waterpipe Must Remain a Comes Into Effect in the City of Edmonton

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Waterpipe Smoking in Public Places Measures for Waterpipe Must Remain a Comes Into Effect in the City of Edmonton July 02, 2020 TOBACCO, VAPING & CANNABIS INFORMATION SERIES citing “relaxation after a stressful day at Waterpipes school” (Cloud 9 Hookah Lounge & Bar, Calgary) or hosting themed nights with onsite Background DJs and karaoke. Such promotion of Waterpipes, also called hookah or narghile, waterpipe establishments demonstrate the involves smoking products known as “shisha”. increasing commercialization of shisha in It dates back several centuries with its origin Alberta over the past two decades, with both traced to India and also to South Africa, Persia tobacco and purported non-tobacco- and Ethiopia.1 Traditional tobacco shisha is a containing products readily available. mixture of tobacco and water, and sometimes In fact, an increase in prevalence and spread mixed with glycerin and/or honey. Tobacco- of use of waterpipes has been observed containing shisha is sometimes marketed as globally. The World Health Organization “washed” or “unwashed.” Washing tobacco (WHO) reports that contributing factors to this does not affect nicotine levels and tobacco still increase include: the introduction of flavoured contains dangerous chemicals after being tobacco, social acceptability, developments in washed. mass communications and social media, and Shisha is also available without tobacco and a lack of waterpipe-specific policy and such products are often described as “herbal.” regulations. 3 Flavouring has been added to most products Prevalence to make them more appealing including many non-traditional flavours (such as those In 2017, past-30-day use of a waterpipe to inspired by cocktails and energy drinks). smoke tobacco was reported by 1% (208,000) Overtly flavoured shisha is not traditional, nor of Canadians aged 15 years and older. 4 A are venues that have recently opened in closer look at age groups demonstrated the Alberta.2 past 30-day prevalence among youth aged 15 Venues offering public waterpipe use promote to 19 was one percent (1% or 30,000) and among young adults aged 20 to 24, the rate a range of casual to luxury atmospheres, increased to 3% (75,000).5 WATERPIPES | 2 The 2018-19 Canadian Student Tobacco, Alberta Health Services (AHS) supports these Alcohol and Drug Survey (CSTADS) reported recommendations and continues to advocate 6.9% of Grade 7-12 students had ever tried for clean air legislation to protect against waterpipe, down from 8.6% in 2016-2017.6 exposure to waterpipe smoke. An aspect of concern surrounding the spread Indoor public use of waterpipes in Alberta of waterpipe use is the potential for it to exposes Albertans to carcinogens and other impede quit attempts by those who smoke contaminants in public venues. This cigarettes or serve as a bridge to cigarette undermines the fundamental objective of smoking among young people.7 This worry provincial legislation which is to protect has been echoed in a recent systematic Albertans from exposure to carcinogens and review which concluded that waterpipe other contaminants in public venues. tobacco smoking is associated with more than Cities/municipalities in Alberta including Red doubling of the odds of later initiation of Deer, Cold Lake and Spruce Grove have cigarette smoking. 8 made strides by enacting bylaws to prevent In order to maintain a downward trend in indoor waterpipe use. On July 1st, 2020 a ban prevalence rates, prevention and policy on all waterpipe smoking in public places measures for waterpipe must remain a comes into effect in the city of Edmonton. priority. As public waterpipe venues do not require a The trend of banning public waterpipe unique business license, accurate information use on the number of venues in Alberta is not readily available. A scan of waterpipe lounges Over the last decade, public waterpipe use in Alberta indicates at least 30 in operation in was banned in Syria, Lebanon, Turkey, and cities/towns where bylaws do not exist. Jordan. 9,10,11,12 As of March 31, 2018 New Brunswick, Newfoundland/Labrador, Nova Despite a ban on other flavored tobacco Scotia, Prince Edward Island and Quebec products since 2015, a subsequent review of have all banned waterpipe in public spaces.13 the Tobacco and Smoking Reduction Act in A growing number of cities and communities 2019 and the introduction of Bill 19 - The in British Columbia and Ontario have also Tobacco, Smoking and Vaping Amendment implemented waterpipe bans. 14 Alberta’s Act in June 2020, flavoured waterpipe and Tobacco and Smoking Reduction Act vaping products continue to be available in continues to provide an exemption that Alberta. permits the use of waterpipes in public Tobacco product labelling establishments. In the past, testing conducted by public health Alberta Health’s Office of the Chief Medical officials in Ottawa, Toronto and New York City Officer of Health recommended in 2012 that has determined that tobacco was present waterpipe use should be prohibited in within products sold at lounges, although enclosed public places and work-places, and customers were told that the items were within five metres of entrances, windows and tobacco free.16 Testing is logistically difficult air intakes in public venues and workplaces.15 WATERPIPES | 3 and capacity to comprehensively test shisha than that of tobacco products. 20 The same products for tobacco content is insufficient. research study also found toxic trace metals Some waterpipe venues in Alberta prepare and carcinogens – at levels equal to or their own “mixes” of shisha, using Red Bull or greater than those in cigarettes – in three raw Monster Juice, which adds to the complexity herbal shisha products tested.21 of monitoring these products. However, it Air quality in shisha venues affects not only does not change the health risks associated owners/operators of waterpipe venues, but with the products. also employees. If the waterpipe venue is part In order to increase awareness of health risks of a multi-unit building, people in adjacent and effects associated with tobacco use, units may also be adversely affected. Health Canada has proposed to make Ventilation is not an option because a changes to health-related labelling of tobacco ventilation system with the technology to products. 17 The Forward Regulatory Plan eliminate the carcinogens in tobacco smoke 2019-2021: Tobacco Products Labelling does not exist.22 Regulations also proposes new requirements The recent outbreak of the 2019 novel for labelling on products such as waterpipe coronavirus (a.k.a. COVID-19), has prompted tobacco, which are not currently subject to considerations of public health policies and any labelling requirements. the risks of smoking and vaping in the Waterpipe smoking and disease transmission, trajectory and outcomes of infectious diseases. Studies of infectious Tobacco smoke from waterpipes has been viruses, including the novel coronavirus, linked to diseases also known to be indicate they can remain viable and infectious associated with cigarette use. Such diseases in aerosols and on surfaces, for long periods include malignancies, cardiovascular disease, of time.23,24 The risk of disease transmission lung diseases, pregnancy complications, oral through frequent hand to mouth contact is or dental complications, hematologic well-established. Waterpipes are also said to 18 disturbances and genetic abnormalities. increase a person’s exposure to harmful The charcoal used to heat waterpipes adds microorganisms due to moisture conditions additional health risks as it produces high that encourage their development and device levels of CO, metals and cancer-causing structures that make proper cleaning and 25 chemicals.19 sanitization difficult. Alberta's own research has found that even The communal nature of waterpipe smoking the non-tobacco, or “herbal” shisha products within social settings includes using a single used in waterpipes produce toxic air mouthpiece and hose, shared between users, 26,27 pollutants – including carbon monoxide, often in restaurant and/or lounge settings. volatile aldehydes and polyaromatic Waterpipe users are therefore also at an hydrocarbons. In fact, both the main-stream increased risk of communicable diseases like and second-hand smoke produced by herbal herpes and meningococcal disease that are shisha contained these known cancer- transmitted through sharing waterpipe 28 causing agents at levels equal to or greater mouthpieces. WATERPIPES | 4 With regard to tobacco and nicotine The findings of the review amidst public dependence, a review examining whether health concerns regarding the growing waterpipe smoking supports dependence in popularity of waterpipe smoking demonstrates its users is aptly summarized by the the importance of public health action on following:29 waterpipe use. Informing the public of the risks of waterpipe use (including nicotine • waterpipe smoking delivers active dependence) and ensuring waterpipe doses of dependence-producing smoking is included in the same public health nicotine policies as cigarette smoking is a vital • waterpipe tobacco smokers may component of current tobacco control engage in waterpipe use on a daily interventions.30 basis • waterpipe tobacco smokers do For more information, please contact Alberta experience withdrawal, alter their Health Services Tobacco Reduction Program behaviours to access waterpipes, and at [email protected]. have difficulty quitting. References 1 Knishkowy, B., & Amitai, Y. (2005). Water-pipe (narghinarghile) Survey (GATS). International Journal of Environmental Research smoking: an emerging health risk behavior. Pediatrics,116,
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