Nursing Reports 2015; volume 5:5306 Water pipe tobacco smoking: smoke from cigarette and water pipe tobacco (WT) smoking at confined places.1 Often, WT Correspondence: Govindaraj Vaithinathan are the Bahraini smokers aware smoking occurs in groups as a social activity Asokan, College of Health Sciences, University of of its health effects? that has a history of at least 400 years in the Bahrain, Salmanya Medical Complex, P.O. Box Middle East, India, and parts of Asia. WT varies 32038, Kingdom of Bahrain. Ebrahim Khalil, Sajida Mansor Ayyad, in size and shape; it is also known as shisha, Tel.: 00973.17285421 - Mobile: 00973.39497564. E-mail: [email protected] Fatima S. Sharaf Al-Alawi, Hasan A. Ali hookah, narghile, goza, and hubble bubble. Khalil, Muyassar Sabri Hassan Awadalla, The specially made tobacco in water pipe Key words: Water pipe; smoking; health effects. Govindaraj Vaithinathan Asokan comes in different flavors and the popular fla- vors are: apple, banana, berry, cherry, choco- Acknowledgments: the authors are grateful to Dr. College of Health Sciences, WHO late, cappuccino, coconut, mint, licorice and Aneesa Al-Sindi, Dean, College of Health Collaborating Centre for Nursing watermelon. Sweeter additives and flavors Sciences, University of Bahrain for the support Education, University of Bahrain, were developed to attract female consumers.2 and encouragement provided in this work. The authors would like to thank Mr. Hasan Al Basri for Salmanya Medical Complex, Kingdom All forms of tobacco smoking are harmful to statistical assistance. of Bahrain health. More than 4000 chemicals in tobacco smoke have been identified; at least 250 are Contributions: GVA, idea conceiving; EK, SMA, known to be harmful and more than 60 are HAAK, data collection; MSHA data interpretation. known to cause cancer. Toxic trace metals All authors contributed equally in drafting and Abstract have been found in herbal shisha products and editing the manuscript. their smoke emissions contained carcinogens Conflict of interest: the authors declare no poten- equivalent to, or in excess of, those of tobacco The tobacco epidemic kills half of its users tial conflict of interest. annually and 600,000 deaths occur in people products.3 A meta-analysis of data from four exposed to cigarette and water pipe tobacco (WT) nations indicated that daily use of WT pro- Received for publication: 1 June 2015. smoking. A population-based cross sectional duced nicotine absorption of a magnitude sim- Revision received: 3 September 2015. study was conducted to explore the knowledge ilar to that produced by daily cigarette use.4 Accepted for publication: 3 September 2015. and perceptions on health effects of WT smoking Smoking WT for approximately 20 to 80 min is only amongst Bahraini adults in the popular coffee equivalent to smoking 100 or more of ciga- This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY- shops of Bahrain and in women’s congregations. rettes.5 Besides, smoking WT produces more NC 3.0). Randomly, 206 Bahraini adults of both genders second hand smoke than cigarettes; thereby, were selected and distributed with a developed passive smokers are at similar risk for theuse dis- ©Copyright E. Khalil et al., 2015 questionnaire to collect data; results were ana- eases caused by cigarette smoking. Existing Licensee PAGEPress, Italy lyzed using SPSS (SPSS Inc., Chicago, IL, USA). evidence of diseases as a result of WT smoking Nursing Reports 2015; 5:5306 Among the WT smokers, the highest proportion includes lung cancer, oral cancer, stomach can- doi:10.4081/nursrep.2015.5306 (45%) was observed between 21 and 30 age group cer, cardiovascular and respiratory diseases, and in the higher educational category. Majority reduced lung function, coronary heart disease smoked daily. The leading motives of WT smoking and adverse effects during pregnancy. Babies were meeting friends, passing of time and pleas- born to mothers who smoked WT weighed less similar to cigarettes.11 Over the past several ure. Many smokers believed WT as less harmful at birth6 and were also found to be at increased years, a global upsurge of WT smoking has than cigarettes, but affect the respiratory system, risk of respiratory diseases. The risks of con- been recorded in the Middle East, USA, and causes: cancers, cardiovascular disease and tracting infectious diseases and the opportuni- Canada, France, Russia, UK and Australia pregnancy-related disorders. The knowledge ty to spread arise from the shared mouthpiece owing to the increasing popularity amongst scores were significantly higher in the younger of commercialwater pipe and moist smoke. WT smoking young people. In the West: more than half of age group, higher educational qualifications, and has been associated with outbreaks in the the young population in Denmark reported higher income. A considerable proportion of Middle East; for instance, two outbreaks in tried smoking WT,12 and a Canadian study on smokers perceived WT smoking as a sign of 2010, which revealed a possible association nicotine dependence in teens, reported 23% maturity, acceptable by the society. The percep- between tuberculosis and sharing a WT pipe.7 WT use.13 In the Arab World: a premarital tion scores were significantly higher inNon women Factors attributed to WT smoking comprise screening program in Abu Dhabi recorded and in the age group of >40. This study has social acceptability, lack of knowledge of health 4.8% smoking WT;14 amongst Egyptian female revealed a lack of knowledge amongst the effects, and concentrated preventive programs university students, 37.8% smoked WT only, Bahraini adults who assume that health risks of to cigarette more than WT smoking.8,9 and 35.2% smoked both WTS and cigarettes,15 WT are lower than cigarettes demanding further Lingering popular myths of WT smoking are: i) and the prevalence of WT smoking amongst research to evaluate WT smoking risks, health WT is less harmful and addictive than ciga- male medical students in Saudi Arabia16 was effects, environmental effects of smoke, and reg- rettes; ii) nicotine content in WT is lower than 12.6% and was lower compared with the preva- ulatory services in Bahrain for a responsive that of cigarettes and water used in WT filters lence in dental students. According to the approach to curb the WT tobacco epidemic. all the hazardous chemicals such as carbon National non-communicable diseases monoxide, tar and nicotine.10 On the other (NNCDs) risk factor survey of 2007, Bahrain, 17 hand, water in the pipe partially cools the the prevalence rate of tobacco use was 23.1% smoke, makes it less irritating by its taste, and smoking WTS was 8.4%. WT smoking was Introduction smell and smoothness of sweetened tobacco. higher amongst males, particularly in young Yet, by all yardsticks, WT is not less toxic; adults between the age group of 20 and 29 The global tobacco epidemic kills half of its greater exposure to toxins with higher nico- (17.8%). Amongst females, the prevalence rate users annually accounting up to 6 million tine intake results from more frequent puffs was higher in older women between the age deaths. An additional, 600,000 deaths occur in and longer sustained sessions. Further, fre- group of 50 and 64 (11.5-13.2%). non-smokers being exposed to second-hand quent use of WT is a determinant for addiction Governmental and non-governmental [page 24] [Nursing Reports 2015; 5:5306] Article healthcare organizations have a shared com- smoking on a five point Likert scale (Table 3). mitment to tobacco control in which nurses The questionnaire was built in English lan- Results are a vital force in the interdisciplinary health guage and translated to Arabic language. Back care team. More specifically, public health or translation of the Arabic version of the ques- A total of two hundred and six participants community nurses have a greater role in tionnaire to English language ensured reten- participated in the study and the gender distri- tobacco cessation practices as public health tion of the originality of the questions. For bution was skewed (male: 174, female: 32). nursing involves working with communities affirming face and content validity, the ques- Among the four categorized age groups, the and populations as partners, focusing on pri- tionnaire was scrutinized by a panel of experts highest proportion (45%) of WT smokers was mary prevention and health promotion. Public from College of Health Sciences, University of observed in the age group between 21 and 30. health nurses practice in diverse settings. Bahrain. Pre-testing and piloting our question- Participants with college degree/equiva- High-risk and vulnerable populations are often naire in thirty WT smokers (coffee shops lent/other higher degrees had the highest pro- the focus of care that includes WT smokers.18 n=15, matams n=15) rendered suitable modi- portion (45%) of smoking WT, whereas, no With deep-seated myths amongst smokers fications to the questionnaire before embark- explicit variation among the four categories of of WT, we hypothesized a significant relation- ing the main study. The developed question- income was noticeable (Table 1). The mean ship between adults smoking WT and their low naire used in the study was specific, realistic age of the smokers was 30, declared age at ini- level of knowledge on its health effects in and measurable that had an acceptable inter- tiation of smoking WT was 19 and an average Bahrain. Although, objectively, the NNCD sur- nal consistency (Cronbach’s a=0.61). time spent in a smoking session was 75 min. vey has estimated the prevalence of WT smok- Generally, by late evenings the coffee shops Through a solitary attempt, 47% of the partici- ing amongst adults in Bahrain along with are vibrant with customers and data collection pants had admitted to have made efforts to quit other non-communicable diseases, the survey was accomplished during such ideal time.