1. Hubbly Bubblies, Hookahs, Nagrily, Water pipes – call them what you like! N.B., they are dangerous addictive killers! CANSA Smart Anti-Tobacco Advice

2. Aaaah, the folly of youth!? They go to university, are intelligent, get degrees, but act stupidly.

3. Briefly, when smoking through the water pipe you smoke tobacco which contains nicotine and it is addictive. Doesn’t matter how it’s flavoured. It’s a dangerous addictive drug! Hookahs are often smoked socially, & therefore the smokers smoke much longer, more intensely, & inhale more deeply, holding the smoke in their lungs. Remember! The Innocent-looking & very sociable-looking Hubbly, can be more dangerous than cigarettes because of the illusion that it’s not dangerous!

4. Filtering through water is almost irrelevant. The smoke might be cooled a little, but: A. it starts off at very, very high temperature burning on charcoal, & B. The Carcinogens are still inhaled by the smoker.

5. According to History… Water pipes have been used to smoke tobacco & other substances by indigenous Africans & Asians for at least 4 centuries. According to a physician during the reign of Emporer Akbar (who ruled 1 556 to 1605), he purported water pipe smoking to be “a less harmful method of tobacco use”. The physician Hakim Abul Fath suggested that tobacco “smoke should be first passed through a small receptable of water so that it would be rendered harmless” So, remember: a widespread, but unsubstantiated belief held by many water pipe users today – that the practice is relatively safe – is as old as the water pipe itself!

6. Enter the jolly marketing gurus….. who will always make out our old enemy, Nicotine, to be very appealing: Marketing tools associated with water pipes & water pipe tobacco may reinforce the so-called “it’s Safe!” unsubstantiated belief. E.g. the label of a popular water pipe tobacco brand sold in South West Asia & North America states: “0,5% nicotine & 0% tar” A ruthless approach, but if there is money to be made, the marketers will smoke the pipe! Remember: Take charge of your own health, investigate before you make a decision to start smoking the pipe.

7. About the Water pipe: There are regional & cultural differences in some water pipe design features. But, all water pipes contain water through which smoke passes prior to reaching the smoker.

8. Water pipes have a head, body, water bowl & hose (see figure) Holes in the bottom of the head allow smoke to pass into the body’s central conduit. This conduit is submerged in the water that half-fills the water bowl. The hose is not submerged, exits from the water bowl’s top, and ends with a mouthpiece, from which the smoker inhales. The tobacco that is placed into the head is very moist (& often sweetened & flavoured) : it does not burn in a self-sustaining manner. Thus, charcoal is placed atop the tobacco–filled head (often separated from the tobaccos by perforated aluminium foil) When the head is loaded, & the charcoal lit, a smoker inhales through the hose, creating a vacuum above the water, & drawing air through the body & over the tobacco and charcoal Having passed over the charcoal, the heated air, which now also contains charcoal combustion products, passes through the tobacco, and the mainstream smoke aerosol is produced. The smoke passes through the water pipe body, bubbles through the water in the bowl, & is carried through the hose to the smoker. During a smoking session, smokers typically replenish & adjust the charcoal periodically. A pile of lit charcoal may be kept in a firebox for this purpose. As an alternative, smokers may opt for commercially available quick lighting charcoal briquettes.

9. Names for the water pipe also differ….. “Narghile” – in the east Mediterranean countries, incl. Turkey & Syria “Shisha” & “Goza” in Egypt & some North African countries “Hookah” in India R emember : It all sounds so cool, but it really is not!

10. It is so easy to get you addicted….. Water pipes can be be bought from dedicated supply shops, incl. Internet vendors, which also sell charcoal, tobacco & accessories. Water pipes are marketed as portable, with accessories i.e. carry cases with shoulder straps! Some accessories are sold with claims to reduce the harmfulness of the smoke, i.e. mouthpieces that contain activated charcoal or cotton, chemical additives for the water bowl & plastic mesh fittings to create smaller bubbles. Remember : None of these accessories have been demonstrated to reduce the smoker’s exposure to toxins or risk of tobacco-caused disease and death

11. The Enemy is called Nicotine… Contrary to ancient folklore & popular belief, the smoke that emerges from the water pipe contains numerous toxicants known to cause LUNG CANCER, heart disease & other diseases. Remember: Water pipe tobacco smoking delivers the addictive drug NICOTINE, and, as is the case with other tobacco products, more frequent use is associated with the smokers being more likely to report that they are addicted.

12. The Scary Realities… A water pipe smoking session may expose the smoker to more smoke over a longer period of time than occurs when smoking a cigarette. Cigarette smokers typically take 8 – 12, 40-47 ml puffs over 5-7 minutes and inhale 0.5 to 0.6 litres of smoke. Remember: In contrast, water pipe smoking sessions typically the last 20-80 minutes, during which the smoker may take 50-200 puffs which range from about 0.15 to 1 litre of smoke each. The water pipe smoker may therefore inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes! While water does absorb some of the nicotine, water pipe smokers can be exposed to a sufficient doses of this drug to cause addiction.

13. Research…. Preliminary research on patterns of smoking, the chemistry of the smoke that is inhaled, and health effects support the ideas that water pipe smoking is associated with many of the same risks as cigarette smoking. The science base support the following conclusions: 1.Using the water pipe to smoke tobacco poses a serious potential health hazard to smokers & others exposed to the smoke emitted. 2.Using the water pipe to smoke tobacco is not a safe alternative to cigarette smoking. 3.A typical 1 hour long water pipe smoking session involves inhaling 100-200 times the volume of smoke inhaled with a single cigarette. 4.Even after it has been passed through water, the smoke produced by a water pipe contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer causing chemicals. 5.Commonly used heat sources that are applied to burn the tobacco, i.e. wood cinders or charcoal, are likely to increase the health risks because when such fuels are combusted they produce their own toxicants, including high levels of carbon monoxide, metals and cancer causing chemicals.

14. Some more about Research…. Pregnant women & the foetus are particularly vulnerable when exposed either actively or involuntarily, to the water pipe smoke toxicants. Second-hand smoke from water pipes is a mixture of tobacco smoke, in addition to smoke from the fuel, & therefore poses a serious risk for non-smokers. There is no proof that any device, or accessory can make water pipe smoke safer. Sharing a water pipe mouthpiece, poses a serous risk of transmission of communicable diseases, including tuberculosis and hepatitis. Water pipe tobacco is often sweetened & flavoured, making it very appealing; the sweet smell & taste of the smoke may explain why some people, particularly young people who otherwise would not use tobacco, begin to use and smoke the water pipes!