1. The Amazing Hookah Hoax Linda Hancock, FNP, PhD Wellness Resource Center Virginia Commonwealth University Sponsored by VCU’s Cancer Awareness Team

2. Goals Share information –You teach me what you know and…I’ll teach you what I know Let’s all agree to be as objective as possible: –think like a scientist & seeker of the truth Have some fun, play games, win prizes –Game #1 Name that Hookah –Game #2 Trivia Quiz Question –Game #3 Compare and Contrast Challenge Play Stump the chump: Ask some thought provoking questions

3. First… Let’s clarify Terms NOT Talking about Bongs or Pot Although we can deal with those questions at the end if you wish

4. Water pipes and tobacco Not..

5. Who are you and why did you come to this session? A.I’m here for a class and/or extra credit. B.I’m interest in the subject. C.I’m a friend of the “event organizers”. (special thanks to Kappa Phi Gamma)

6. What best describes your experience with tobacco in hookahs and cigarettes? A.I’ve smoked cigarettes but not hookah B.I have used a hookah but not cigarettes. C. I’m a non-tobacco user. (neither hookah tobacco nor cigarette use) D. I have smoked both.

7. Are you a current hookah tobacco user? (i.e.- smoked a hookah even once in the past month) A.No B.Yes

8. Are you a current cigarette smoker? (used even one cigarette in the past month) A.Yes B.No

9. Most VCU students (7 of 10) didn’t smoke at all in the past month. Only about 15% smoke daily. FREE Quit Kits

10. What Linda is not --

11. Who am I? FNP VCU OHP & Student Health Never used a hookah… But I’ve read a lot of research I’ve talked to experts AND… I love smokers! quit@vcu.edu

12. I’m still learning. But… I will give you an Education Guarantee If we come up with questions that this group and I can’t answer… I will pester Tom Eissenberg, Phd for answers. –VCU psychology professor and –Internationally recognized Hookah Expert Put your name on the email list –(I promise I will only use it one time to share the answers to questions from today)

13. Game #1: The Name Game List as many names for Water Pipes as you can (Write your answers down- Group quality control will be in effect) Africa, India, Egypt, US Saudi Arabia Jordan, Lebanon, Syria Iran Pakistan China Many places Hookah Shisha, Borry, Goza Narghile, Arghile Ghalyoun, Ghalyan Huqqa Shui yan dai Hubble Bubble

14. History of Hookahs 16 th century Use declined, almost died out by 1980’s 1990’s maassel came on the market Maassel is tobacco fermented with molasses and fruit Easier to use with more pleasant taste and aroma

15. Which type of smoke do you think has more cancer causing chemicals? A.Hookah B.Cigarettes

17. Maassel or mu’essel (assal means honey in Arabic) Moist paste like mixture 30% crude cut tobacco Fermented with approximately 70% honey, molasses and pulp of different fruits. Hookah Materials

18. Toxin Content of smoke (single hookah session compared to a single cigarette) ChemicalHOOKAHCIGARETTECOMPARISON “Tar”802mg22.3 mg36 times the tar Nicotine2.96 mg1.74 mg1.7 times the nicotine Carbon Monoxide 145 mg17.3 mg8.4 times the carbon monoxide

19. Charcoal wikipedia.com Charcoal is the blackish residue consisting of impure carbon obtained by removing water and other volatile constituents from animal and vegetation substances.carbonanimalvegetation It is usually produced by heating wood in the absence of oxygen.woodoxygen

20. The quick-lighting charcoal used by many hookah smokers may be an additional hazard, because it produces greater levels of carbon monoxide and other dangerous substances than standard charcoal.carbon monoxide

21. Hookah cultural use is changing… Make me smarter… Tell me about Hookah bars & Hookah Etiquette Where? When? How?

22. Which type of hookah is more common in the bars near VCU? A. Multiple B. Single

23. Can you catch infections from a hookah mouth piece? A.Yes B.No

24. Literature Review suggests… Tuberculosis Mono Hepatitis Helicobacter Pylori (causes stomach ulcers) Pulmonary Aspergillosis (fungus)

25. Game # 2: Trivia Quiz What famous children’s book had a hookah smoking caterpillar? Write the answer down! A. The Wizard of Oz B. The Chronicles of Narnia C. Alice in Wonderland D. Mr. Toad’s Wild Ride

26. Alice in Wonderland

27. What chemicals are in tobacco? What chemicals occur in combustion? What chemicals are in charcoal, fruit, etc?

28. “TAR” Production The burning or heating of organic matter creates tar. The by-products of tar are turpentine and charcoal.

29. Carbon Monoxide Colorless, odorless, tasteless, and non- irritating, making it difficult for people to detect Carbon monoxide (CO) is a product of combustion of organic matter Early symptoms of carbon monoxide poisoning include increased heart rate, drowsiness and headache

30. Other chemicals of importance Polyaromatic Hydrocarbons Carcinogenic Nitrosamines Heavy Metals (lead, arsenic, cadmium)

31. Some things the same.. Some things different Caution about comparing apples to oranges

32. Chemical exposure also depends upon the type, shape and size of the hookah Confounding Variables

33. Game #3: Comparison Competition Make two lists- compare hookah to cigarettes –What is the same? –What is different? –Win a prizes if you think of something I did not!!!

34. What’s the same? Hookah and cigarette smoking… –Both use tobacco –Both light organic matter on fire –Both create “tar”, carbon monoxide, carcinogens –Both have heavy metals –Both have nicotine –Both can be social behaviors or private –Both are legal at 18 –Both create secondhand smoke –Both…

35. What’s different? Charcoal, molasses & fruit Chemicals/Preservatives? –How much “tar”, carbon monoxide, carcinogens, heavy metals? Combustion- 900 0 C versus 450 0 C If shared mouth pieces - risk for infection Filter type differs- Cellulose versus Water (Do filters work?) Different concentrations of nicotine? Addiction rates? Patterns of use differs –Both can be social or private – but hookah more often social groups –Hookahs are harder to carry –Cigarettes are portable – linked to many settings Puff topography differs –45 minute session versus periodic use –Inhalation may be deeper and longer OTHER things?

36. Thomas Eissenberg, a professor of psychology at Virginia Commonwealth University co-authored a hookah study which found that a session of hookah smoking which lasts about 45 minutes, delivers 36 times more tar, 15 times more carbon monoxide and 70% more nicotine than a single cigarette. WikipediaVirginia Commonwealth University

37. Tar It’s actually a MYTH that the water removes most of the chemicals. A large amount of “tar” remains in hookah smoke. Oh, and hookah smoke has higher levels of heavy metals like lead.

38. CO is an “issue” Hookah makes more CO than cigarettes because of burning charcoal. CO binds with Hemoglobin irreversibly - carboxyhemaglobin (COHb) Hookah smokers have significantly higher levels of COHb in their blood than heavy cigarette smokers (15-40 cigs/day) Ratio of CO to nicotine –Cigarettes vs Hookah 16:1 50:1

39. Nicotine Give me your opinion: Can you get addicted to hookah smoking? A.Yes B.No

40. Periodontal disease research The prevalence of periodontal diseases was 30% in water pipe smokers 24% in cigarette smokers 8% in non-smokers.

41. Is hookah smoking addictive? Not many studies on this issue. After a 45 minute session of smoking –Concentrations of nicotine and cotinine are found in blood, urine and saliva. Depending upon puff topography… –Hookah smoking cessation can be the equivalent of 15 cigarettes.

42. Linda’s greatest concern about hookah…. What is the most devastating drug?

43. Factors to consider What’s your genetic snowflakeness? Increased tolerance – frequency/amount Intending to quit but not being able to Purchasing a hookah and using alone Switching to other forms of nicotine

44. A hoax is an attempt to convince an audience into believing that something false is real. -Let’s evaluate this statement from the internet.

46. Health and cultural kisses of death Grain of Truth Fatal Flaw Studies have shown that the typical hookah smoker spends more time per smoking session than do other smokers. Presumably because the smoke is less immediately harsh or irritating. Ironically, use of the hookah may increase the smoker's toxic exposure.

47. Tom Eissenberg, PhD VCU psychology professor and internationally recognized hookah expert His thoughts on the relative risk of tobacco in cigarettes vs. hookah… “While we don’t yet have the necessary data to make an empirically based statement, there is no reason a priori to expect that the risk of a hookah would be any less than cigarettes, and several reasons to think that it might be as high or higher than cigarettes.”

48. What about secondhand smoke? Does a hookah make secondhand smoke? Do hookah bars allow cigarette smoking?

49. VCU’s campaign

52. Consider joining the Cancer Awareness Team or Project Reach Sign up sheets and information are at the back.

53. Anyone interested in smoke-free Restaurants and workplaces Rally at the State Capitol –Monday Nov 13 th in Richmond –11:00 am to noon Senator Brandon Bell (R) from Roanoke Sponsoring smoke-free legislation for VA

54. What questions do you still have? Let’s play STUMP the CHUMP

55. Life is about a calculated risks. But ya gotta know the facts to calculate.