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cigarettes.z This survey found that 91% of weekly hookah <br />smokers and 51 % of daily hookah smokers did not have <br />the will to quit, which highlights the addictive nature of <br />hookah smokingZ among myriad factors.16 <br />('arhon monoxide in hookah smoke: Effects on <br />tun<~s. heart. ;end hrain <br />Hookah smokers are exposed to three-fold greater <br />amounts of CO-an odorless gas-than are cigarette <br />smokers. Based on their chemical analysis, Shihadeh and <br />Saleh" provide strong evidence that the CO-to-nicotine <br />ratio in hookah smoke is 50:1, and that for cigarette <br />smoke is 16:1. One of the reasons for the greater CO con- <br />centrations in Hookah smoke is the charcoal that is added <br />to enhance the burning of the moist tobacco concoction. <br />Hemoglobin, the iron-containing protein in blood that <br />transports oxygen from lungs to all parts of the body in <br />vertebrates, has extremely high affmity for CO, and forms <br />carboxyhemoglobin (COHb), which can no longer serve <br />as either the oxygen acceptor or as the oxygen carrier. <br />Hookah smokers have significantly higher levels of <br />COHb in their blood than heavy cigarette smokers who <br />smoke 15 to 40 cigarettes." <br />Because the duration of a single puff of hookah smoke <br />is double that of a cigarette, and the suction pressure for <br />inhalation of hookah smoke is four times that fora ciga- <br />rette, the hookah smoke reaches deeper into lung tissue.18 <br />Consequently, hookah smoking may cause greater venti- <br />latory incapacitation, especially in older individuals, than <br />cigarette smoking causes.19 Since smoking rates among <br />18- to 24-year-olds are the highest of any age group in <br />CaliforniaZ°, the recent trend of hookah smoking among <br />youth, unless checked, may exacerbate the future inci- <br />dence of chronic obstructive pulmonary disease. <br />Blood pressure (systolic, diastolic, and mean), expired <br />CO, and heart rate all increase upon hookah smoking.21 <br />Heart and brain have extremely critical requirements for <br />a minimal threshold of oxygen. Episodes of sudden and <br />short periods of oxygen deprivation can result in heart <br />attack or brain stroke.22 Chronic exposure to nicotine also <br />has a direct effect on the heart, causing atrial flutter.23 This <br />exposure leaves hookah smokers vulnerable to this debil- <br />itating condition. <br />How hookah smoke may affect fertility, virility <br />anal babies <br />It is becoming increasingly clear that, like tobacco smok- <br />ing, mainstream hookah smoke and second-hand hookah <br />smoke cause deleterious effects on reproductive systems <br />in men and women and produce genotoxic24, mutagenic, <br />and teratogenic25 effects on babies of smoking parents. <br />These effects include infertility in females and sterility of <br />males, and low birth weight z6, z' and birth defects in babies <br />born to smoking mothers.28, z9 A recent study of 100 Egyptian <br />infertile women determined that the couples' infertility was <br />due to sterility of husbands who were hookah smokers.30 <br />High concentration of CO is a major component of sec- <br />ond-hand smoke from hookah. The contribution from burning <br />charcoal in hookah may also have significant and deleterious <br />effects on young babies that may be exposed to mild CO lev- <br />els. Even at very low levels, such as 25 to 50 parts per million <br />parts of air, CO can produce permanent damage to the inner <br />ear in young babies and irreversible loss of hearing."-" <br />TRI)RP research on hookah smoking <br />TRDRP is at the forefront of recognizing and supporting inno- <br />vative and novel ideas in a proactive manner. Keeping with its <br />mandate, TRDRP funds innovative and high-quality biomed- <br />ical, policy, and prevention research in California. This <br />research aims to mitigate the suffering and economic burden <br />due to myriad diseases caused by tobacco products. <br />This year, as over the past 15 years, TRDRP has once <br />again distinguished itself among all federal and public fund- <br />ing agencies in leading the charge against tobacco by award- <br />ing the first ever research grant on hookah smoke. TRDRP has <br />made athree-year new investigator grant award to Nada <br />Kassem, Dr.P.H., M.S., R.N., C.H.E.S., to study "Water Pipe <br />Use, ETS Exposure and Home Policies among Arab Americans." <br />Dr. Kassem is currently a faculty research investigator at the <br />Center for Behavioral Epidemiology and Community Health, <br />Graduate School of Public Health, San Diego State University. <br />This is the first tobacco-related research grant award to Dr. <br />Kassem. <br />TRDRP invites research grant applications from California <br />scientists on all aspects of hookah smoke for various funding <br />mechanisms. <br />Dedicated to the fond memory of Sureruler S. Katoch, B.Sc., M.Sc., <br />M.Phil., Ph.D. - a dear friend and scientific collaborator -who <br />dedicated his life to mitigating cardiovascular disease, and sod - <br />denlydied on May 14, 2005 due to a massive heart attack. Dr. <br />Katoch was Professor and Chairman, Department of Bio-Sciences, <br />Himachal Pradesh University, Shimla, India. Surender will be <br />sorely missed by family members and numerous friends all over <br />the world. <br />3 <br />Author's contact information: <br />Kamlesh Asotra, Ph.D. <br />Tobacco-Related Disease Research Program <br />University of California O•(ju:e of the Prersident <br />3001akeside Driue, 6th Floor <br />Oakland CA 946/2 <br />(SIO) 287-3366 <br />kcvr~leshasotrzi(, u co p. ed u <br />www.trdrp.org <br />75A-23 <br />