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
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