Waterpipes – smoking without risk? health effects, habits, attitudes and surveillance

The use of Tobacco causes injuries, illnesses and life-long addiction. Smoking waterpipes has been common in Eastern and African cultures for centuries, but has spread to the Western World since the 1990s, including Sweden in more recent years. 27 percent of Swedes, 15 years of age and older, have tested waterpipe smoking; a way of smoking that appears to attract adolescents and young adults in particular. One out of three boys and one out of four girls in grade 9 have tried smoking a waterpipe and more than 60 percent of the students in the second year of high school have smoked a waterpipe in 2009. Many have smoked more than once and it is common for waterpipe smoking to be connected to the use of cigarettes, snuff, alcohol or narcotics. Research indicates that there is a risk that waterpipe smoking may function as an introduction to cigarettes.

Waterpipe smoking produces large amounts of smoke that contains toxic substances and particles. For instance, this smoke contains nicotine that causes addiction, carbon monoxide that increases the risk of cardiovascular diseases, and tar that contains many carcinogenic substances. Smoke from waterpipes is similar to that from cigarettes, which means that it most likely causes injuries and ill health similar to effects associated with cigarette smoking.

Today, research shows that waterpipe smoking doubles the risk of lung cancer, causes illnesses of the respiratory tract and increases the risk of severe periodontoclasia. Waterpipe smoking also produces large amounts and high levels of harmful particles in the air, which contribute to a high risk of passive smoking.

Interviews with young Swedes indicate that waterpipe smoking fills a social function and that most of the young people share their waterpipes and smoke in the company of others. The flavoured and sweetened tobacco used tastes good and is smooth, mild and easy to inhale. Young people do not perceive waterpipe smoking as harmful. Nor do they believe that it can lead to addiction. The waterpipe invites playfulness and experimentation so that sometimes even illegal drugs, such as hashish and marijuana, are used in waterpipes.

Tobacco for waterpipes falls under the Swedish Tobacco Act as well as the Swedish Act on Excise Duty on Tobacco. Consequently, it is subject to their regulations regarding sales, packaging, health warnings and taxation.

The tobacco is sold in shops, at markets and on the Internet and is also bought on trips abroad. Despite an age limit set at 18, it is easily obtainable for younger people. The tobacco for waterpipes available today is sold at a very low price and health warnings are often missing. There is often misleading information about the content and it is frequently designed to look like a harmless product, such as tea, coffee, chewing gum or candy.

In addition to sweetened tobacco, substances without tobacco are also used for waterpipe smoking. These products are not subject to tobacco legislation as they do not contain any tobacco, but normally, according to the Swedish Act on Excise Duty on Tobacco, they should be taxed as tobacco used for smoking. The low price of both tobacco for waterpipes and substances without tobacco leads to the conclusion that they are rarely taxed.

In order to limit the use of waterpipes and access to tobacco for them, more research is needed, as are more public knowledge concerning waterpipe smoking and its health effects and coordination between various authorities and organisations, especially concerning legislation and surveillance.

Source: Swedish National Institute of Public Health – Vattenpipa – rök utan risk? Hälsoeffekter, vanor, attityder och tillsyn.