Asking the shisha question

Abstract

In an excellent editorial, Jawad and colleagues1 highlighted the need for increased awareness of the prevalence and health effects of shisha pipe smoking. By not asking about shisha use, GPs may be missing the opportunity to give smoking cessation advice. In each of the past 3 years, a St George’s medical student has conducted a research project on shisha pipe smoking. In the first survey conducted in 2010, Sajjaad Ismail gave a questionnaire to consecutive shisha cafe attenders in Manchester. The response rate was 85% (202/237). We found that 40% (95/237) of responders did not know the constituents of shisha, 52% (123/237) were unaware of the health risks, and 40% (95/237) would not tell their doctor about shisha if asked about smoking. A similar survey by Abdelaziz Elgindi of 103 shisha cafe attenders in London in 2011 (response rate 94%, 103/110) found that of the 42 responders who also smoked cigarettes, 89% (34/38) reported that smoking shisha relieved the cravings they had for cigarettes compared with only 52% (22/42) who said that cigarettes relieved the cravings they had for shisha (P = 0.001). A head of shisha is estimated to contain around 10 times as much nicotine as one cigarette.2 Most recently in 2012 David Rawaf conducted an online survey of medical students at St George’s, London, with a response rate of 62% (137/222), of which, 65% (89) were white, 11% (15) Middle Eastern, 10% (14) Indian, 7% (10) Pakistani, with the rest Bangladeshi, black, Chinese, and others. It was found that 79.4% (43) have smoked a shisha pipe before, of which the majority are white (58%, or 25). However, only 12 students were ‘regular’ shisha smokers (more than once a week), out of those, three smoked cigarettes. Of the regular smokers, six were Pakistani, four were Indian, and one each of black and white origin. The majority of responders (79%, or 108) did not smoke cigarettes, with 77% (83) having smoked a shisha pipe once. As an aside, it was discovered that medical students had a good understanding of the constituents and health risks of shisha, and most (85%, or 116) felt that clinicians should ask about shisha smoking. As can be seen, shisha smokers are from varying backgrounds, so it is indeed a culture-wide trend, especially among students. However, the dangers are not fully understood by the public, and it is on the shoulders of current and future clinicians to raise awareness. We agree with Jawad and colleagues that GPs, particularly those working in areas with many ethnic-minority patients, should consider ‘asking the shisha question’.