Mayor Fischer calls for conversation on dangers of e-cigarettes, hookah

Cites research suggesting that both are gateway to smoking
LOUISVILLE, Ky. (April 8, 2016) — Mayor Greg Fischer announced that he has asked the Louisville Department of Public Health and Wellness to lead a community conversation on the possibility of expanding Louisville’s current smoking ban to include e-cigarettes and hookah.

Smoking has devastated our community, causing pain, suffering and shortened lives, and saddled taxpayers with enormous healthcare costs,” the Mayor said.  “I believe broadening the ban to include e-cigarettes and hookah is a logical extension of the battle to save lives from the dangers of tobacco, and today I ask the Public Health Department to begin a community conversation on this pressing issue.”

Fischer called on the department to review all available research, study other cities’ related actions, and seek public input in a broad community conversation on the issue. The department will set up meetings where citizens can hear experts discuss available research and offer their opinions on the products and a potential ban.

Kentucky’s rates of smoking and of smoking-related illnesses, such as lung cancer, are among the nation’s highest.  These high rates led to Louisville’s current smoking ban, passed in 2008, which bans smoking in all indoor locations.

Reducing the prevalence of tobacco use – and resulting death rates – is “critical to the future of our citizens and our community as a whole,” Fischer said.  It’s also a core element of Healthy Louisville 2020, the Mayor’s strategic plan for making Louisville a healthier city.

“Research suggests that the use of e-cigarettes and hookah may lead to use of tobacco cigarettes, and, with flavors like chocolate, cinnamon, vanilla and many others, there’s a real danger of our children being lured into a lifetime of tobacco use,” he said.

According to the FDA, more than a third of the bad effects of e-cigarettes happen to non-users in public places.  E-cigarettes contain such toxic chemicals as nicotine, formaldehyde and acrolein.  And while people may think that hookah is less harmful than cigarette smoking, it has many of the same health consequences, according to the Kentucky Center for Smoke-free Policy. Both national and local air-quality studies show that hookah lounges have levels of toxins that far exceed safe levels established by the EPA.

The Greater Louisville Medical Society and the Louisville Metro Board of Health both have approved resolutions stating that the increasing prevalence of alternative tobacco products and nicotine delivery systems represent threats to public health that should be addressed in the city’s secondhand smoke law.

Though some argue that e-cigarettes are helpful to people attempting to quit smoking, Dr. Vivek Murthy, the U.S. Surgeon General, is among those expressing worry about e-cigarettes, and their growing use among both adults and children.  Relatedly, the Centers for Disease Control and Prevention has said hookah smoking has many of the same health risks as cigarette smoking.

The Mayor stressed that any ban — should one eventually be recommended — would affect only public places, so citizens would still be allowed to use these products in their homes and other private spaces.

“One of the pillars of my administration is to make Louisville a healthier community,” Fischer said. “The health department review and conversation will give us the tools to ensure we’re doing that in a measured and effective way.”

Resource : http://www.lanereport.com/62273/2016/04/mayor-fischer-calls-for-conversation-on-dangers-of-e-cigarettes-hookah/

Hooked on shisha? Why hookahs might be more harmful than you think

Shisha, hookah or waterpipes are thought by some to be a safer alternative to smoking cigarettes, but the evidence doesn’t necessarily agree
Waterpipe smoking is on the rise, particularly among teenagers and young adults. And one of the likely reasons for this is the belief that shisha is less harmful than cigarette smoking. But is this the case?

Shisha (also known as hookah, waterpipes, hubble bubble) is the name for pipes containing water at the bottom, and a platform at the top where flavoured tobacco (or non-tobacco herbal mixtures) is covered with foil. Hot charcoal is then placed on top of the foil, and when a user breathes through a hose, a vacuum is created, drawing smoke through the water and into the mouth, where it is inhaled into the lungs. Shisha is a social activity, with one pipe sometimes having a number of hoses, or the hose being passed around.

Some users say they believe the water the smoke passes through acts as a filter, purifying the smoke and therefore making it less dangerous, and less addictive. However, there’s little evidence that this is the case, and new research suggests that waterpipe smoking is associated with a number of the same illnesses as cigarette smoking.

The authors of this research, published in the International Journal of Epidemiology, systematically reviewed studies investigating use of shisha and health outcomes. They identified 50 studies that fit these criteria, and found evidence that use of waterpipes was associated with respiratory disease, lung cancer, oral cancer, poor mental health, low birthweight of offspring, metabolic syndrome, and cardiovascular disease.

Of course, these are observational studies, and as such causation can be hard to ascertain. Not only that, but the studies included in this systematic review vary in quality, meaning that combining their results in a meta-analysis isn’t always possible, and even where it is, isn’t necessarily reliable. Perhaps an even bigger problem is that the measure of waterpipe use itself varied dramatically between each study. Some studies only looked at ever versus never using a waterpipe, while others tried to assess cumulative use.
Cigarettes and shisha are used in very different ways, and no studies have directly compared the health risks from cigarette smoking to waterpipe use, meaning a direct comparison of harms is difficult. Shisha may represent lower harm because it is more commonly used socially and at special events rather than smoked every day, or it could represent a more severe problem as the cooler smoke is more pleasurable to inhale so held in the lungs for longer, causing more damage.

There has been far less investigation of the constituents of shisha smoke compared to cigarette smoke, but the research that is available suggests tar, nicotine, carbon monoxide and a number of carcinogens seen in cigarette smoke are also present in shisha smoke. While it might be thought that herbal shisha is safer than tobacco shisha, the burning of the charcoal used to heat the pipe produces carbon monoxide and benzene, which are also inhaled through the pipe. There have been case reports of acute CO poisoning after shisha use, which isn’t the case with cigarettes.

Perhaps even more worryingly, anecdotally there seems to be a lack of understanding that the flavoured products used in waterpipes predominantly contain tobacco. Although there are some herbal products, which claim to be a safer alternative, most of the products available for use, even the flavoured ones, are flavoured tobacco. And while herbal products don’t contain nicotine, they still release a number of the same toxins as found in tobacco smoke, and the CO and benzene from the charcoal is still inhaled.

While the evidence for its impact on health is much sparser for waterpipes than for cigarettes, and some of the individual papers are of lower quality, the information to date suggests that waterpipe use, puff for puff, is likely to be comparable to cigarette smoking. But, although a waterpipe session might last for an hour and involve a great deal more puffs than an individual cigarette, waterpipes are less likely to be used every day so escalation of use, and therefore nicotine dependence, is hopefully less likely. What we really need is more information on how easy waterpipe users find it to quit, and better measures of how waterpipe use changes over time, particularly in these young people who seem to be taking up the habit.

Resource : https://www.theguardian.com/science/sifting-the-evidence/2016/apr/19/hooked-on-shisha-why-hookahs-might-be-more-harmful-than-you-think

Region bans waterpipe or hookah smoking in public places

 Health concerns muffled what little outcry there was about the potential for lost business when Peel Council voted Thursday to ban waterpipe smoking in the region’s bars, cafes, lounges and various other public spaces.

Councillors voted 20-2 to enact a new bylaw that would prohibit waterpipe smoking in enclosed public places and workplaces as well as specified outdoor spaces where the public might gather.

The bylaw would come into effect Nov. 1, pending approval from local municipalities.
 The decision is the culmination of a review into the rising popularity of waterpipes, also known as hookahs, and the related health effects.

Peel Public Health expressed concerns waterpipe use was becoming particularly popular among the region’s youth.

Health officials also told council there are many misconceptions about the health risks associated with hookah smoking.

Many smokers believe it carries none of the health risks linked to cigarettes.
 However, according to Peel Medical Officer of Health Eileen de Villa, smokers and those inhaling secondhand smoke are exposed to carbon monoxide and fine particulate matter that have harmful effects on the lungs.

She explained to council that the ban addresses concerns about public health and workplace safety.

There was overwhelming support on council to broaden the Region’s efforts to create smoke-free public and work environments in Peel.

Essentially, prohibition would be in the same areas where tobacco smoking is already banned.

Mississauga’s Carolyn Parrish and Brampton’s Michael Palleschi were the only councillors to vote against the bylaw.

Parrish wanted implementation of the bylaw grandfathered so establishments already offering waterpipe smoking would be allowed to continue.

She was worried business owners who may have made substantial investments to specifically cater to smokers could be hurt financially and some even forced to close.

Parrish also suggested that banning hookah smoking, a common social activity in Middle Eastern countries and other areas of the world, might be discriminatory.

“I really think this is very harsh and I really think it’s very harsh against a particular community,” she said.

The president of the Canadian Arab Network shared her concerns, but the Region also heard from many other organizations, including the Canadian Arab Institute and Arabic Cultural Club of Ontario, that supported the ban.

Representatives from the Ontario Campaign for Action on Tobacco, the Ontario Lung Association and a scientific advisor with the Ontario Tobacco Research Unit at the University of Toronto appeared at council to commend the Region for its actions.

Those speakers told councillors hookah smoking can be more toxic than cigarettes.

Peel joins municipalities like Toronto, which implemented a similar ban in licensed businesses in that city April 1.

“I think the peel approach is more comprehensive and more effective (than Toronto’s ban),” remarked Mississauga Mayor Bonnie Crombie, whose concerns initiated the Region’s review of waterpipe smoking.

Peel’s ban includes enclosed public and workspaces, restaurant or bar patios, playgrounds, schools, and sporting areas and adjacent spaces designated for spectators. The Region will also be pressing the provincial government to include the hookah in its Smoke-Free Ontario legislation.

Resource :http://www.bramptonguardian.com/news-story/6519649-region-bans-waterpipe-or-hookah-smoking-in-public-places/

Study: E-Cigs, Hookah Popular Among Middle and High School Students

E-cigarettes and smoking hookah have gained popularity among middle and high school students in the U.S., according to the Centers for Disease Control and Prevention.

The number of middle and high school students using e-cigarettes tripled from 2013 to 2014.

Among high school students, 13.4 percent were found to be using e-cigarettes in 2014 compared with 4.5 percent in 2013. The number of middle school students using e-cigarettes also tripled from 1.1 percent in 2013 to 3.9 percent in 2014.

Vince Willmore, vice president for communication at the Campaign for Tobacco Free Kids, said marketing of e-cigarettes has played a big role in young people using the product.

“They’re available in flavors that appeal to kids like cotton candy and gummy bear, so it’s not surprising that kids are using more of these products because they’re being marketed in the very same way that regular cigarettes have been marketed to kids,” he said.

In 2014, former Gov. Steve Beshear signed a law banning the sale of e-cigarettes to minors in Kentucky.

Smoking among young people has long been prevalent in Kentucky. In 2012, an estimated 24.1 percent of high school students were smokers, according to United Health Foundation.

CDC’s findings also show the number of middle and high school students smoking hookah nearly doubled.

Among high school students, 9.4 percent were found to be smoking hookah in 2014 compared with 5.2 percent in 2013. The number of middle school students smoking hookah also doubled from 1.1 percent in 2013 to 2.5 percent in 2014.

Willmore said smoking hookah has become a social activity for some young people.

“There’s a perception that hookah smoking is not as harmful as regular smoking, but the evidence shows that it is very harmful,” Willmore said.

Currently, e-cigarettes and hookah are not regulated by the U.S. Food and Drug Administration.

The government agency has issued a proposed rule that would extend its authority to cover additional products that meet the legal definition of a tobacco product, according to the FDA.

“We so desperately need the Food and Drug Administration to regulate e-cigarettes to prevent marketing and sales to kids, and the use of flavors that appeal to kids,” Willmore said.

E-cigarette use among youth now surpasses use of every other tobacco product overall, including conventional cigarettes, according to the data.

CDC says 24.6 percent of high school and 7.7 percent of middle school students were found to be using some type of tobacco product. There was no decline in overall tobacco use between 2011 and 2014.

The CDC and FDA’s Centers for Tobacco Products used data from the 2014 National Youth Tobacco Survey.
Resource : http://wfpl.org/wfpl-orge-cigarettes-hookah-tobacco-popular-among-middle-and-high-school-students/

Being Hooked on Hookahs Can Damage Lungs

So is there a way to smoke tobacco without generating the seriously negative effects of cigarette smoking? We would say no, but some folks apparently believe that bubbling tobacco smoke through water before inhaling it somehow “cleans” it.

(Just to be clear, using a hookah is not the same as using an e-cigarette, which contains none of the tobacco-sourced carcinogens of cigarettes.)

However, a new study in the American Journal of Respiratory and Critical Care Medicine puts the kibosh on the concept of safe tobacco smoking — even such “washed” smoke.

Hookahs, or waterpipes or shisha, have been around at least since the 16th century — probably originating in India. From there, their use has spread all over the world, most lately to Southeast Asia and the U.S.

To use a hookah, a quantity of tobacco mixed with molasses (also known as shisha) or other flavoring, is placed in the bowl at the top of the device. A screen is then added and burning charcoal is placed on top of the screen. The charcoal then heats the tobacco, and the resultant smoke is drawn through the water in the large chamber and inhaled by the user.

We have known for years that the tobacco smoke treated in this manner still contains the deadly toxicants found in cigarette smoke, and that these are inhaled by the user. For example, a direct comparison of the blood levels of carbon monoxide linked to hemoglobin found that they are three times higher after using a hookah for 45 minutes than after smoking one cigarette. Levels of nicotine in the blood were similar in both situations.

Senior author of the latest study, Dr. Ronald Crystal from the Weill Cornell Medical Center in New York and his colleagues, assessed clinical and biological changes associated with hookah use. The investigators compared these changes in young hookah users who were light users of the devices, but otherwise didn’t smoke tobacco, with the same measurements in non-smokers who didn’t use hookahs. These light users had used hookahs to smoke three or fewer bowls of tobacco per week for less than five years; on average they were 24-years old.  The hookah users had more cough and sputum, as well as more abnormalities in the cells lining the airways than did the control non-smokers. Taken together, such results indicate early lung damage.

According to Dr. Crystal, hookah tobacco smoking is completely unregulated, even though exposure to the toxic effects of tobacco smoke is highly likely. While regulators fuss over how to regulate electronic cigarettes, which expose users to none of the toxicants found in cigarette smoke, they seem to have missed the likelihood that there’s an  alternative route to smoking-caused illnesses. Perhaps they’ll wake up and smell the smoke soon.

Resource : http://acsh.org/news/2016/04/07/being-hooked-on-hookahs-can-damage-lungs/