![]() ![]() After “bubbling” through the water, the cooled smoke reaches the surface and is drawn through the hose and is inhaled. During inhalation, charcoal-heated air passes through the pierced aluminum foil and through the tobacco down the pipe and towards the water. After that, the “ignited” charcoal is placed on the top perforated foil to initiate the tobacco heating process. 2) starts by loading the tobacco into the bowl before wrapping the head with aluminum foil and then perforating the foil by using a screen pincher or toothpick. The user or the person preparing the hookah (Fig. Hookah preparation and mechanism of action This suggests that flavored tobacco plays a major role as a “motivator” for using hookah, which provides the user with the pleasant taste and smell. Other flavors include chocolate, clove/spice, alcohol, and other beverages. Among US women, candy/sweet and menthol are the second and third preferred flavors, respectively, with fruit flavors still the number one choice. Similarly, among university students, fruit flavored tobacco was preferred to unflavored ones. In the USA, there are different flavors used in the hookah tobacco with the most popular being the fruit flavors. Finally, Tumbak, which is used mainly in Asia, is a pure form of unflavored tobacco leaves (Ajami) smoked with charcoal. ![]() Jurak is commonly used in the Middle East and Gulf region. Jurak, on the other hand, contains tobacco, sugarcane, and around 20% other spices and dried fruits. Hadidi and Mohammed estimated that the nicotine contents of Mouassal is about 3.4 mg/g. In brief, Mouassal which is an Arabic translation for “honeyed” contains 30% tobacco and around 70% honey/sugarcane as well as glycerol and flavors. There are three commonly used types of hookah tobacco, Mouassal, Jurak, and Tumbak, each contains different ingredients. Hence, hookah effects may be under/overestimated in some studies, so future research should take into consideration such variations to make results more relevant. ![]() The same theory could be applied to yields of other chemicals, especially nicotine. Indeed, one study reported that differences in pipe material affected the levels of carbon monoxide (CO) exposure, correlating the non-porous plastic hose with higher yields of CO compared to the more porous leather hose. It is noteworthy that manufacturing material variability may influence the levels of smoke/chemicals exposure. Taken together, in this review of literature, we will provide insights on the negative health effects of hookah in general, with a focus on what is known regarding its impact on the cardiovascular system.Įven though hookah retains some of its features globally (presence of liquid through which smoke passes), there is immense variability in the consumables, sizes, and materials used to manufacture apparatus parts, due to personal preferences and cultural/regional differences. A major source of tobacco addiction is nicotine, whose levels in hookah are extremely variable as they depend on the type of tobacco used. Moreover, because of the overlapping toxicant/chemical profile to conventional cigarettes, hookah smoke effects on the cardiovascular system are thought to be comparable to those of conventional cigarettes. In fact, hookah users are at risks of infections, cancers, lung disease, and other medical conditions. Hookah users however are exposed to many of the same toxic compounds/by-products as cigarette users, but at dramatically higher levels, which might lead to more severe negative health effects. ![]() The misperception of hookah being less harmful than cigarettes and the availability of different but “appealing” flavors are considered among the main reasons for this trend. Hookah or waterpipe smoking or use is an emerging trend in the US population, especially among the youth. ![]()
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