Shisha smoking is on the rise. It is common for people to enjoy a few puffs at cafes and restaurants late at night and especially during Ramadan.

This ancient water pipe consisting of a long tube attached to a glass or plastic container that holds water in its base is known as shisha in Saudi Arabia and Egypt, narghile in Lebanon and hookah in English, which is also widely known by this name in the Indian subcontinent and elsewhere in Asia and Africa. It has been used for centuries to smoke away the day’s stress, while relaxing with friends and family.

People smoke shisha for relaxation. It is thinking people who smoke shisha, while people indulge in cigarette smoking to overcome nervousness and competition, and maybe it is seen as a style statement, says septuagenarian shisha smoker Abdul Aziz Anqari, who owns a family shisha business in downtown Jeddah. He says he has never smoked a cigarette. “Cigarettes are for nervous people, competitive people, people on the run.”

The tobacco in the shisha, which is flavored with fruit and sugar syrup, is burned using charcoal. Because the smoke passes through the water before the smoker inhales it, water pipes are believed by some to filter out the harmful substances in tobacco smoke. However, water pipe smoke contains the same toxins as cigarette smoke. A former cigarette smoker does not agree. “I can truly say that shisha smoking is very smooth and not noticeable when inhaled.”

Shisha smoking may reflect a social and entertainment behavior, but it does increase the risk of cardiovascular and respiratory diseases, says a medical expert. In fact, the prevalence of smoking in the Kingdom has reached striking levels that require immediate action, says Dr. Alaa El-Alem, medical director at Pfizer. Previous studies have suggested that shisha smoking increases heart rate and blood pressure, and impairs lung function.

In Saudi Arabia, there has been a recent trend toward increased shisha smoking. Saudi adolescents nowadays spend part of their leisure time smoking shisha in cafes and restaurants. Several studies have shown that shisha smoking is practiced more frequently, either daily or once a week, each session lasting from 30 minutes to an hour or more. The favorite places for smoking shisha are with friends in cafes and open places.

An important paper presented at the sixth annual conference of the Medical Services Department of Ministry of Defense and Aviation, which was held in Riyadh recently, highlighted smoking prevalence in the Kingdom, associated health risks, global anti-smoking guidelines and latest and most effective techniques to combat smoking.

Quoting a World Health Organization study featured by the globally-recognized Saudi Medical Journal of the Armed Forces Hospital in Riyadh, El-Alem underlines alarming facts on smoking, whether cigarette or shisha, being the leading and main avoidable cause of death worldwide.

The study revealed that the prevalence of smoking among school students in the Kingdom ranged between 12 and 30 percent, which generally rose up to 37 percent of university students and 33 percent of students at the country’s faculties of medicine and medical science institutes.

The higher proportion of shisha smokers among university students might possibly reflect the higher socioeconomic status of their families. One explanation is that even highly educated parents might consider shisha smoking prestigious and an indication of a modern standard of living.

Not only is the graph rising among males across the Kingdom, but also smoking is increasing among women of different age groups, including 14 percent of schoolgirls, 11 percent of female university students and 16 percent of female doctors. Other community groups were also no exception when it came to high smoking prevalence including military personnel with 30.5 percent, and 15 percent of rural and desert inhabitants.

With a mortality figure of 30,000 tallied every year in the Kingdom because of smoking-associated diseases, smoking has become a problem requiring immediate attention and action, according to the study. Globally, smoking was made accountable for more than five million mortalities every year resulting from smoking-associated health problems. This number is expected to double by the end of 2010 should smoking prevalence continue to grow at the same alarming rate.

Smoking becomes such an integral part of the smoker’s life that the rapid emergence of many withdrawal symptoms, when trying to kick the habit, such as headaches and sleep disorders, are extremely troublesome. Added to this are frustration, a general sense of dissatisfaction, tendency to isolation and depression, as well as the continual craving for nicotine.

Calling for clear and prompt action, the paper stressed the need to raise the community’s awareness of smoking health risks from various perspectives, economically and socially, with special emphasis on the benefits of quitting smoking. It also highlighted the need to enforce stringent and effective measures to help prevent smoking in different places and environments through putting in place firm legislations, levying high taxes and customs duties on tobacco products, etc.

Many methods to stop smoking, such as hypnosis, acupuncture and the use of lasers, silver touch, tranquilizers together with nicotine patches, gum and nasal sprays containing a small dose of nicotine, have all been shown by medical studies to have limited long term effectiveness.

Certain medicines have been made available recently to combat smoking. Some of them work to prevent nicotine from attaching itself to receptors in the brain leading to addiction. This in turn leads to reduced craving and a significant lessening of withdrawal symptoms.

Considering that three out of every four smokers desire to quit smoking and only five percent of that number succeed in quitting without medical assistance, the paper concludes with the recommendation to provide medical support for those wishing to quit smoking, a factor which plays a crucial role in helping to reduce the prevalence of nicotine addiction. One of the most effective means of assistance and support is the allocation of a toll free number for smokers to call round the clock, which would eventually cover even remote areas, providing medical advice and encouraging smokers attend clinics to assist them in beating this most serious addiction.

Several studies show that the attitudes and beliefs of the parents, the availability of recreation facilities and the regulations governing smoking at public places should be considered with planning for intervention strategies. Public health interventions including laws and regulations governing smoking in restaurants and cafes should be rigorously implemented.