Effects of Hookah on General Health, Research Paper Example

Introduction

Smoking remains to be one of the most preventable ways of developing diseases, yet it is a practice that is done by millions of individuals around the world.  Hookah also known as shisha, waterpipe tobacco, maassel, narghile, or argileh smoking, has been widely gaining popularity worldwide throughout the years as a safer alternative to smoking. This Evidence-Based Project (EBP) aims to learn more about shisha/hookah and how it affects the cardiovascular system and overall health about other tobacco products that have been linked to harmful effects. Because of marketing campaigns that portray hookah as a “safer alternative” to smoking, as well as social trends, hookah smoking continues to grow in popularity. Hookah smokers spend hours in their social groups smoking without understanding that “an hour-long hookah smoking session includes 200 puffs whereas smoking a normal cigarette includes 20 puffs”.

In differentiate, a few ponders have connected shisha smoking to an expanded chance of cardiovascular complications, counting blood vessel solidness, tall blood weight, and heart rate, as well as an expanded hazard of cancer (Rezk-Hanna & Benowitz, 2019). Other studies have linked hookah smoking to respiratory issues and sometimes death (Rezk-Hanna & Benowitz, 2019). (Akl, E et al., 2010). The lasting impacts of hookah smoking must be addressed. Despite this, more studies are needed to raise public consciousness about hookah smoking’s possible effects, given a large amount of evidence already available. Since most young people believe hookah is less dangerous than other tobacco products like cigarettes, this lack of awareness must be resolved to minimize increased use and educate people about the dangers of hookah smoking. These results can be combined and used in public education initiatives and policy development for more evidence-based hookah regulation. There is also a pressing need to recognize hookah users in the clinical environment and offer cessation counseling.

Problem Statement

Hookah smoking has become common worldwide, in part because it is thought to be a unique and acceptable way to socialize with friends, relax, and unwind, but also because some people believe hookah is a healthy way to smoke tobacco. “Hookah utilize begun centuries prior in antiquated Persia and India,” agreeing to the CDC. Hookah cafés are getting to be progressively common all through the world, counting within the Joined together Kingdom, Russia, France, the U.S. and the Center East” (CDC, 2020). Religious leaders, philosophers, and socialites were the only ones who were allowed to smoke hookah at the time. It was thought that it gave them the ability to think critically about political and social issues. They were less aware of the dangers it posed to their welfare. Tobacco use today is hazardous to both smokers’ and non-smokers’ health.

Significance of the Problem

Tobacco usage can be prevented because of mortality and morbidity around the world. Several studies have linked long-term water pipe usage to an increased incidence, seriousness, and mortality of the cardiovascular disease. Agreeing to the CDC (2020), “about 1 in 13 (7.8%) tall school understudies within the Joined together States utilized a hookah to smoke tobacco amid the past year, and almost 1 in 8 (12.3%). Youthful grown-ups matured 19-30 a long time had utilized a hookah to smoke tobacco amid the past year,” concurring to a study conducted in 2018. It is projected that over 100 million individuals rely on hookah usage regularly around the world (Qasim, Hanan et al., 2019). Hookah smoking remains to gain its popularity due to marketing strategies labeling hookah as the “safer alternative” to smoking as well as social trends.  According to an article by the CDC (2020), the way that hookah is used enables smokers to absorb more of the toxic substances that are also found in cigarette smoke at higher levels when compared to that of cigarette smokers.

Bhatnagar, A. et al. (2019) conducted a coordinate comparison of vascular work in hookah and cigarette smokers, finding that long-term hookah clients had a more critical decay of vascular work. This may be ascribed to hookah smoking’s higher presentation to hurtful or possibly hurtful constituents and nicotine. Agreeing to the report, all of which are signs of blood vessel firmness (Razk-Hanna et al., 2018). Given the increment in hookah smokers and inquire about highlighting the unfavorable impacts on common wellbeing and the cardiovascular framework, youthful grown-ups ought to be taught on stopping smoking hookah.

PICO Research Question

“Among youthful grown-ups, what are the impacts of hookah smoking compared to that of cigarette smoking on the cardiovascular framework and generally health?”

P (population): Young adults

I (interventions): shisha/hookah smoking

C (comparisons): cigarette smoking

O (outcome): cardiovascular system and health

Conceptual and Theoretical Framework

The clinical issue is the impact of hookah on overall health. It’s a problem that needs to be solved because it’s a worldwide trend. Hookah smokers have a lot of myths about tobacco. Smoking from a water pipe, they say, is less dangerous than smoking cigarettes. Since users do not inhale smoke when participating in the activity, they believe it is less hazardous than smoking (Qasim, Hanan et al., 2019). They say that by keeping the smoke in their mouth, they prevent nicotine absorption (Qasim, Hanan et al., 2019). The ease with which they can smoke hookah often plays a role in how they feel about it. Cigarettes have a terrible reputation, and there are limits on where they can be smoked. On the other hand, smoking shisha has a preconceived idea that it is socially appropriate since it has fewer restrictions. Hookah stations can be found in cafes, lounges, and restaurants all over the world. People use this product for various reasons, including peer pressure, tobacco taste, and curiosity (Qasim, Hanan, et al., 2019). Many people are unaware of the hazardous chemical makeup, which is close to that of cigarettes.

Literature Review

Akl, Elie A, Swarna Gaddam, Sameer K Gunukula, Roland Honeine, Philippe Abou Jaoude, Jihad Irani, The effects of waterpipe tobacco smoking on health outcomes: a systematic review, International Journal of Epidemiology, Volume 39, Issue 3, June 2010, Pages 834–857

Since it was one of the first meta-analyses of studies examining the relationship between waterpipe-smoking, this article filled a void in the literature. The study had two reviewers independently review the abstract data using a structured and pilot-tested method to ensure reliability. If the two parties could not reach an agreement through discussion, a third party would step in. The pilot test conducted before the survey was an excellent way to determine the survey’s reliability. There was assessment bias for both the risk factor and the result, which significantly impacted validity.

Significance

Akl et al. (2010) presented findings that validated our PICO issue’s aspects. The research uncovered several different health-related results linked to hooking smoking. Hookah smoking is substantially associated with cancer of the lungs, respiratory disorder, and periodontal diseases based on the available data from twenty-four separate studies using a systematic analysis (2010). This suggests that more high-quality cohort studies are needed to accurately classify and measure all of hookah smoking’s health effects and investigate how it interacts with other types of tobacco (2010). The consequences for public health practice are essential. Even though the evidence in this study was not very good, it still suggests that hookah smoking has negative health consequences that can be tackled. Since young adults are unaware of the dangers of hookah smoking, focusing health resources on educating hookah smokers may be one way to address this public health issue, mainly because hookah smoking has grown in popularity over time.

Rezk-Hanna, M., & Benowitz, N. L. (2019). Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk. Nicotine & Tobacco Research, 21(9), 1151–1161.

The study by Rezk-Hanna and Benowitz (2019) aimed to investigate all aspects of hookah-pipe smoking to compare it to other nicotine products and determine if hookah smoking is, in reality, the healthier option. Rezk-Hanna and Benowitz (2019) examined the toxicological constituents of Shisha, the tobacco used in hookah-pipe smoking, and compared them to cigarette constituents. The members in hookah and cigarettes were discovered to be very similar, and those in common have already been linked to having adverse effects on general health, especially cardiovascular health (Rezk-Hanna & Benowitz, 2019). Some of the constituents discovered were unique to hookah-pipe smoking, such as pollutants from charcoal burning, flavorings and phenol from Shisha. Finally, oxidants and carbon monoxide from the water used at the hookah pipe’s bottom give off the smoke (Rezk-Hanna & Benowitz, 2019).

Since hookah-pipe smoking has been promoted and glamorized as a healthy alternative to smoking cigarettes, and because it is socially acceptable, many young people smoke hookah at social events, common hookah lounges, and even at home (Rezk-Hanna & Benowitz, 2019). Young people inhale all of the known constituents for long periods, which can be toxic. According to Rezk-Hanna and Benowitz (2019), there is still a lot of mystery around hookah smoking, and the possible adverse effects of the constituents explicitly mentioned in hookah on health. Rezk-Hanna and Benowitz (2019) recommend conducting a study in which they examine hookah smoking over a long period to determine the potential adverse effects of long-term hookah smoking.

Significance

According to a report by Rezk-Hanna and Benowitz (2019), some constituents in hookah are the same in cigarettes linked to adverse effects on cardiovascular health. According to this report’s findings, hookah smoking is not a safe tobacco option and is just as dangerous as, if not more hazardous than, cigarette smoking (Rezk-Hanna & Benowitz, 2019). This is relevant to the latest Evidence-Based Project.

El-Zaatari Z.M., Chami H.A., Zaatari G.S. (2020). Health effects associated with waterpipe smoking Tobacco Control. Retrieved from: https://tobaccocontrol.bmj.com/content/24/Suppl_1/i31

Ziad M El-Zaatari, Hassan A Chami, and Ghazi S Zaatari (2020) address the number of cross-sectional examinations that have announced the retention of a few poisons and cancer-causing agents. During hookah (waterpipe smoking), which is solidly connected to health impacts. The article examines the legend that hookah smoking is “better” than cigarette smoking; the investigation additionally tracked down a “moderate connection between’s water pipe smoking and emotional wellness analyze among a wide example of U.S. understudies.” In a cross-sectional examination of 2536 Syrians, it was likewise connected to a higher BMI and hazard of stoutness in the wake of controlling for cigarette smoking, the number of ongoing illnesses, age, sexual orientation, pay, and marital status. More cross-sectional examinations tracked down that selective hookah smokers have higher urinary miniature egg whites 143, lower back torment 144, and more severe danger of gastroesophageal reflux infection (GERD) (water smokers pipe).

The focused on the gathering’s warmth rate, and the circulatory strain was determined when hookah meetings kept going 30–an hour after going without WPS, as per contemplates. (Zaatari and associates, 2020). The examination likewise neglected to report the sort of tobacco utilized, regardless of how they accepted cigarette smoking had a similar effect as hookah smoking. They needed to know whether all smoking types had similar impacts as hookah or if some are more remarkable than others.

Significance

Moreover, the inquire about fizzling to report the tobacco utilized, despite the truth that they accepted cigarette smoking, had the same effect as hookah smoking. They needed to know if all smoking shapes had the same impacts as hookah or if a few are more capable than others. It depicts a story investigation of current information on the wellbeing impacts of hookahs as an evidence-based approach, and it draws bolster for the work required to evaluate the scope of infection in this community of smokers, as well as the esteem of administrative activities to check this quickly expanding plague (Zaatari et al., 2020).

Kadhum, M., Jaffery, A., Haq, A., Bacon, J., & Madden, B. (2014). Measuring the Acute Cardiovascular Effects of Shisha Smoking: a cross-sectional study. JRSM Open, 5(6), 205427041453112. Doi: 10.1177/2054270414531127

Kadhum, Jaffery, Haq, Bacon, and Madden (2015) performed a cross-sectional analysis in six shisha cafes to see if smoking shisha/hookah had any acute cardiovascular effects. For five months, researchers went to six different shisha cafes for two hours every Saturday to recruit participants for their analysis (Kadhum et al., 2015). Researchers received informed consent from those interested in participating after outlining the study’s intent and procedure (Kadhum et al., 2015). A brief initial questionnaire was provided to ensure that any cardiovascular effects measured were not due to other factors such as smoking, having cardiorespiratory issues, or having recently smoked hookah within the previous 24 hours (Kadhum et al., 2015). Those who said yes to all of those questions were excluded from the report. A total of 61 people between 18 and 25 took part in the study (Kadhum et al., 2015).

To establish a baseline, three cardio indicators were tested. Blood pressure was determined using a blood pressure cuff, heart rate was determined by palpating the radial arteries, and carbon monoxide levels were determined using a carbon dioxide detector (Kadhum et al., 2015). Individuals were then told to smoke hookah for the allotted time, ranging from 45 to 90 minutes. After the participants had stopped or after the entire 90-minute time limit had been reached, the three measures were calculated once more (Kadhum et al., 2015). Kadhum et al. collected the data and used a paired t-test to interpret it. The findings revealed a statistically significant difference between the measures measured before hookah use and those measured after hookah use (2015). Kadhum et al. (2015) also conducted a correlational study to see whether the substantial rise in carbon monoxide was accompanied by significant increases in blood pressure and heart rates.

Significance

According to Kadhum et al. (2015), their research was an observational study in which causation could not be established. Researchers discuss the study’s limitations and some potential consequences to investigate further and recognize the possible adverse health effects associated with hookah smoking (Kadhum et al., 2015). Even though their analysis found a statistically significant rise in acute cardio indicators, researchers suggest that a more factual study is needed to fully assess the effects of Shisha, taking into account all possible variables (Kadhum et al., 2015). This is relevant to the current Evidence-Based Project. This may indicate that Shisha has adverse effects on overall health, especially the cardiovascular system. This study’s findings will aid in the current project of determining why hookah smoking is not a safe tobacco substitute.

Qasim, H., Alarabi, A. B., Alzoubi, K. H., Karim, Z. A., Alshbool, F. Z., & Khasawneh, F. (2019). The effects of Hookah/waterpipe smoking on general health and the cardiovascular system. Environmental health and preventive medicine, 24(1), 58.

The study, titled “The effect of shisha smoking on overall health and the cardiovascular systems,” predicted the misconception that hookah was less dangerous than cigarettes. The article discussed the factors that contribute to it being riskier and what makes it more hazardous than smoking cigarettes. This study stressed the three key factors when addressing adverse outcomes from hookah use were puffing topography, toxicants, and tampered air quality. The duration of a hookah session usually is much longer than that of a cigarette session. A typical hookah session lasts 17-20 minutes, while a cigarette session lasts 6 minutes on average (Qasim, Hanan et al., 2019). These contaminants have been related to higher levels of nicotine in users’ plasma. As a result, the longer the session, the more contaminants are exposed to. The higher plasma carboxyl-hemoglobin levels in users’ blood are acknowledged in this report. This indicates that their blood had higher levels of CO2. Higher CO2 levels indicate hypoxia and cellular respiration deficiency. Carcinogenic chemicals like NNAL and PAHS have also shown up in medical studies, in addition to higher plasma levels in their blood. The poor quality of air in homes and hookah cafes/lounges has been linked to these carcinogens.

The apparatus of the shisha fixture was linked to overall health results. Sharing mouthpieces increased the risk of pathogen transmission. Hepatitis C is an example of a disease that can be spread by sharing a spokesperson (Qasim, Hanan et al., 2019). Coughing, sputum overproduction, and shortness of breath were all signs of pulmonary discomfort in hookah users. There was an increase in macrophages, lymphocytes, and neutrophils. Hypertriglyceridemia, hyperglycemia, and hypertension were common (Qasim, Hanan et al., 2019). According to the report, CEA levels were higher in cigarette smokers than hookah smokers (Qasim, Hanan et al., 2019). Regardless, shisha users are more likely to develop tumors, especially gastric and esophageal cancer. The research focused on elevated heart rates, increased blood pressures, increased vascular resistance, and decreased blood flow while addressing the cardiovascular system. Because of the high nicotine plasma level, 3.6 percent of participants’ heart rates exceeded 200 beats per minute after a 30-minute session (Qasim, Hanan et al., 2019). Increased cardiac work and oxygen demand cause beta-adrenergic stimulation. Myocardial infarction, acute stroke, and Coronary artery disease were among the long-term symptoms.

Significance

To summarize, hookah smoking exposes consumers to high levels of carcinogens, pollutants, and poor air quality. Smoking’s long-term side effects include cardiovascular and general health issues. As a result, hookah smoking is not a healthier alternative to smoking cigarettes. As a result, education must be implemented to avoid more health problems among consumers.

Article Summary

The research looked into how hookah smoking is seen as a “safer alternative” to cigarette smoking, which is why it’s becoming more socially acceptable among young adults. This has become a common way to spend time with friends at social gatherings; there are even hookah lounges dedicated to hookah smoking, and many people smoke hookah at home. According to several studies, hookah smokers are subjected to the same poisonous components or byproducts as cigarette smokers. Because of the way hookah is used and the fact that a typical hookah session is considerably longer than a cigarette smoking session, hookah smokers are subjected to a significantly higher quantity of these toxic components. The smoke from a hookah consists of tall levels of these noxious specialists indeed after it has passed through water. Since young adults have a false understanding that hookah is harmless than other tobacco products such as cigarettes, this lack of knowledge is what needs to be addressed to reduce the increased use and educate individuals on the dangerous effects of hookah smoking. There is also a great need to identify and provide cessation counselling in the clinical setting regarding the use of hookah.

Generally, the writing that was chosen and checked was dependable and solid, appearing they ought to talk about hookah smoking’s developing notoriety and the conceivable negative impacts on common wellbeing and the cardiovascular systems. The writing investigation uncovered a standard crevice within the writing: the need for higher-quality investigate thinks about on the enduring impacts of smoking hookah on the cardiovascular framework and common wellbeing in hookah tobacco clients. According to the data collected so far, healthcare practitioners and customers are both confused regarding hookah smoking’s health complications. Because of the information currently available about the possible consequences of hookah smoking, there is a pressing need for initiatives aimed at raising public awareness and educating hookah smokers.

Methodology

To fix our clinical problem, two surveys will be distributed. Before beginning the analysis, the first survey will be given out. It will aid in determining who meets the study’s eligibility requirements. After the participants have been educated on the dangers of smoking shisha, the second survey will be issued. The information gathered will be used to answer our PICO query, which compares hookah and cigarettes’ health risks.

Outcomes

The hookah has long been promoted as a healthy alternative to cigarettes, and most people worldwide believe it. Most businesses, such as restaurants, nightclubs, and residences, have now adopted hookah, and some say that if they do not, they will lose customers to those who do. When asked if they smoke or not, the majority of people say they do not smoke. When asked if they smoke hookah, they reply, “We use hookah.” Hookah usage is deeply rooted in our community, and it is not considered a form of smoking. “The smoldering charcoal utilized to char the hookah tobacco transmits a noteworthy sum of carbon monoxide, a colorless, odorless gas that’s an asphyxiant and can cause heart disappointment. These compounds are often found in lower concentrations than in cigarette smoke, and other times they are found in higher concentrations” (Everts, 2015).

According to Hanan et al. (2019), the literature on hookah’s health effects could be underestimated or exaggerated, so future studies should account for these differences and make findings more applicable in terms of public education and policy-shaping for more evidence-based hookah regulation. People ought to be cautious almost smoking hookah since it increments the hazard of cardiovascular dangers such as blood vessel solidness, tall blood weight, heart rate, and an expanded chance of cancer. This can be accomplished by education so that people are aware of the possible consequences. Over a month, interviews (questionnaires) will be used to elicit input from the targeted groups to determine the intervention’s result.

Implementation

Evidence-based practice (EBP) has been widely advocated for tobacco prevention (cigarette use) and has reduced tobacco use. This has been accomplished by establishing smoke-free indoor and outdoor areas, banning tobacco advertisements, increasing tobacco products’ price and making tobacco prevention products and services readily available (Bondurant and Wedge, 2009). The latest trend is hookah smoking, which is still a type of tobacco but is more socially acceptable and promoted as a “safer alternative” to cigarette smoking. EBP for hookah smoking can be used in healthcare environments, social settings like hookah lounges and bars, and classrooms. In the healthcare environment, this can be accomplished by conducting interviews with clients as part of the social history process. Clients are often quizzed about their tobacco, illegal drug, and alcohol use histories but never about hookah.

Given the existing data on hookah smoking’s possible effects, this should be discussed as part of a routine clinical review in health care settings. Waterpipe smoking should be taxed in addition to waterpipe tobacco since it is most often performed in dedicated commercial venues places such as pubs, restaurants, or hookah lounges, where staff members usually prepare for hookah smoking. Besides, graphic health alerts about hookah smoking dangers should be needed in these social settings. In terms of item bundling, hookah companies ought to show visual wellbeing notices not as it were on the tobacco bundling for waterpipes but moreover on the water pipe hardware itself. Schools and universities are excellent places to teach young people about the dangers of hookah smoking. Since they make up the majority of smokers, this group should be targeted. In classrooms, pamphlets, fliers, and graphic health warning signs may be an effective way to educate students about hookah smoking.

Procedure

Convenience sampling would be used in many universities, with young adults being asked if they would like to research. Participants will complete a brief questionnaire after obtaining written consent, including questions about how often, for how long, and in what environment they smoke hookah. This overview will moreover inquire whether they accept hookah-pipe smoking is more advantageous than cigarette smoking and mindful of the possibly unsafe wellbeing dangers related with hookah. Following the completion of the questionnaire, participants will be invited to a seminar and given a booklet outlining the parallels between hookah and cigarettes, emphasizing the potential health risks. Participants will be given a second questionnaire after the lecture, in which they will be asked questions about the similarities and health hazards associated with hookah and cigarettes. They’ll also be asked if they think hookah is a better alternative to cigarettes after hearing all of this. Then, six months later, a follow-up questionnaire will be given to see if the education provided about smoking hookah’s possible health risks changed their habits.

Data Collection

Owing to a significant rise in the number of users in this demographic, we will be gathering qualitative data on college students between the ages of 18 and 22. We need consent to ensure that participants’ rights are respected and emphasize that this is a voluntary study. Questions like “How much do you smoke,” “Do you smoke or use other drugs,” “How long have you smoked,” and “Where do you smoke hookah” will be added to the first survey. Participants will receive a community-based intervention consisting of educational pamphlets, a 2-hour interactive lecture, and a resource list for support groups. There will also be psychological facilities, primary care providers, and a CDC website/phone number. To see how much the participants have heard, the second survey will ask, “What are the wellbeing dangers of smoking hookah,” “What are the wellbeing dangers of smoking cigarettes,” and “Are they comparable?” Two CDC workers will be chosen at irregular to assess the information and compile topics from the surveys. All of this is often accomplished to survey the adequacy of the participants’ instruction. To manage the cause and impact on patients, this consider will use a story subjective examination approach. This approach can be utilized to assess the reactions from the respondents’ interviews. Based on the interviewers’ responses, the data will be analyzed using existing themes and trends (stories and shared experiences).

Evaluation for Practice Change

Surveys and questionnaires may be used in various environments to assess applied initiatives’ efficacy and evaluate for practice improvement. Considering the selling of hookah equipment and accessories (hookah bowl, foil, hose, etc.) online and in-store and deciding whether sales went up or down is one way to do this. Whether or not there was a rise or decline in the pattern of sales over time would help determine practice change. Surveys may also be performed at hookah joints to measure revenue and the number of regular customers over time to determine the pattern. Since this would be a new question added to a patient’s social background, health care professionals will inquire about waterpipe tobacco usage and assess for a declining pattern over time. Besides, one of the suggested interventions is holding a conference to inform people about the potential effects of hookah smoking, including questionnaires. Have a follow-up study focusing on visit hookah smokers in 6 months to see in case there has been a decrease in waterpipe tobacco utilize. Pop-up surveys on social media may moreover be utilized to survey waterpipe tobacco use’s adequacy and design.

Conclusion

When a patient makes an appointment or visits a health care facility, questions are asked to screen for potential health problems. Patients ought to answer on the basis of whether they smoke cigarettes or not when asked the questions. Nurses should be advised to ask patients whether they smoke hookah while discussing whether they smoke because of the general and cardiovascular health risks. When patients say they smoke Shisha, they should be taught. Preventative and treatment-related services should be used to provide education. Studies on the importance of delivering education in healthcare settings may be conducted. Our research focuses on education on college campuses through seminars. As a result, a comparison of data from healthcare facilities and community-based settings would be helpful. In the future, it will also be beneficial to perform quantitative studies because quantitative analysis produces statistical data results. This makes it simple to compare products. Possible research may include gathering numerical data from people with acute and long-term health problems. Earlier investigate had recognized wellbeing dangers related with hookah smoking, but it needed data around how numerous individuals were influenced. Future data collection may aid in addressing the dangers associated with hookah use.

References

American Heart Association News (2019, January 15th). Hookah smoking gains popularity amid growing evidence of health risks. Retrieved from https://www.heart.org/en/news/hookah-smoking-gains-amid-growing-evidence-of-health-risks

Akl, Elie A, Swarna Gaddam, Sameer K Gunukula, Roland Honeine, Philippe Abou Jaoude, Jihad Irani, The effects of waterpipe tobacco smoking on health outcomes: a systematic review, International Journal of Epidemiology, Volume 39, Issue 3, June 2010, Pages 834–857

Bhatnagar, A., Cobb, C., Eissenberg, T., Goldstein, L., Maziak, Wasim.  (2019). Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement from the American Heart Association. Circulation, 139: e917–e936.

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Centers for Disease Control (2020, January). Hookahs. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.html

El-Zaatari Z.M., Chami H.A., Zaatari G.S. (2020). Health effects associated with waterpipe smoking Tobacco Control. Retrieved from: https://tobaccocontrol.bmj.com/content/24/Suppl_1/i31

Everts. S. (2015). What’s hookah, and is it healthier than smoking a cigarette? Retrieved from: https://cen.acs.org/articles/93/i25/s-Hookah-Healthier-Smoking-Cigarette.html

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Kadhum, M., Jaffery, A., Haq, A., Bacon, J., & Madden, B. (2014). Measuring the Acute Cardiovascular Effects of Shisha Smoking: a cross-sectional study. JRSM Open, 5(6), 205427041453112. DOI: 10.1177/2054270414531127

Qasim, H., Alarabi, A. B., Alzoubi, K. H., Karim, Z. A., Alshbool, F. Z., & Khasawneh, F. T. (2019). The effects of Hookah/waterpipe smoking on general health and the cardiovascular system. Environmental health and preventive medicine, 24(1), 58.

Rezk-Hanna, M., Doering, L., Robbins, W., Sarna, L., Elashoff, R. M., & Victor, R. G. (2018). Acute Effect of Hookah Smoking on Arterial Stiffness and Wave Reflections in Adults Aged 18 to 34 Years of Age. The American Journal of Cardiology, 112 (5).

Rezk-Hanna, M., & Benowitz, N. L. (2019). Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk. Nicotine & Tobacco Research, 21(9), 1151–1161.

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