Tobacco use in shisha: Studies on waterpipe smoking

<strong>in</strong>dividuals are cutt<strong>in</strong>g back the number of pipes smoked. This is an established step <strong>in</strong> the
progression to quit smok<strong>in</strong>g. [39]
Smok<strong>in</strong>g duration was significantly positively correlated with systolic blood pressure
among waterpipe smokers (r r = 0.2, P < 0.05; non-presented data).
Among cigarette smokers smok<strong>in</strong>g duration was significantly positively correlated with
systolic (r r = 0.27, P < 0.001) and diastolic blood pressure ( r = 0.21, P < 0.001) along with the
random blood glucose levels (r r = 0.15,
P < 0.001). Many believe cigarette smok<strong>in</strong>g suppresses
body weight. [40, 41] It was observed that cigarette smokers were less likely to be obese <strong>in</strong>
comparison to waterpipe smokers. This may be due to a sedentary life associated with nonportable
waterpipe smok<strong>in</strong>g compared to cigarettes.
This study revealed a superadded risk factor for waterpipe smokers, which is obesity.
Thus, they may be at a greater risk for other morbidities. Egypt, accord<strong>in</strong>g to the tobacco
epidemic curve, [25] has started to suffer smok<strong>in</strong>g consequences at a community level. In the
early 1990s, smok<strong>in</strong>g-related mortality was estimated to be 704 deaths/100 000 among males
and 287 deaths/100 000 among females, both above the age of 35. [42] Also, some differences
are expected <strong>in</strong> develop<strong>in</strong>g countries, where life expectancy is low and premature mortality and
chronic morbidity are high; smok<strong>in</strong>g is likely to have wider health effects earlier than has been
the case <strong>in</strong> developed countries. [43] Health education programmes should expla<strong>in</strong> the risk
augmentation for obese <strong>in</strong>dividuals who smoke: waterpipe smok<strong>in</strong>g is no safer than cigarette
smok<strong>in</strong>g.
As was also documented <strong>in</strong> the Egyptian National Hypertension Project, [44] it is strik<strong>in</strong>g
that those <strong>in</strong>dividuals who were aware of their hypertensive status constituted a m<strong>in</strong>ority of
the detected cases and their hypertension was mostly uncontrolled (Tables 2.9 and 2.10). The
newly diagnosed cases were much more often under the age of 40 years than other age groups
(92% among females and 89% among males; Table 2.9). Thus at least 70% of the <strong>in</strong>dividuals
<strong>in</strong> a given age group were not aware of be<strong>in</strong>g hypertensive.
Table 2.9 Proportion of hypertensives who were newly diagnosed
Proportion of hypertensive who were: < 40 years 40–59 years ≥ 60 years Overall
Male P < 0.001 n = 234 n = 385 n = 181
newly diagnosed 91.5% 81.3% 75% 83%
Female P < 0.001 n = 263 n = 497 n = 243
newly diagnosed 88.6% 74.6% 71.2% 78%
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