Hookah smoking is becoming a popular trend globally. Waterpipe smoking is the second
most prevalent form of alternate tobacco products. The rapid increase in hookah use is because of the
misconception prevalent in society that hookah smoking is less harmful than cigarette smoking.
Smoking ban policies had given impetus of switching from cigarette smoking to alternate tobacco
products like waterpipe. Hookah users regard hookah to be more socially acceptable, less stigmatizing
with flavors and to alleviate cigarette craving symptoms. Newer basic science research on animal
models and human cells has shown consistently mutagenic, oxidative, and inflammatory changes that
could cause possible health effects of premalignant oral lesion and chronic diseases like atherosclerosis
and chronic obstructive pulmonary disease. Studies on the chemistry of waterpipe smoke had
shown alarming results with the smoke containing seven carcinogens, 39 central nervous system depressants,
and 31 respiratory irritants. Enormous data exist showing waterpipe smoking causing various
health effects. Hookah smoking effects on cardiovascular disease is additive with hookah containing
a significant amount of nicotine, tar, and heavy metals causing both acute and chronic effects
on the cardiovascular system. These effects include increased heart rate, blood pressure, prevalence
of coronary heart disease, heart failure, ST-segment elevation myocardial ischemia, recurrent ischemia,
and worse outcomes including mortality related to these diseases. The objectives of the review
are to assess the factor associated with the increasing use of hookah, its health effects, options for
hookah smoking cessation, and public health policy initiatives to mitigate waterpipe use.
Keywords: Carcinogenesis, cardiovascular diseases, health policy, nicotine dependence, oxidative stress, smoking, tobacco use
cessation, water pipe.
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