Waterpipe tobacco smoking has become a widespread practice. In the UK, shisha smoking has been taken up by many, reflected in the increased number of shisha lounges and cafes. The evidence of the harmful effects of shisha smoking is growing and an association with lung cancer and respiratory illness has already been identified.1 Eissenberg found that, relative to cigarette smoking, shisha smoking is associated with greater carbon monoxide exposure and significantly more smoke exposure.2 We wanted to explore whether this form of smoking is being addressed by healthcare professionals in general practice.
In a cross-sectional study of 50 general practices in the West Midlands 4% of responders did not know what shisha was, while 16% of primary care healthcare professionals thought that shisha smoking is a problem in their locality. When clarifying a patient’s smoking status, 76% do not enquire about smoking shisha. Only 10%, sometimes or always, include shisha smoking in their smoking cessation advice; 36% of healthcare workers feel that one shisha pipe is equivalent to 16–20 normal strength cigarettes, whereas 20% feel it is equivalent to 0–5 cigarettes.
Enquiring about shisha seems to be done poorly in general practice in the West Midlands, and we believe a greater awareness and understanding of shisha is needed among healthcare professionals providing smoking cessation advice. The World Health Organisation suggests that a shisha smoker may inhale the smoke of up to 100 or more cigarettes during an estimated 20–80-minute session of smoking.3 We feel that it is necessary for those engaged in smoking cessation to ask ‘the shisha question’.4
- © British Journal of General Practice 2014