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Muʽassel

Muʽassel (Arabic: معسل, meaning "honeyed"), or maassel, is a syrupy tobacco mix containing molasses, vegetable glycerol and various flavourings which is smoked in a hookah, a type of waterpipe. It is also known as "shisha".[1]

A package of Al Fakher brand double crunch flavour muʽassel

Argilah or Argileh (Arabic: أرجيلة, sometimes pronounced Argilee),[2] and shisha or sheesha (شيشة), is the common term for the hookah itself in the Arab world.

History edit

Although hookah pipes have been used for several hundred years, muʽassel is a recent invention, going back to the early 1990s. Before this, raw tobacco was smoked in hookah pipes, which was not very easy to use. The tobacco needed to be mixed with water, squeezed, and molded prior to use. It was hard to keep lit and produced a strong harsh smell and taste with a potent nicotine delivery. At the end of the twentieth century, hookah was no longer a very popular way to smoke tobacco, and in the Middle East was popular mainly among older, Arab men who smoked it with friends in cafes. Young people became interested in hookah use beginning in the early 1990s when milder sweetened and flavored hookah tobacco, commonly called Muʽassel, first became available. It is made by fermenting tobacco with molasses, glycerine and fruit essence, producing a moist and pliable mixture. Its ease of use and pleasant aroma and taste made it popular with young people. It quickly became the most common type of hookah tobacco globally, and sales skyrocketed, fuelled by the ever increasing variety, growing internet availability and advertising.[3]

Culture edit

Middle East edit

Arab world edit

 
Bedouin smoking a hookah, locally called nargileh, in a coffeehouse in Deir ez-Zor, on the Euphrates, 1920s

In many places in the Arab world, the smoking of shisha is a part of traditional culture, and is considered a social custom. Social smoking is typically done with the use of a hookah with a single hose which is passed around the group or double hose, but some hookahs can employ up to four hoses. When the smoker is finished, the hose is either placed back on the table, signifying that it is available, or is handed directly to the next user. Social convention dictates that the mouthpiece and hose should be folded back on itself in such a way that the mouthpiece is not pointing at the recipient. Disposable mouth tips are sometimes used in cafes.

Many cafés in the Middle East offer hookah. Cafés are widespread and are common social gathering places (akin to public houses in Britain). Some expatriate residents arriving in the Middle East frequent hookah cafés in lieu of pubs in the region, especially where prohibition is in place and alcohol is not served.[citation needed]

Levant edit

In the Levant (Syria, Israel, Palestine, Lebanon, Jordan), hookah (sometimes referred to as "arguileh", or "narguileh") is widely used, and its availability is nearly universal. Hookah has become part of the culture. Smokers are often seen on the side of the streets, parks, bus stops, and other public venues. Cafes are sometimes observed to be fully occupied by hookah smokers, even during late hours of the night.[4] It is not uncommon to see women smoking hookah. In the Levant, it is very social, and the activity is often accompanied by a game of Tawla (Backgammon), cards, or tea.

Iran edit

 
Persian woman in Qajari dress smoking the traditional Qalyan

In Iran, the hookah is known as a ḡalyān (Persian: قليان, قالیون, غلیون, also spelled ghalyan, ghalyaan or ghelyoon). It is similar in many ways to the Arabic hookah but also differs in several ways. One difference is the uppermost part of the hookah, the "ghalyoun," locally called 'sar' (سر, i.e. head), where the tobacco is placed. Compared to Turkish hookahs, the Iranian version tends to be somewhat larger. Additionally, the majority of the hose is flexible and covered with soft silk or cloth, while Turkish hookahs often have mouthpieces and partially rigid hoses which are as long as or longer than the flexible part of the hose.[5]

Each smoker will typically carry their own personal mouthpiece (called an amjid, امجید). The amjid is a detachable hookah mouthpiece, and is usually made of wood or metal and can be decorated with valuable or other stones. Amjids are considered to be decorative and are a highly personal item. Public smoking venues will often carry disposable or cleanable amjid for the use of smokers who do not carry their own.[citation needed]

The exact date of the first use of ḡalyān in Persia is not known. According to Cyril Elgood, it was Abu’l-Fatḥ Gīlānī, a Persian physician at the court of the Mughal emperor Akbar I, who "first passed the smoke of tobacco through a small bowl of water to purify and cool the smoke and thus invented the hubble-bubble or hookah." However, Ahlī Šīrāzī refers to the use of the ḡalyān in one of his poems, thus dating its use to at least as early as the time of Ṭahmāsp I in the late 14th century.[6] Therefore Abu’l-Fatḥ Gīlānī may be credited with the introduction of the Persian ḡalyān in India.

Although the Safavid Shah ʿAbbās I strongly condemned tobacco use, towards the end of his reign smoking ḡalyān and čopoq (a long-stemmed pipe with a small bowl for smoking tobacco, distinct from the ḡ/qalyān, or water pipe.[6]) had become common at every level of society. In schools and learned circles, both teachers and students had ḡalyāns during lessons. Smoking was so popular, that the shah had his own private ḡalyān servant, and the first evidence for the position of hookah tender (ḡalyāndār) dates from this time. At this time, water pipes were made from materials such as glass, pottery, and a particular type of gourd. Due to the unsatisfactory quality of indigenous glass, glass reservoirs were sometimes imported from Venice. In the time of Shah Solaymān in the late 15th and early 16th century, ḡalyāns became more elaborately embellished as their use increased. The wealthy owned gold and silver pipes, and even the general population spent more on ḡalyāns than they did on the basic necessities of life. An emissary of Shah Sultan Husayn, to the court of Louis XV in the early 16th century, on his way to the royal audience at Versailles, had in his retinue an officer holding his ḡalyān, which he used while his carriage was in motion. We have no record indicating the use of ḡalyān at the court of Nāder Shah Afšār, although its use seems to have continued uninterrupted. There are portraits of Karīm Khan Zand and Fatḥ-ʿAlī Shah Qājār which depict them smoking the ḡalyān.[6] Iranians had a special tobacco called Khansar (خانسار, presumably name of the origin city). With Khansar, coals would be put on the Khansar without foil. Khansar has less smoke than the normal tobacco.

Caucasus edit

Azerbaijan edit

It is one of the popular entertainment and hangout activities, mostly among youngsters and men in Azerbaijan, especially in Baku.

South Asia edit

Pakistan edit

Hookah (called chillum or huqqa in Pakistan) is the most common way to consume tobacco among elderly in lower socio-economic and rural people in Pakistan. However, in recent years, use has increased among youth and urban residents, who often consume hookah in cafes.[7]

India edit

 
The intricate work on a Malabar Hookah
 
The hookah family

Hookah was popular in India especially during Mughal rule.[8] The hookah then become less popular; however, it is once again garnering the attention of the masses, and cafés and restaurants that offer it as a consumable are popular. The use of hookahs from ancient times in India was not only a custom, but a matter of prestige. Rich and landed classes would smoke hookahs.

Tobacco is smoked in hookahs in many villages as per traditional customs. Smoking a tobacco-molasses shisha is now becoming popular amongst the youth in India. There are several chain clubs, bars and coffee shops in India offering a wider variety of muʽassels, including non-tobacco versions. Hookah was recently banned in Bangalore. However it can be bought or rented for personal usage or organised parties only.[9]

Koyilandy, a small fishing town on the west coast of India, once made and exported hookahs extensively. These are known as Malabar Hookhas or Koyilandy Hookahs. Today these intricate hookahs are difficult to find outside of Koyilandy and not much easier to find in Koyilandy itself.

Due to their harm to health, hookah has recently been banned in many states in India.[10] There have been numerous raids and bans recently on hookah smoking, especially in Gujarat[11]

Nepal edit

 
A hookah at a restaurant in Nepal

Hookahs (हुक़्क़ा), especially wooden ones, are popular in Nepal. Historically, hookah usage was considered to symbolize elite family status. Today, however, hookahs have become popular among tourists and young people.[12]

Bangladesh edit

Hookah, as the traditional smoking device, has been commonly used in Bangladesh since the Mughal ages. But mu'assel wasn't introduced in Bangladesh until the early 2000s. Hookah became very popular among the young crowds, and hookah bars and lounges opened up in large numbers to cater to those crowds. However, due to health concerns and unregulated consumption, the government banned hookah in late 2010 and hookah lounges were ordered to shut down.[citation needed] A few hookah lounges were given permission to continue business as they mostly served to foreigners.

Southeast Asia edit

Philippines edit

In the Philippines, hookah use was more or less traditionally confined to the minority Arab Filipino and Indian Filipino communities. The custom has also been present in the indigenous Muslim Filipino community (a considerable religious minority), where a historical following of Middle Eastern socio-cultural trends led to the hookah being a rare—albeit prestigious—social habit of the nobility in the vital trade hubs of Mindanao such as Cotabato and Jolo.

Hookah was meanwhile virtually unknown to the predominant Christian Filipinos in Luzon and the Visayas before the late 20th century. Presently, hookah use is gaining popularity among younger, more cosmopolitan Christians, particularly with college students and young adults who may be underage and thus unable to purchase cigarettes.[13]

In the National Capital Region and other conurbations such as Metro Cebu and Metro Davao, hookahs and flavoured shisha are available in various high-end bars, clubs and "shisha lounges" as well as in traditional Middle Eastern restaurants.

Vietnam edit

In Vietnam, shisha has been around for a long time, with the response of young people, so the hobby of smoking shisha is becoming more and more popular. Most people think that smoking shisha is better than smoking due to less nicotine.[citation needed] People can smoke shisha at cafes, karaoke bars and bars in Vietnam.

South Africa edit

In South Africa, hookah, colloquially known as a hubbly bubbly or an okka pipe, is popular[needs update?].[citation needed]

United States and Canada edit

 
A hookah and a variety of muʽassel packages are on display in a Harvard Square store window in Cambridge, Massachusetts, United States.

Hookah was popular in the 1960s and 1970s, although in this era they used open flames rather than coals.[14] In recent years hookah use has increased dramatically in the United States and Canada.[15] Hookah bars and cafes have become popular especially among college students and young adults in big cities across North America. A major reason for this popularity is thought to be the invention of mu’assel in the early 1990s; this moist sweetened and flavored hookah tobacco is popular among young people because the tobacco is masked with a pleasant taste and aroma.[16] There is a growing hookah bar and café industry, especially in inner cities and near universities and colleges where youth and young adults gather.[15]

Recently, certain cities, counties, and states have implemented indoor smoking bans, many of which include hookah. In some jurisdictions, hookah businesses can be exempted from the policies through special permits. Some permits, however, have requirements such as the business earning a certain minimum percentage of their revenue from alcohol or tobacco.

In cities with indoor smoking bans, hookah bars have been forced to close or switch to tobacco-free muʽassel. In many cities though, hookah lounges have been growing in popularity. From the year 2000 to 2004, over 200 new hookah cafés opened for business, most of them targeted at young adults[17] and located near college campuses or cities with large Middle-Eastern communities. This activity continues to gain popularity within the post-secondary student demographic.[18] According to a 2018 study, 1.1% of students with some college but no degree, an associate degree or an undergraduate degree reported waterpipe or pipe tobacco product use either every day or some days.[19] As of November 2017, at least 2,082 college or university campuses in the U.S. have adopted 100% smokefree campus policies that attempt to eliminate smoking in indoor and outdoor areas across the entire campus, including residences.[20]

Hookah use by youth and adolescents rose from 1998 even as cigarette use decreased: youth hookah use more than doubled from 2011 to 2014 according to the Centers for Disease Control and Prevention.[21] However, since then the US Department of Health and Human Services has stated that older teens have decreased their use of hookahs in recent years.[22] The most recent research, from 2014 to 2018, shows that the percentage of high school seniors who had used a hookah in the last year decreased from 20 percent to 8 percent.[23] Among adolescents and young adults, hookah use is highest among those aged 19–20, and those who live in cities. It is less common in suburban and rural areas.[24] In 2011, 18.5% of 12th-grade students reported having smoked a hookah in the past year.[1] By 2019, 3.4% of highschool students reported having used hookah in the last 30 days.[25][26]

Health effects edit

Smoking muʽassel exposes users to many of the same harmful and toxic chemicals found in cigarette smoke. Several of the toxic chemicals in mu’assel smoke can cause cancer, including polycyclic aromatic hydrocarbons (e.g., fluorene and pyrene), heavy metals (e.g., arsenic, chromium, lead), radioactive elements (uranium, polonium, lead), and ultrafine particles.[citation needed] A single session of smoking muʽassel results in far more toxicants inhaled than a session of cigarette smoking, largely because a session of hookah use is much longer than an average session of cigarette smoking: 60 minutes on average for hookah users versus five minutes for a single cigarette.[27] A typical session of smoking muʽassel results in a user inhaling 90,000 ml of smoke versus 500 ml for a cigarette, as well as 1.7 times as much nicotine, 8.4 times as much carbon monoxide, and 36 times as much tar.[27] Muʽassel smoking also exposes users to heavy metals and is thought to expose users to more carcinogens than cigarettes.[28] Hookah smokers inhale large amounts of carbon monoxide generated from the combustion of mu’assell as well as the charcoal used to burn the mu’assel. Carbon monoxide is a highly toxic odorless gas that can damage the heart and central nervous system. There have been many cases of carbon monoxide poisoning among hookah smokers that require treatment in hospital emergency departments for symptoms such as headache, nausea, vomiting, dizziness, fatigue and weakness. This is sometimes called “hookah sickness.”[29] The charcoal used to heat up the muʽassel increases carbon monoxide and metal inhalation.[15]

These toxicants have led the American Lung Association, Centers for Disease Control and Prevention, and Food and Drug Administration to conclude that smoking muʽassel using a hookah "has many of the same health risks as cigarette smoking."[28][30][31] These risks include lung cancer, respiratory disease, low birth weight in babies,[15] increased risk of respiratory disease in babies, heart disease and artery clogging, as well as oral, stomach, esophagus and bladder cancers.[30] Herbal muʽassel and shisha poses similar risks to its tobacco-containing counterpart: smoke from herbal muʽassel contains equal or greater levels of carbon monoxide, nitric oxide, aldehydes, tar, and carcinogenic polycyclic aromatic hydrocarbons (PAH) as tobacco-containing smoke.[32] These chemicals contribute to cancers, heart disease, and lung disease.[30]

In addition, mu’assell contains nicotine, which smokers inhale. Nicotine is addictive, which can make quitting hookah difficult and cause withdrawal symptoms such as irritability and depression when people go without smoking hookah for an extended time.

Smoking muʽassel in a hookah also releases secondhand smoke that harms the health of those around the smoker. Secondhand smoke from hookahs contains carbon monoxide, PAH, aldehydes, ultrafine particles (<2.5μm), and respirable particulate matter (particles small enough to enter the lungs). Studies of hookah lounges in Virginia have found that hookah lounges have worse air quality than comparable restaurants that allow indoor cigarette smoking.[33] Acute effects of exposure to secondhand smoke from hookahs including wheezing, nasal congestion, and chronic cough, although long term effects have yet to be studied.[34] The detrimental effects of secondhand smoke from hookahs apply equally to tobacco-free muʽassel or shisha: one study found that herbal hookah smoke contains carcinogens equal or greater to that of hookah smoke with tobacco, in addition to PAH, carbon monoxide, and metals.[34]

See also edit

References edit

  1. ^ a b Morris, Daniel S. (2012). "Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States". Preventing Chronic Disease. 9: E165. doi:10.5888/pcd9.120082. ISSN 1545-1151. PMC 3505114. PMID 23153772.
  2. ^ "How to pronounce أرجيلة". Forvo. Retrieved 27 June 2018.
  3. ^ "Hookah fact sheet".
  4. ^ Yarshater, E. "Galyan. Encyclopedia Iranica (Vol. X, Fasc. 3, P. 261-265)".
  5. ^ Yarshater, E (2012). "Encyclopedia Iranica (Vol X. Fasc. 3. P. 261-65)".
  6. ^ a b c "Encyclopædia Iranica | Articles". Iranica.com. Retrieved 2010-08-22.
  7. ^ Khan, Nazeer; Lftikhar, Sundus; Siddiqui, Muhammad Umer; Padhiar, Adnan Ahmed; Affanulhaq, Syed (2010-09-21). "Effect of Age and Gender on the Knowledge, Attitude and Practice of Shisha Smoking among Medical and Dental Students of Karachi, Pakistan". Journal of the Dow University of Health Sciences (JDUHS). 4 (3): 107–112. ISSN 2410-2180.
  8. ^ "Huqqah in Mughal India". Rana Safvi. 2014-12-10. Retrieved 2021-04-16.
  9. ^ . The Times of India. Archived from the original on 2013-05-11.
  10. ^ "Indian police ban hookah bars". Telegraph (UK). from the original on November 30, 2011.
  11. ^ "Hookah". Indian Express. Retrieved 2008-06-08.
  12. ^ Nepal, ECS. . ECS Nepal. Archived from the original on 24 July 2011. Retrieved 28 February 2011.
  13. ^ "Use of Cigarettes and Other Tobacco Products Among Students Aged 13-15 Years - Worldwide, 1999-2005". Cdc.gov. Retrieved 2010-08-22.
  14. ^ Jillian Krotki (29 October 2008). "Hookah lounge brings '60s pastime back to the present". Seminole Chronicle. Archived from the original on 19 September 2012. Retrieved 3 September 2013.
  15. ^ a b c d "Hookah Smoking — A Growing Threat to Public Health" (PDF). American Lung Association. Retrieved 27 June 2018.
  16. ^ CDCTobaccoFree (2020-01-22). "Hookahs". Centers for Disease Control and Prevention. Retrieved 2021-04-16.
  17. ^ Lyon, Lindsay "The Hazard in Hookah Smoke". (28 January 2008)
  18. ^ Quenqua, Douglas "Putting a Crimp in the Hookah". The New York Times, 30 May 2011
  19. ^ Creamer, MR; Wang, TW; Babb, S; et al. (15 November 2019). "Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018". Morbidity and Mortality Weekly Report. 68 (45): 1013–1019. doi:10.15585/mmwr.mm6845a2. PMC 6855510. PMID 31725711.
  20. ^ Wang, TW; Tynan, MA; Hallett, C; et al. (22 June 2018). "Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017". Morbidity and Mortality Weekly Report. 67 (24): 686–689. doi:10.15585/mmwr.mm6724a4. PMC 6013086. PMID 29927904.
  21. ^ Arrazola, RA; et al. (17 April 2015). "Tobacco use among middle and high school students--United States, 2011-2014". Morbidity and Mortality Weekly Report. 64 (14): 381–385. PMC 5779546. PMID 25879896.
  22. ^ Office of Adolescent Health (1 May 2019). "Adolescents and Tobacco: Trends : Hookah". www.hhs.gov. The U.S. Department of Health and Human Services (HHS). Retrieved 8 July 2020.
  23. ^ Johnson, LD; et al. (January 2019). Monitoring the Future - national survey results on drug use 1975-2018: Overview, key findings on adolescent drug use (PDF) (Report). Institute for Social Research, The University of Michigan. Retrieved 8 July 2020.
  24. ^ "Hookah isn't harmless". National Institute on Drug Abuse. 2016. Retrieved 8 July 2020.
  25. ^ Wang, TW; Gentzke, AS; Creamer, MR; et al. (6 December 2019). "Tobacco product use and associated factors among middle and high school students--United States, 2019". Morbidity and Mortality Weekly Report. 68 (12): 1–22.
  26. ^ "Tobacco Product Use Among High School Students" (PDF). Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. 2019. Retrieved 8 July 2020.
  27. ^ a b Cobb, Caroline; Ward, Kenneth D.; Maziak, Wasim; Shihadeh, Alan L.; Eissenberg, Thomas (2010). "Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States". American Journal of Health Behavior. 34 (3): 275–285. doi:10.5993/AJHB.34.3.3. ISSN 1087-3244. PMC 3215592. PMID 20001185.
  28. ^ a b AN EMERGING DEADLY TREND:WATERPIPE TOBACCO USE (PDF) (Report). American Lung Association. February 2007. Retrieved June 27, 2018.
  29. ^ "Is 'Hookah Sickness' Just Carbon Monoxide Poisoning?". www.vice.com. Retrieved 2021-04-16.
  30. ^ a b c "Hookahs". Smoking & Tobacco Use. Centers for Disease Control and Prevention. December 1, 2016. Retrieved 27 June 2018. "Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking."
  31. ^ "Hookah Tobacco (Shisha or Waterpipe Tobacco)". Tobacco Products. U.S. Food and Drug Administration. May 7, 2018. Retrieved 27 June 2018.
  32. ^ Shihadeh, Alan; Salman, Rola; Jaroudi, Ezzat; Saliba, Najat; Sepetdjian, Elizabeth; Blank, Melissa D.; Cobb, Caroline O.; Eissenberg, Thomas (May 2012). "Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, tar and nicotine yields". Food and Chemical Toxicology. 50 (5): 1494–1498. doi:10.1016/j.fct.2012.02.041. ISSN 0278-6915. PMC 3407543. PMID 22406330.
  33. ^ Cobb, Caroline Oates; Vansickel, Andrea Rae; Blank, Melissa D.; Jentink, Kade; Travers, Mark J.; Eissenberg, Thomas (September 2013). "Indoor air quality in Virginia waterpipe cafes". Tobacco Control. 22 (5): 338–343. doi:10.1136/tobaccocontrol-2011-050350. ISSN 1468-3318. PMC 3889072. PMID 22447194.
  34. ^ a b Kumar, Sumit R; Davies, Shelby; Weitzman, Michael; Sherman, Scott (March 2015). "A review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure". Tobacco Control. 24 (Suppl 1): i54–i59. doi:10.1136/tobaccocontrol-2014-052038. ISSN 0964-4563. PMC 4345792. PMID 25480544.

muʽassel, arabic, معسل, meaning, honeyed, maassel, syrupy, tobacco, containing, molasses, vegetable, glycerol, various, flavourings, which, smoked, hookah, type, waterpipe, also, known, shisha, package, fakher, brand, double, crunch, flavour, muʽasselargilah, . Muʽassel Arabic معسل meaning honeyed or maassel is a syrupy tobacco mix containing molasses vegetable glycerol and various flavourings which is smoked in a hookah a type of waterpipe It is also known as shisha 1 A package of Al Fakher brand double crunch flavour muʽasselArgilah or Argileh Arabic أرجيلة sometimes pronounced Argilee 2 and shisha or sheesha شيشة is the common term for the hookah itself in the Arab world Contents 1 History 2 Culture 2 1 Middle East 2 1 1 Arab world 2 1 2 Levant 2 1 3 Iran 2 2 Caucasus 2 2 1 Azerbaijan 2 3 South Asia 2 3 1 Pakistan 2 3 2 India 2 4 Nepal 2 5 Bangladesh 2 6 Southeast Asia 2 6 1 Philippines 2 6 2 Vietnam 2 7 South Africa 2 8 United States and Canada 3 Health effects 4 See also 5 ReferencesHistory editAlthough hookah pipes have been used for several hundred years muʽassel is a recent invention going back to the early 1990s Before this raw tobacco was smoked in hookah pipes which was not very easy to use The tobacco needed to be mixed with water squeezed and molded prior to use It was hard to keep lit and produced a strong harsh smell and taste with a potent nicotine delivery At the end of the twentieth century hookah was no longer a very popular way to smoke tobacco and in the Middle East was popular mainly among older Arab men who smoked it with friends in cafes Young people became interested in hookah use beginning in the early 1990s when milder sweetened and flavored hookah tobacco commonly called Muʽassel first became available It is made by fermenting tobacco with molasses glycerine and fruit essence producing a moist and pliable mixture Its ease of use and pleasant aroma and taste made it popular with young people It quickly became the most common type of hookah tobacco globally and sales skyrocketed fuelled by the ever increasing variety growing internet availability and advertising 3 Culture editMiddle East edit Arab world edit nbsp Bedouin smoking a hookah locally called nargileh in a coffeehouse in Deir ez Zor on the Euphrates 1920sIn many places in the Arab world the smoking of shisha is a part of traditional culture and is considered a social custom Social smoking is typically done with the use of a hookah with a single hose which is passed around the group or double hose but some hookahs can employ up to four hoses When the smoker is finished the hose is either placed back on the table signifying that it is available or is handed directly to the next user Social convention dictates that the mouthpiece and hose should be folded back on itself in such a way that the mouthpiece is not pointing at the recipient Disposable mouth tips are sometimes used in cafes Many cafes in the Middle East offer hookah Cafes are widespread and are common social gathering places akin to public houses in Britain Some expatriate residents arriving in the Middle East frequent hookah cafes in lieu of pubs in the region especially where prohibition is in place and alcohol is not served citation needed Levant edit In the Levant Syria Israel Palestine Lebanon Jordan hookah sometimes referred to as arguileh or narguileh is widely used and its availability is nearly universal Hookah has become part of the culture Smokers are often seen on the side of the streets parks bus stops and other public venues Cafes are sometimes observed to be fully occupied by hookah smokers even during late hours of the night 4 It is not uncommon to see women smoking hookah In the Levant it is very social and the activity is often accompanied by a game of Tawla Backgammon cards or tea Iran edit nbsp Persian woman in Qajari dress smoking the traditional QalyanIn Iran the hookah is known as a ḡalyan Persian قليان قالیون غلیون also spelled ghalyan ghalyaan or ghelyoon It is similar in many ways to the Arabic hookah but also differs in several ways One difference is the uppermost part of the hookah the ghalyoun locally called sar سر i e head where the tobacco is placed Compared to Turkish hookahs the Iranian version tends to be somewhat larger Additionally the majority of the hose is flexible and covered with soft silk or cloth while Turkish hookahs often have mouthpieces and partially rigid hoses which are as long as or longer than the flexible part of the hose 5 Each smoker will typically carry their own personal mouthpiece called an amjid امجید The amjid is a detachable hookah mouthpiece and is usually made of wood or metal and can be decorated with valuable or other stones Amjids are considered to be decorative and are a highly personal item Public smoking venues will often carry disposable or cleanable amjid for the use of smokers who do not carry their own citation needed The exact date of the first use of ḡalyan in Persia is not known According to Cyril Elgood it was Abu l Fatḥ Gilani a Persian physician at the court of the Mughal emperor Akbar I who first passed the smoke of tobacco through a small bowl of water to purify and cool the smoke and thus invented the hubble bubble or hookah However Ahli Sirazi refers to the use of the ḡalyan in one of his poems thus dating its use to at least as early as the time of Ṭahmasp I in the late 14th century 6 Therefore Abu l Fatḥ Gilani may be credited with the introduction of the Persian ḡalyan in India Although the Safavid Shah ʿAbbas I strongly condemned tobacco use towards the end of his reign smoking ḡalyan and copoq a long stemmed pipe with a small bowl for smoking tobacco distinct from the ḡ qalyan or water pipe 6 had become common at every level of society In schools and learned circles both teachers and students had ḡalyans during lessons Smoking was so popular that the shah had his own private ḡalyan servant and the first evidence for the position of hookah tender ḡalyandar dates from this time At this time water pipes were made from materials such as glass pottery and a particular type of gourd Due to the unsatisfactory quality of indigenous glass glass reservoirs were sometimes imported from Venice In the time of Shah Solayman in the late 15th and early 16th century ḡalyans became more elaborately embellished as their use increased The wealthy owned gold and silver pipes and even the general population spent more on ḡalyans than they did on the basic necessities of life An emissary of Shah Sultan Husayn to the court of Louis XV in the early 16th century on his way to the royal audience at Versailles had in his retinue an officer holding his ḡalyan which he used while his carriage was in motion We have no record indicating the use of ḡalyan at the court of Nader Shah Afsar although its use seems to have continued uninterrupted There are portraits of Karim Khan Zand and Fatḥ ʿAli Shah Qajar which depict them smoking the ḡalyan 6 Iranians had a special tobacco called Khansar خانسار presumably name of the origin city With Khansar coals would be put on the Khansar without foil Khansar has less smoke than the normal tobacco Caucasus edit Azerbaijan edit It is one of the popular entertainment and hangout activities mostly among youngsters and men in Azerbaijan especially in Baku South Asia edit Pakistan edit Hookah called chillum or huqqa in Pakistan is the most common way to consume tobacco among elderly in lower socio economic and rural people in Pakistan However in recent years use has increased among youth and urban residents who often consume hookah in cafes 7 India edit nbsp The intricate work on a Malabar Hookah nbsp The hookah familyHookah was popular in India especially during Mughal rule 8 The hookah then become less popular however it is once again garnering the attention of the masses and cafes and restaurants that offer it as a consumable are popular The use of hookahs from ancient times in India was not only a custom but a matter of prestige Rich and landed classes would smoke hookahs Tobacco is smoked in hookahs in many villages as per traditional customs Smoking a tobacco molasses shisha is now becoming popular amongst the youth in India There are several chain clubs bars and coffee shops in India offering a wider variety of muʽassels including non tobacco versions Hookah was recently banned in Bangalore However it can be bought or rented for personal usage or organised parties only 9 Koyilandy a small fishing town on the west coast of India once made and exported hookahs extensively These are known as Malabar Hookhas or Koyilandy Hookahs Today these intricate hookahs are difficult to find outside of Koyilandy and not much easier to find in Koyilandy itself Due to their harm to health hookah has recently been banned in many states in India 10 There have been numerous raids and bans recently on hookah smoking especially in Gujarat 11 Nepal edit nbsp A hookah at a restaurant in NepalHookahs ह क क especially wooden ones are popular in Nepal Historically hookah usage was considered to symbolize elite family status Today however hookahs have become popular among tourists and young people 12 Bangladesh edit Hookah as the traditional smoking device has been commonly used in Bangladesh since the Mughal ages But mu assel wasn t introduced in Bangladesh until the early 2000s Hookah became very popular among the young crowds and hookah bars and lounges opened up in large numbers to cater to those crowds However due to health concerns and unregulated consumption the government banned hookah in late 2010 and hookah lounges were ordered to shut down citation needed A few hookah lounges were given permission to continue business as they mostly served to foreigners Southeast Asia edit Philippines edit In the Philippines hookah use was more or less traditionally confined to the minority Arab Filipino and Indian Filipino communities The custom has also been present in the indigenous Muslim Filipino community a considerable religious minority where a historical following of Middle Eastern socio cultural trends led to the hookah being a rare albeit prestigious social habit of the nobility in the vital trade hubs of Mindanao such as Cotabato and Jolo Hookah was meanwhile virtually unknown to the predominant Christian Filipinos in Luzon and the Visayas before the late 20th century Presently hookah use is gaining popularity among younger more cosmopolitan Christians particularly with college students and young adults who may be underage and thus unable to purchase cigarettes 13 In the National Capital Region and other conurbations such as Metro Cebu and Metro Davao hookahs and flavoured shisha are available in various high end bars clubs and shisha lounges as well as in traditional Middle Eastern restaurants Vietnam edit In Vietnam shisha has been around for a long time with the response of young people so the hobby of smoking shisha is becoming more and more popular Most people think that smoking shisha is better than smoking due to less nicotine citation needed People can smoke shisha at cafes karaoke bars and bars in Vietnam South Africa edit Further information Hookah South Africa In South Africa hookah colloquially known as a hubbly bubbly or an okka pipe is popular needs update citation needed United States and Canada edit See also Hookah lounge nbsp A hookah and a variety of muʽassel packages are on display in a Harvard Square store window in Cambridge Massachusetts United States Hookah was popular in the 1960s and 1970s although in this era they used open flames rather than coals 14 In recent years hookah use has increased dramatically in the United States and Canada 15 Hookah bars and cafes have become popular especially among college students and young adults in big cities across North America A major reason for this popularity is thought to be the invention of mu assel in the early 1990s this moist sweetened and flavored hookah tobacco is popular among young people because the tobacco is masked with a pleasant taste and aroma 16 There is a growing hookah bar and cafe industry especially in inner cities and near universities and colleges where youth and young adults gather 15 Recently certain cities counties and states have implemented indoor smoking bans many of which include hookah In some jurisdictions hookah businesses can be exempted from the policies through special permits Some permits however have requirements such as the business earning a certain minimum percentage of their revenue from alcohol or tobacco In cities with indoor smoking bans hookah bars have been forced to close or switch to tobacco free muʽassel In many cities though hookah lounges have been growing in popularity From the year 2000 to 2004 over 200 new hookah cafes opened for business most of them targeted at young adults 17 and located near college campuses or cities with large Middle Eastern communities This activity continues to gain popularity within the post secondary student demographic 18 According to a 2018 study 1 1 of students with some college but no degree an associate degree or an undergraduate degree reported waterpipe or pipe tobacco product use either every day or some days 19 As of November 2017 at least 2 082 college or university campuses in the U S have adopted 100 smokefree campus policies that attempt to eliminate smoking in indoor and outdoor areas across the entire campus including residences 20 Hookah use by youth and adolescents rose from 1998 even as cigarette use decreased youth hookah use more than doubled from 2011 to 2014 according to the Centers for Disease Control and Prevention 21 However since then the US Department of Health and Human Services has stated that older teens have decreased their use of hookahs in recent years 22 The most recent research from 2014 to 2018 shows that the percentage of high school seniors who had used a hookah in the last year decreased from 20 percent to 8 percent 23 Among adolescents and young adults hookah use is highest among those aged 19 20 and those who live in cities It is less common in suburban and rural areas 24 In 2011 18 5 of 12th grade students reported having smoked a hookah in the past year 1 By 2019 3 4 of highschool students reported having used hookah in the last 30 days 25 26 Health effects editFurther information Health effects of tobacco and Hookah Health effects Smoking muʽassel exposes users to many of the same harmful and toxic chemicals found in cigarette smoke Several of the toxic chemicals in mu assel smoke can cause cancer including polycyclic aromatic hydrocarbons e g fluorene and pyrene heavy metals e g arsenic chromium lead radioactive elements uranium polonium lead and ultrafine particles citation needed A single session of smoking muʽassel results in far more toxicants inhaled than a session of cigarette smoking largely because a session of hookah use is much longer than an average session of cigarette smoking 60 minutes on average for hookah users versus five minutes for a single cigarette 27 A typical session of smoking muʽassel results in a user inhaling 90 000 ml of smoke versus 500 ml for a cigarette as well as 1 7 times as much nicotine 8 4 times as much carbon monoxide and 36 times as much tar 27 Muʽassel smoking also exposes users to heavy metals and is thought to expose users to more carcinogens than cigarettes 28 Hookah smokers inhale large amounts of carbon monoxide generated from the combustion of mu assell as well as the charcoal used to burn the mu assel Carbon monoxide is a highly toxic odorless gas that can damage the heart and central nervous system There have been many cases of carbon monoxide poisoning among hookah smokers that require treatment in hospital emergency departments for symptoms such as headache nausea vomiting dizziness fatigue and weakness This is sometimes called hookah sickness 29 The charcoal used to heat up the muʽassel increases carbon monoxide and metal inhalation 15 These toxicants have led the American Lung Association Centers for Disease Control and Prevention and Food and Drug Administration to conclude that smoking muʽassel using a hookah has many of the same health risks as cigarette smoking 28 30 31 These risks include lung cancer respiratory disease low birth weight in babies 15 increased risk of respiratory disease in babies heart disease and artery clogging as well as oral stomach esophagus and bladder cancers 30 Herbal muʽassel and shisha poses similar risks to its tobacco containing counterpart smoke from herbal muʽassel contains equal or greater levels of carbon monoxide nitric oxide aldehydes tar and carcinogenic polycyclic aromatic hydrocarbons PAH as tobacco containing smoke 32 These chemicals contribute to cancers heart disease and lung disease 30 In addition mu assell contains nicotine which smokers inhale Nicotine is addictive which can make quitting hookah difficult and cause withdrawal symptoms such as irritability and depression when people go without smoking hookah for an extended time Smoking muʽassel in a hookah also releases secondhand smoke that harms the health of those around the smoker Secondhand smoke from hookahs contains carbon monoxide PAH aldehydes ultrafine particles lt 2 5mm and respirable particulate matter particles small enough to enter the lungs Studies of hookah lounges in Virginia have found that hookah lounges have worse air quality than comparable restaurants that allow indoor cigarette smoking 33 Acute effects of exposure to secondhand smoke from hookahs including wheezing nasal congestion and chronic cough although long term effects have yet to be studied 34 The detrimental effects of secondhand smoke from hookahs apply equally to tobacco free muʽassel or shisha one study found that herbal hookah smoke contains carcinogens equal or greater to that of hookah smoke with tobacco in addition to PAH carbon monoxide and metals 34 See also editSmoking in SyriaReferences edit a b Morris Daniel S 2012 Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States Preventing Chronic Disease 9 E165 doi 10 5888 pcd9 120082 ISSN 1545 1151 PMC 3505114 PMID 23153772 How to pronounce أرجيلة Forvo Retrieved 27 June 2018 Hookah fact sheet Yarshater E Galyan Encyclopedia Iranica Vol X Fasc 3 P 261 265 Yarshater E 2012 Encyclopedia Iranica Vol X Fasc 3 P 261 65 a b c Encyclopaedia Iranica Articles Iranica com Retrieved 2010 08 22 Khan Nazeer Lftikhar Sundus Siddiqui Muhammad Umer Padhiar Adnan Ahmed Affanulhaq Syed 2010 09 21 Effect of Age and Gender on the Knowledge Attitude and Practice of Shisha Smoking among Medical and Dental Students of Karachi Pakistan Journal of the Dow University of Health Sciences JDUHS 4 3 107 112 ISSN 2410 2180 Huqqah in Mughal India Rana Safvi 2014 12 10 Retrieved 2021 04 16 Business at hookah less cafes go up in smoke The Times of India Archived from the original on 2013 05 11 Indian police ban hookah bars Telegraph UK Archived from the original on November 30 2011 Hookah Indian Express Retrieved 2008 06 08 Nepal ECS Smoke on The Water Hubby bubbly Hookah ECS Nepal Archived from the original on 24 July 2011 Retrieved 28 February 2011 Use of Cigarettes and Other Tobacco Products Among Students Aged 13 15 Years Worldwide 1999 2005 Cdc gov Retrieved 2010 08 22 Jillian Krotki 29 October 2008 Hookah lounge brings 60s pastime back to the present Seminole Chronicle Archived from the original on 19 September 2012 Retrieved 3 September 2013 a b c d Hookah Smoking A Growing Threat to Public Health PDF American Lung Association Retrieved 27 June 2018 CDCTobaccoFree 2020 01 22 Hookahs Centers for Disease Control and Prevention Retrieved 2021 04 16 Lyon Lindsay The Hazard in Hookah Smoke 28 January 2008 Quenqua Douglas Putting a Crimp in the Hookah The New York Times 30 May 2011 Creamer MR Wang TW Babb S et al 15 November 2019 Tobacco Product Use and Cessation Indicators Among Adults United States 2018 Morbidity and Mortality Weekly Report 68 45 1013 1019 doi 10 15585 mmwr mm6845a2 PMC 6855510 PMID 31725711 Wang TW Tynan MA Hallett C et al 22 June 2018 Smoke Free and Tobacco Free Policies in Colleges and Universities United States and Territories 2017 Morbidity and Mortality Weekly Report 67 24 686 689 doi 10 15585 mmwr mm6724a4 PMC 6013086 PMID 29927904 Arrazola RA et al 17 April 2015 Tobacco use among middle and high school students United States 2011 2014 Morbidity and Mortality Weekly Report 64 14 381 385 PMC 5779546 PMID 25879896 Office of Adolescent Health 1 May 2019 Adolescents and Tobacco Trends Hookah www hhs gov The U S Department of Health and Human Services HHS Retrieved 8 July 2020 Johnson LD et al January 2019 Monitoring the Future national survey results on drug use 1975 2018 Overview key findings on adolescent drug use PDF Report Institute for Social Research The University of Michigan Retrieved 8 July 2020 Hookah isn t harmless National Institute on Drug Abuse 2016 Retrieved 8 July 2020 Wang TW Gentzke AS Creamer MR et al 6 December 2019 Tobacco product use and associated factors among middle and high school students United States 2019 Morbidity and Mortality Weekly Report 68 12 1 22 Tobacco Product Use Among High School Students PDF Centers for Disease Control and Prevention Centers for Disease Control and Prevention 2019 Retrieved 8 July 2020 a b Cobb Caroline Ward Kenneth D Maziak Wasim Shihadeh Alan L Eissenberg Thomas 2010 Waterpipe Tobacco Smoking An Emerging Health Crisis in the United States American Journal of Health Behavior 34 3 275 285 doi 10 5993 AJHB 34 3 3 ISSN 1087 3244 PMC 3215592 PMID 20001185 a b AN EMERGING DEADLY TREND WATERPIPE TOBACCO USE PDF Report American Lung Association February 2007 Retrieved June 27 2018 Is Hookah Sickness Just Carbon Monoxide Poisoning www vice com Retrieved 2021 04 16 a b c Hookahs Smoking amp Tobacco Use Centers for Disease Control and Prevention December 1 2016 Retrieved 27 June 2018 Although many users think it is less harmful hookah smoking has many of the same health risks as cigarette smoking Hookah Tobacco Shisha or Waterpipe Tobacco Tobacco Products U S Food and Drug Administration May 7 2018 Retrieved 27 June 2018 Shihadeh Alan Salman Rola Jaroudi Ezzat Saliba Najat Sepetdjian Elizabeth Blank Melissa D Cobb Caroline O Eissenberg Thomas May 2012 Does switching to a tobacco free waterpipe product reduce toxicant intake A crossover study comparing CO NO PAH volatile aldehydes tar and nicotine yields Food and Chemical Toxicology 50 5 1494 1498 doi 10 1016 j fct 2012 02 041 ISSN 0278 6915 PMC 3407543 PMID 22406330 Cobb Caroline Oates Vansickel Andrea Rae Blank Melissa D Jentink Kade Travers Mark J Eissenberg Thomas September 2013 Indoor air quality in Virginia waterpipe cafes Tobacco Control 22 5 338 343 doi 10 1136 tobaccocontrol 2011 050350 ISSN 1468 3318 PMC 3889072 PMID 22447194 a b Kumar Sumit R Davies Shelby Weitzman Michael Sherman Scott March 2015 A review of air quality biological indicators and health effects of second hand waterpipe smoke exposure Tobacco Control 24 Suppl 1 i54 i59 doi 10 1136 tobaccocontrol 2014 052038 ISSN 0964 4563 PMC 4345792 PMID 25480544 Retrieved from https en wikipedia org 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