CHAPTER ONE

INTRODUCTION

This chapter contains a background of the study, Statement of problem, research question, objectives and significance of the study.

1.2 Background of Study

Tobacco use is a significant cause of morbidity and mortality rate. Globally, 12% of all deaths among adults aged 30 years and over is attributed to tobacco use [and it is estimated that 80% of these deaths will be in low- and middle-income countries (LMIC) by 2030 if care not taken. Tobacco use is increasing rapidly in LMIC such as Cameroon, due not only to steady population growth with increasing urbanization and westernization of lifestyles, but also targeting by the tobacco industry ensuring that millions of people become addicted each year .

The country is undergoing a rapid socio-economic transition characterized by improving standards of living, rapid unplanned urbanization, and westernization of lifestyles, including increased tobacco use, harmful use of alcohol, unhealthy diet and insufficient physical activity levels. The result of all these modernization is an epidemiological transition in which non-communicable diseases (NCDs) increasingly contribute a significant share of the public health burden of disease. In Cameroon, tobacco use is common in all forms including chewing, sniffing, and especially shisha smoking. Increasing number of women is using tobacco.

In 2003, in the Cameroon Burden of Diabetes Baseline (CAMBoD) survey, overall 6.3% of the total population declared to be current smoker .In addition to active smoking, passive smoking is recurrent; nearly one-third of the population said they were affected by second-hand smoke: in 1994, 35.7% of Cameroonians were exposed to it, while the report of the Ministry of Public Health noted a slightly higher percentage (37%) in a study carried out in 2006 .The 2013 Global Adult Tobacco Survey on people above 15 years of age showed that 13.9% of men and 4.3% of women used tobacco products; 46% of Cameroon youth including males and females consume shisha before it was banned as a result of its effects on the life of men and women though this product is still found in places like snakes, bars and homes. On the Global Youth Tobacco Survey done in 2008 and 2014 among school children aged 13 to 15 years, 5.7% currently smoked cigarettes.

Although it is true that the water filter system in the shisha pipe may filter out some tobacco-specific carcinogens (i.e. cancer-causing agents), shisha smoke contains many of the same additional toxins as cigarette smoke. Studies have revealed that contrary to the beliefs that shisha smoking is less harmful and less addictive compared to cigarettes, its smoke contains high concentrations of hazardous chemicals and nicotine.

Quantities of tobacco by-products found in the blood of shisha smokers are reportedly equivalent to a cigarette smoker who had smoked 10 sticks of cigarette a day. These tobacco hazardous chemicals and by-products expose shisha smokers to a higher risk of diseases such as lung cancer, respiratory diseases, chronic bronchitis, low birth weight, cardiovascular diseases, blindness and nicotine dependence. Male and Female smokers are also exposed to high levels of carbon monoxide, heavy metals and cancer causing chemicals from the burning of charcoal used for heating shisha. In addition, sharing of shisha pipes has been linked to the spread of infectious diseases like hepatitis B, herpes, tuberculosis and flu.

Shisha smoking commonly takes place among boys and girls in groups in places of socialization such as bars, cafes and restaurants as the most preferred while other forms of tobacco use tend to occur individually at homes. However, peer pressure has been cited as the main reason for initiating shisha smoking because the majority of shisha smokers initiates and practice this habit in the company of friends. Shisha smoking is characterized by different flavors such as mint, strawberry, watermelon, star buzz and lemon bee balm. Flavored and sweetened tobacco was the most preferred tobacco smoked in shisha and one of the reasons cited for its proliferation. According to Martinasek et al., shisha has gained popularity becoming the tobacco smoking style of the 21st century among boys and girls similar to the fashionable cigars in the late 1990s.

The social context of its usage, fruity flavors and the misconception of less harm have been put forward to explain the popularity of this method of tobacco use among boys and girls. Studies conducted in different countries have identified factors associated with shisha smoking like limited knowledge about the health hazards of shisha smoking, individual factors including age, sex, education, attitude, residence and peer pressure, among others. Additionally, having a parent who smoked and awareness about the complications of shisha smoking was also highlighted.

However, the most popular type of tobacco used in waterpipes is called ma’assel. It is a mixture of crude tobacco fermented with molasses (black honey). Different fruit flavors are added to it (apple, strawberry, etc.). This is the most popular form, as was shown in a survey of cafés in Cairo. In the Syrian Arab Republic, it was rarely addressed in surveys before the early 1990s, and a Syrian view linked it to a waterpipe epidemic in Syria. Tombak is just another form of ma’assel. Jurak is a different form, which is prepared by a more complicated process. It is moistened, dried and shaped before being used.

Another name for it in the Syrian Arab Republic is ajami. Waterpipe smokers are less likely to use the latter form whether in Egypt or in the Syrian Arab Republican 2004, striking evidence of higher nicotine content in the tobacco used in waterpipe smoking was obtained. An analysis of 13 commercial types of pipe tobacco used in Saudi Arabia was carried out and a wide variation in nicotine content in all brands was noticed with an average of 8.32 mg/g tobacco (range 1.8–41.3 mg/g).

The addition of several additives: honey, glycerin and other flavors in the process of preparing the flavored (ma’assel) tobacco helps to lower the nicotine content in each gram of flavored tobacco. Smoking one head of flavored (ma’assel) tobacco, which contains on average one-third of nicotine presented in 20 cigarettes (204 mg/pack), resulted in a 20% higher plasma nicotine level.

In general, compared to cigarette smoking, waterpipe smoking is characterized by less frequent exposure (one to four sessions per day) but with a much more intense exposure per session which varies between 15 and 90 minutes. The uptake of tobacco nicotine is equivalent to 2–12 cigarettes per portion of tobacco used (hagar). A regular user of waterpipe, usually smokes several hagars per session and on average smokes 2-3 sessions per day. This translates into intake of nicotine equivalent to more than one pack of cigarettes per session for most waterpipe smokers. However, it is known that waterpipe smoking produces more smoke than cigarette smoking and it has been estimated that smoke exposure could be as much as 100- 200 cigarettes per session. Therefore, the types and magnitudes of health hazards of waterpipe smoking are likely to be different from those of cigarette smoking, and there is a need to standardize exposure measurements for the proper assessment of health hazards related to this particular kind of tobacco exposure.

Doctors say on the increasing shisha consumption that people believe shisha is not as harmful as cigarettes, however according to the British Heart Foundation, an hour-long shisha consumption session is equivalent to consuming more than 100 cigarettes. The doctors also highlight that traditionally, shisha tobacco is cigarette tobacco, and considering cigarettes have nicotine, carbon monoxide, tar, heavy metals such as lead, arsenic, it makes shisha consumption highly dangerous.

1.2 Statement of the problem

The problem with shisha is that, the consumption of shisha exposes the consumers which in this context are youths to different health implications and other domains of life depending on their age and sex too. Again, it becomes difficult to control shisha product since the youths (boys and girls) consuming it won’t stop consuming it despite its effects, however, there is the problem of compounds absorbed by its consumers and which are both strange and even overdosed mixtures hence puffs of smoke from this product are 3 to 4 times more harmful than those from conventional cigarettes with the risk of cancer even higher. Thus, regulations, identification of places of consumption of these products, are to be monitored in order to eliminate shisha consumption.

Despite actions made by the Government, youths still consume shisha in bars and home in Cameroon. Significant shortcomings still exist in developing and/or implementing comprehensive shisha use and prevention policies. These findings highlight major gaps as well as opportunities that can be harnessed to improve shisha control in Cameroon.

1.3 Research question

 1.3.1 General research question

What is the effect of shisha smoking on boys and girls in Molyko Buea municipality?

  1.3.2 Specific Research question

1. What are the individual factors that influence shisha smoking between boys and girls in Molyko Buea municipality?
2. What are the environmental factors that influence shisha smoking among boys and girls in Molyko Buea municipality?
3. How do psychological factors influence the consumption of shisha among boys and girls in Molyko Buea municipality?
4. What are the effects of shisha smoking among boys and girls in Molyko Buea municipality?

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