Recent studies have shown Lebanese youth to be among the heaviest shisha smokers in the world, as relaxing with a nargileh pipe continues to be a popular pastime across the country despite its significant health risks.
With this in mind, a team from the American University of Beirut Medical Center launched a powerful social media campaign designed to raise awareness of the link between smoking tobacco from a waterpipe, or nargileh, and cancer.
According to a 2018 study on the global prevalence of waterpipe tobacco smoking, 65.3 percent of Lebanese under 24 have smoked shisha at least once in their life, while 37.2 percent of Lebanese youth had smoked it in the 30 days before their interview for the study, putting them first in the world for shisha smoking.
Nadine Chatila, AUBMC’s director of communications and public relations, said that shisha’s availability in Lebanon poses a real health risk.
“If you walk around anywhere in Beirut at lunchtime, you see people smoking shisha – they can deliver it to your home or they’ll offer you a free drink,” she said, “there’s too much temptation.”
AUBMC’s campaign video, which was shared on Facebook to mark Feb. 4’s World Cancer Day, shows guests at a cafe erupting with laughter when comical, high-pitched voices come out when they attempt to speak after taking a puff on a nargileh pipe that had been secretly filled with helium.
As the giggles subside, a waiter appears with an iPad.
Moments later, the customers’ faces drop as a rasping voice begins to speak, imploring them to “quit nargileh” before it’s too late.
A message then appears on the screen warning that shisha smokers are at a higher risk of developing throat cancer.
The voice belongs to a taxi driver suffering from the disease, who Chatila said wanted to share his story as a “wake-up call” to people that smoke shisha without considering the real risks it poses.
“We chose to focus on cancer because it is shocking, something that people can feel,” she said.
According to a 2015 report by the American Lung Association, smoking a nargileh pipe exposes the user to “potentially dangerous chemicals, including carbon monoxide and metals.”
Chatila added that AUBMC featured the video on social media to maximize outreach to young Lebanese people.
Lebanese American University student Mira Moghrabi said that it was important that the campaign targeted young people, since students have easy access to nargileh in cafes and restaurants just outside their campuses.
“If a student has three breaks during their day at university, then they will smoke nargileh three times,” she said.
Smoking shisha on a regular basis has dangerous consequences that reach far beyond cancer.
Earlier this year, the U.K.-based Brighton and Sussex Medical School published the largest study of its kind that found smoking shisha “significantly increases” the risk of users developing type 2 diabetes and obesity.
Professor Gordon Ferns from BSMS said that while it’s unclear why shisha smoking can result in diabetes and obesity, “it is possible that the toxins in the smoke … cause tissues to become resistant to the effects of the hormone insulin.”
“However, it is also possible that hookah smoking is associated with other social behaviors that lead to weight gain,” he added.
At the time of writing, the video AUBMC shared on Facebook was viewed over 1.5 million times, and had received more than 15,000 reactions, 7,000 comments and 24,000 shares.
One user who commented on the Facebook video asking for help to quit smoking received a response from the AUBMC, inviting him to contact the medical center for advice.
AUBMC currently runs a smoking cessation program that costs $166 and includes eight 45-minute sessions of counseling and therapy.
Chatila said that while many people visit the clinic to give up cigarettes, only one person had so far been treated for shisha addiction, because “people don’t believe that shisha is addictive.”
While some lauded the social media campaign and were convinced it would genuinely help people quit smoking, others felt it was a waste of time.
Smoking a “double apple” flavored pipe on a sunny afternoon in Beirut, 25-year-old restaurant manager Mohammad Zaidan told The Daily Star that although he knows shisha poses a health risk, he continues to smoke for at least an hour every day.
He said he doubts the campaign would have any effect.
“We all know shisha is bad, but it’s a habit, we’re used to it,” he said.
Others were more optimistic, however. AUB master’s student Samar Baydoun, 24, described the video as “emotional,” saying it motivated her to work on quitting smoking nargileh entirely.
Chatila said the inspiration for a campaign that centered on nargileh came from the success of a previous AUBMC awareness-raising video that won an award in the “corporate social responsibility” category at the Dubai Lynx Awards.
The video, released in 2016, showed customers being brought a large bunch of cigarettes to their table when they’d ordered nargileh, reflecting oft-cited research that an hourlong nargileh session is equivalent to 100 regular cigarettes.
The award-winning video was aired on local TV stations and viewed over a million times.
“We saw how interested people are in the topic [of nargileh],” Chatila said, which prompted the AUBMC team to make another campaign, this time focusing on cancer.
Chatila also lamented the lack of implementation of Lebanon’s Law 174, which prohibits all forms of smoking, including shisha, inside enclosed public spaces.
More than seven years after parliamentarians signed the law in 2011, smoking inside restaurants, cafes and bars in Lebanon is almost universal. Its implementation has gradually ebbed since 2015 when former Interior Minister Nouhad Machnouk announced his support for the law’s relaxation.
Landscape worker Charbel Saadeh, 31, who said he smokes nargileh up to 15 times every week, believes any law curbing smoke is destined for failure. “Any law [prohibiting smoking] won’t work,” he said. “If there’s no nargileh in restaurants, there’ll be no customers, and they can’t open.”
When asked why the AUBMC campaign focused on shisha smokers rather than political lobbying, Chatila said that as a medical center, “our role is to raise awareness, not create policy and regulation.”