Hookah smoking seen as emerging public health threat in Kurdish region of Iraq

February 23, 2017

A commentary by two UNC Gillings School of Global Public Health researchers concludes that hookah smoking is an emerging threat to public health globally, perhaps especially now in the Kurdish region of Iraq.

Dr. Dilshad Jaff

Dr. Dilshad Jaff

Dr. Anant Kumar

Dr. Anant Kumar

Dilshad Jaff, MD, MPH, research adviser for conflict prevention and disaster preparedness in the Gillings School’s Gillings Global Gateway®, and Anant Kumar, PhD, adjunct associate professor in the Public Health Leadership Program, are co-authors of the study, which appeared in the Journal of Health Systems.

Tobacco use, including cigarette smoking, is among the top five causes of disease and death in the Kurdistan region of Iraq, but the use of a water pipe, or hookah, for tobacco delivery has become increasingly fashionable among young men and women in the region.

Because the water-aerated smoke and often honey-soaked tobacco taste less harsh, many consumers do not realize that hookah use can cause the same poor health outcomes as smoking – including respiratory disease, cancer, and low birth weight in the infants of pregnant women who smoke.

In addition, there are negative health outcomes related to sharing the mouthpiece of the hookah, including the spread of infectious diseases such as tuberculosis, herpes and influenza.

The authors attribute the increase in hookah use to young people’s associating smoking with independence, sex, success and adventure – as well as the easy access and availability of the product.

They encourage the Iraqi government and Kurdish authorities to identify hookah smoking as a serious public health threat and to commission research studies that will describe and forestall the epidemic.

“It is alarming that so many young men and women in the region have begun to practice this harmful habit recently,” Jaff said. “The ongoing armed conflict, economic distress, and the availability of cheap and accessible tobacco products are among the factors that contribute to this public health problem.”

Jaff, a physician who also is adjunct assistant professor of maternal and child health at the Gillings School, has worked for more than 15 years in conflict zones in the Middle East, addressing complex humanitarian crises. Kumar, who was a Fulbright Scholar at the Gillings School in 2015-2016, is associate professor in the Xavier Institute of Social Service, in Ranchi, India.


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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu