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{{short description|Syrupy tobacco mixture used in hookahs}}
[[File:Al Fakher The Double Crunch Formerly Double Apple Package.png|thumb|A package of Al Fakher brand double crunch flavour muʽassel]]

'''Mu{{ayin}}assel''' ({{lang-ar|معسل}}, meaning "honeyed"), or '''maassel''', is a syrupy [[tobacco]] mix containing [[molasses]], vegetable [[glycerin|glycerol]] and various flavourings which is smoked in a [[hookah]], a type of waterpipe. It is also known as "'''shisha'''".<ref name=CDC>{{Cite journal| doi = 10.5888/pcd9.120082| pmid = 23153772| pmc = 3505114| issn = 1545-1151| volume = 9| pages = E165| last = Morris| first = Daniel S.| title = Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States| journal = Preventing Chronic Disease| date = 2012}}</ref>

''Argilah'' or ''Argileh'' ({{lang-ar|أرجيلة|link=no}}, sometimes pronounced ''Argilee''),<ref>{{cite web |title=How to pronounce أرجيلة |url=http://forvo.com/word/%D8%A3%D8%B1%D8%AC%D9%8A%D9%84%D8%A9/ |website=Forvo |access-date=27 June 2018}}</ref> and ''shisha'' or ''sheesha'' ({{lang|ar|شيشة}}), is the common term for the hookah itself in the [[Arab world]].

==History==
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, fueled by the ever increasing variety, growing internet availability and advertising.<ref>{{Cite web|url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm|title=Hookah fact sheet}}</ref>

==Culture==

===Middle East===

====Arab world====
[[File:Syriancafe.jpg|thumb|[[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 (tubing)|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 [[Smoking pipe|mouthpiece]] is not pointing at the recipient. Disposable mouth tips are sometimes used in cafes.

Many cafés in the Middle East offer hookah.<ref name="Authentic hookah lounge">{{Cite web|url=http://dev.leap13.com/hookah/hookah-lounge/2017/11/28/authentic-hookah-lounge/|title=Authentic hookah lounge}}</ref> Cafés are widespread and are common social gathering places (akin to [[public house]]s in Britain). Some [[expatriate]] residents arriving in the Middle East frequent hookah cafés in lieu of [[public house|pubs]] in the region, especially where [[prohibition]] is in place and alcohol is not served.<ref name="Authentic hookah lounge"/>

====Levant====
In the [[Levant]] (Syria, Palestine, Lebanon, Jordan), hookah (sometimes referred to as "{{transl|ar|arguileh}}", or "{{transl|ar|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.<ref>{{Cite web|url=http://www.iranicaonline.org/articles/galyan-|title=Galyan. Encyclopedia Iranica (Vol. X, Fasc. 3, P. 261-265)|last=Yarshater|first=E}}</ref> It is not uncommon to see a female 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====
[[File:Qalyoon.jpg|thumb|left|[[Persian woman]] in [[Qajars (Turkic people)|Qajari]] dress smoking the traditional Qalyan]]
In Iran, the hookah is known as a '''''ḡalyān''''' ({{lang-fa|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' ({{lang|fa|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.<ref>{{Cite web|last=Yarshater|first=E|date=2012|title=Encyclopedia Iranica (Vol X. Fasc. 3. P. 261-65)|url=http://www.iranicaonline.org/articles/galyan}}</ref>

Each smoker will typically carry their own personal mouthpiece (called an {{transl|fa|amjid}}, {{lang|fa|امجید}}). The {{transl|fa|amjid}} is a detachable hookah mouthpiece, and is usually made of wood or metal and can be decorated with valuable or other stones.<ref name=":0">{{Cite web|last=Parsian Rashed Pooyan Co.|title=History of Hookah|url=http://parsianrashed.com/En/History_En.html}}</ref> {{transl|fa|Amjids}} are considered to be decorative and are a highly personal item. Public smoking venues will often carry disposable or cleanable {{transl|fa|amjid}} for the use of smokers who do not carry their own.<ref name=":0" />

The exact date of the first use of ḡalyān in Persia is not known. According to Cyril Elgood, it was [[Abdul-Qadir Gilani|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 [[Tahmasp I|Ṭahmāsp I]] in the late 14th century.<ref name=":1" /> Therefore Abu’l-Fatḥ Gīlānī may be credited with the introduction of the Persian ḡalyān in India.

Although the [[Safavid]] [[Abbas I of Persia|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.<ref name=":1" />) 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 [[Suleiman I of Persia|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 [[Sultan Husayn|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 [[Nader Shah|Nāder Shah Afšār]], although its use seems to have continued uninterrupted. There are portraits of [[Karim Khan|Karīm Khan Zand]] and [[Fat′h-Ali Shah Qajar|Fatḥ-ʿAlī Shah Qājār]] which depict them smoking the ḡalyān.<ref name=":1">{{cite web|url=http://www.iranicaonline.org/articles/galyan- |title=Encyclopædia Iranica | Articles |publisher=Iranica.com |access-date=2010-08-22}}</ref>
Iranians had a special tobacco called ''Khansar'' ({{lang|fa|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===
====Azerbaijan====
It is one of the popular entertainment and hangout activities, mostly among youngsters and men in Azerbaijan, especially in [[Baku]].

===South Asia===
====Pakistan====
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.<ref>{{Cite journal|last=Khan|first=Nazeer|last2=Lftikhar|first2=Sundus|last3=Siddiqui|first3=Muhammad Umer|last4=Padhiar|first4=Adnan Ahmed|last5=Affanulhaq|first5=Syed|date=2010-09-21|title=Effect of Age and Gender on the Knowledge, Attitude and Practice of Shisha Smoking among Medical and Dental Students of Karachi, Pakistan|url=https://www.jduhs.com/index.php/jduhs/article/view/177|journal=Journal of the Dow University of Health Sciences (JDUHS)|language=en|volume=4|issue=3|pages=107–112|issn=2410-2180}}</ref>

====India====
[[File:Big hookah.jpg|thumb|The intricate work on a Malabar Hookah]]
[[File:The hookah family.jpg|thumb|The hookah family]]
Hookah was popular in India especially during [[Mughal Empire|Mughal]] rule.<ref>{{Cite web|date=2014-12-10|title=Huqqah in Mughal India|url=https://ranasafvi.com/huqqah-in-mughal-india/|access-date=2021-04-16|website=Rana Safvi|language=en-US}}</ref> 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 [http://en.wiktionary.org/wiki/shisha 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.<ref>{{cite news| url=http://articles.timesofindia.indiatimes.com/2011-06-07/bangalore/29628694_1_hookah-bars-shisha-joints | archive-url=https://web.archive.org/web/20130511190209/http://articles.timesofindia.indiatimes.com/2011-06-07/bangalore/29628694_1_hookah-bars-shisha-joints | url-status=dead | archive-date=2013-05-11 | work=[[The Times of India]] | title=Business at hookah-less cafes go up in smoke}}</ref>

[[Koyilandy]], a small fishing town on the west coast of India, once made and exported hookahs extensively. These are known as [[Koyilandy#Koyilandy hookahs|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.<ref>{{Cite news|title=Indian police ban hookah bars|work=Telegraph (UK)|url=http://www.telegraph.co.uk/news/worldnews/asia/india/8923159/Indian-police-ban-hookah-bars.html|archive-url=https://web.archive.org/web/20111130152036/http://www.telegraph.co.uk/news/worldnews/asia/india/8923159/Indian-police-ban-hookah-bars.html|url-status=live|archive-date=November 30, 2011}}</ref> There have been numerous raids and bans recently on hookah smoking, especially in [[Gujarat]]<ref name="Indian Express">{{cite web|url =http://www.indianexpress.com/news/-Ban-on-public-smoking-up-in-smoke-in-Gujarat-/465845/| title = Hookah|publisher = Indian Express|access-date = 2008-06-08}}</ref>

===Nepal===
[[File:Hukkah nepal.jpg|thumb|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.<ref>{{cite web|last=Nepal|first=ECS|title=Smoke on The Water: Hubby-bubbly Hookah|url=http://www.ecs.com.np/feature_detail.php?f_id=176|publisher=ECS Nepal|access-date=28 February 2011|url-status=dead|archive-url=https://web.archive.org/web/20110724190114/http://www.ecs.com.np/feature_detail.php?f_id=176|archive-date=24 July 2011}}</ref>

===Bangladesh===
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.<ref>{{Cite web|title=new age|url=http://archive.newagebd.net/84643/killer-in-disguise/|access-date=2021-04-16|language=en-GB}}</ref> A few hookah lounges were given permission to continue business, as they mostly served to foreigners.

===Southeast Asia===
====Philippines====
In the Philippines, hookah use was more or less traditionally confined to the [[minority group|minority]] [[Arab Filipino]] and [[Indian Filipino]] communities. The custom has also been present in the indigenous [[Moro people|Muslim Filipino]] community (a considerable [[Religious minorities|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 [[Christianity in the Philippines|Christian Filipino]]s in [[Luzon]] and the [[Visayas Islands|Visayas]] before the late 20th century. Presently, hookah use is gaining popularity among younger, more cosmopolitan Christians, particularly with college students and [[Youth|young adults]] who may be underage and thus unable to purchase [[cigarette]]s.<ref>{{cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5520a2.htm |title=Use of Cigarettes and Other Tobacco Products Among Students Aged 13-15 Years - Worldwide, 1999-2005 |publisher=Cdc.gov |access-date=2010-08-22}}</ref>

In the [[Metro Manila|National Capital Region]] and other [[conurbation]]s 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 ====
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.<ref>{{Cite web|title=Tìm hiểu về thuốc shisha và chọn loại tốt|url=https://shop1gia.net/tim-hieu-ve-thuoc-shisha/|access-date=November 8, 2018|website=VIỆT STAR SHISHA|language=vi}}</ref> People can smoke shisha at cafes, karaoke bars and bars in Vietnam.

===South Africa===
{{see|Hookah#South Africa}}
In South Africa, hookah, colloquially known as a ''hubbly bubbly'' or an ''okka pipe'', is popular{{Update inline|reason=Is this still valid, or has the fad died down?|?=yes|date=March 2021}}.{{citation needed|date=March 2021}}

===United States and Canada===
{{See also|Hookah lounge}}
[[File:HarvardSquareHookah.jpg|thumb|A hookah and a variety of muʽassel packages are on display in a [[Harvard Square]] [[window shopping|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.<ref>{{cite news |author=Jillian Krotki|title= Hookah lounge brings '60s pastime back to the present |newspaper=Seminole Chronicle |date=29 October 2008|url= http://www.seminolechronicle.com/vnews/display.v/ART/2008/10/29/4908dae9de4c4|access-date=2013-09-03|url-status=dead|archive-url=https://archive.today/20120919133210/http://www.seminolechronicle.com/vnews/display.v/ART/2008/10/29/4908dae9de4c4|archive-date=19 September 2012|df=dmy-all}}</ref> In recent years hookah use has increased dramatically in the United States and Canada.<ref name="ALAgrowing" /> 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.<ref>{{Cite web|last=CDCTobaccoFree|date=2020-01-22|title=Hookahs|url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm|access-date=2021-04-16|website=Centers for Disease Control and Prevention|language=en-us}}</ref> There is a growing hookah bar and café industry, especially in inner cities and near universities and colleges where youth and young adults gather.<ref name="ALAgrowing" />

Recently, certain cities, counties, and states have implemented indoor [[smoking ban]]s, 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<ref>Lyon, Lindsay "The Hazard in Hookah Smoke". (28 January 2008)</ref> and located near [[college campus]]es or cities with large Middle-Eastern communities. This activity continues to gain popularity within the post-secondary student demographic.<ref>Quenqua, Douglas "[https://www.nytimes.com/2011/05/31/health/31hookah.html?hp Putting a Crimp in the Hookah]". The New York Times, 30 May 2011</ref> 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.<ref>{{cite journal|last1=Creamer, MR|last2=Wang, TW| last3=Babb, S|title=Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018|journal=Mortality and Morbidity Weekly Report|date=15 November 2019|volume=68|issue=45|pages=1013–1019|doi=10.15585/mmwr.mm6845a2|pmid=31725711|pmc=6855510|display-authors=etal}}</ref> 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.<ref>{{cite journal|last1=Wang, TW|last2=Tynan, MA| last3=Hallett, C|title=Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017
|journal=Mortality and Morbidity Weekly Report|date=22 June 2018|volume=67|issue=24|pages=686–689|doi=10.15585/mmwr.mm6724a4|pmid=29927904|pmc=6013086|display-authors=etal}}</ref>

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]].<ref>{{cite journal|last1=Arrazola, RA|title=Tobacco use among middle and high school students--United States, 2011-2014|journal=Mortality and Morbidity Weekly Report|date=17 April 2015|volume=64|issue=14|pages=381–385|display-authors=etal}}</ref> 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.<ref>{{cite web |url= https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/tobacco/trends/index.html |title= Adolescents and Tobacco: Trends : Hookah |last= Office of Adolescent Health |date= 1 May 2019 |website= www.hhs.gov |publisher= The U.S. Department of Health and Human Services (HHS)|access-date= 8 July 2020}}</ref> 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.<ref>{{cite report|last1=Johnson, LD | title= Monitoring the Future - national survey results on drug use 1975-2018: Overview, key findings on adolescent drug use.|date= January 2019 |url= http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2018.pdf|publisher= Institute for Social Research, The University of Michigan |access-date= 8 July 2020|display-authors=etal}}</ref> 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.<ref>{{cite web |url= https://teens.drugabuse.gov/blog/post/hookah-isn-t-harmless|title= Hookah isn't harmless |date= 2016 |publisher= National Institute on Drug Abuse |access-date= 8 July 2020}}</ref> In 2011, 18.5% of 12th-grade students reported having smoked a hookah in the past year.<ref name=CDC /> By 2019, 3.4% of highschool students reported having used hookah in the last 30 days.<ref>{{cite journal|last1=Wang, TW|last2=Gentzke, AS| last3=Creamer, MR|title=Tobacco product use and associated factors among middle and high school students--United States, 2019|journal=Mortality and Morbidity Weekly Report|date=6 December 2019|volume=68|issue=12|pages=1–22|display-authors=etal}}</ref><ref>{{cite web|url=https://www.cdc.gov/tobacco/infographics/youth/pdfs/tobacco-use-teens-2019-p.pdf |title=Tobacco Product Use Among High School Students|date=2019 |website=Centers for Disease Control and Prevention |publisher=Centers for Disease Control and Prevention |access-date=8 July 2020}}</ref>

==Health effects==
{{See|Health effects of tobacco|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.<ref name=":2">{{Cite web|title=Facts About Hookah|url=https://www.lung.org/quit-smoking/smoking-facts/health-effects/facts-about-hookah|access-date=2021-04-16|website=www.portableshishauk.com|language=en}}</ref> 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.<ref name=Cobbetal>{{Cite journal| issn = 1087-3244| volume = 34| issue = 3| pages = 275–285| last1 = Cobb| first1 = Caroline| last2 = Ward| first2 = Kenneth D.| last3 = Maziak| first3 = Wasim| last4 = Shihadeh| first4 = Alan L.| last5 = Eissenberg| first5 = Thomas| title = Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States| journal = American Journal of Health Behavior| date = 2010| pmid = 20001185| pmc = 3215592| doi = 10.5993/AJHB.34.3.3}}</ref> 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.<ref name=Cobbetal /> Muʽassel smoking also exposes users to [[heavy metals]] and is thought to expose users to more [[carcinogens]] than cigarettes.<ref name=ALAemerging>{{cite report |date=February 2007 |title=AN EMERGING DEADLY TREND:WATERPIPE TOBACCO USE |url=http://www.lungusa2.org/embargo/slati/Trendalert_Waterpipes.pdf |publisher=American Lung Association |access-date=June 27, 2018 }}</ref> 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.<ref name=":2" /> 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.”<ref>{{Cite web|title=Is 'Hookah Sickness' Just Carbon Monoxide Poisoning?|url=https://www.vice.com/en/article/xd78gz/is-hookah-sickness-just-carbon-monoxide-poisoning-992|access-date=2021-04-16|website=www.vice.com|language=en}}</ref> The charcoal used to heat up the muʽassel increases carbon monoxide and metal inhalation.<ref name="ALAgrowing">{{cite web |publisher=American Lung Association |url=http://www.lung.org/assets/documents/tobacco/hookah-policy-brief-updated.pdf |title=Hookah Smoking — A Growing Threat to Public Health |access-date=27 June 2018}}</ref>

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."<ref name="ALAemerging" /><ref name="CDCfactsheet">{{cite web |title=Hookahs |website=Smoking & Tobacco Use |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/ |access-date=27 June 2018 |date=December 1, 2016}} "Although many users think it is less harmful, hookah smoking has many of the same health risks as cigarette smoking."</ref><ref>{{cite web |title=Hookah Tobacco (Shisha or Waterpipe Tobacco) |url=https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm482575.htm |website=Tobacco Products |publisher=U.S. Food and Drug Administration |access-date=27 June 2018 |date=May 7, 2018}}</ref> These risks include [[lung cancer]], [[respiratory disease]], low birth weight in babies,<ref name="ALAgrowing" /> increased risk of respiratory disease in babies, [[heart disease]] and [[artery]] clogging, as well as [[oral cancer|oral]], [[stomach cancer|stomach]], [[esophagus cancer|esophagus]], and [[bladder cancer]]s.<ref name="CDCfactsheet" /> 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.<ref>{{Cite journal| doi = 10.1016/j.fct.2012.02.041| issn = 0278-6915| volume = 50| issue = 5| pages = 1494–1498| last1 = Shihadeh| first1 = Alan| last2 = Salman| first2 = Rola| last3 = Jaroudi| first3 = Ezzat| last4 = Saliba| first4 = Najat| last5 = Sepetdjian| first5 = Elizabeth| last6 = Blank| first6 = Melissa D.| last7 = Cobb| first7 = Caroline O.| last8 = Eissenberg| first8 = Thomas| title = Does switching to a tobacco-free waterpipe product reduce toxicant intake? A crossover study comparing CO, NO, PAH, volatile aldehydes, tar and nicotine yields| journal = Food and Chemical Toxicology| date = May 2012| pmid = 22406330| pmc = 3407543}}</ref> These chemicals contribute to cancers, heart disease, and lung disease.<ref name="CDCfactsheet" />

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.<ref>{{Cite journal| doi = 10.1136/tobaccocontrol-2011-050350| issn = 1468-3318| volume = 22| issue = 5| pages = 338–343| last1 = Cobb| first1 = Caroline Oates| last2 = Vansickel| first2 = Andrea Rae| last3 = Blank| first3 = Melissa D.| last4 = Jentink| first4 = Kade| last5 = Travers| first5 = Mark J.| last6 = Eissenberg| first6 = Thomas| title = Indoor air quality in Virginia waterpipe cafes| journal = Tobacco Control| date = September 2013| pmid = 22447194| pmc = 3889072}}</ref> 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.<ref name="Kumar">{{Cite journal| doi = 10.1136/tobaccocontrol-2014-052038| issn = 0964-4563| volume = 24| issue = Suppl 1| pages = i54–i59| last1 = Kumar| first1 = Sumit R| last2 = Davies| first2 = Shelby| last3 = Weitzman| first3 = Michael| last4 = Sherman| first4 = Scott| title = A review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure| journal = Tobacco Control| date = March 2015| pmid = 25480544| pmc = 4345792}}</ref> 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.<ref name="Kumar" />

== See also ==
* [[Smoking in Syria]]

== References ==
{{reflist|2}}

{{DEFAULTSORT:Mu'assel}}
[[Category:Arab culture]]
[[Category:Arabic words and phrases]]
[[Category:Tobacco in the United Arab Emirates]]
[[Category:Tobacco in Egypt]]
[[Category:Tobacco smoking]]

Muʽassel - Revision history

->Slippery Shaman: /* top */ removed unnecessary word