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COMMENTARY
Year : 2021  |  Volume : 65  |  Issue : 1  |  Page : 76-81  

Herbal smoke: Next hurricane on horizon


1 Assistant Professor, Department of Pedodontics, Dr HSJIDS, Panjab University, Chandigarh, India
2 Assistant Professor, Department of Public Health Dentistry, Dr HSJIDS, Panjab University, Chandigarh, India
3 Sub-Investigator, Department of Community Dentistry and Oral Disease Prevention, Eastman Institute of Oral Health, Rochester, New York, USA

Date of Submission31-Aug-2020
Date of Decision21-Dec-2020
Date of Acceptance31-Dec-2020
Date of Web Publication20-Mar-2021

Correspondence Address:
Archna Agnihotri
Department of Pedodontics, Dr HSJIDS, Panjab University, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_707_20

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   Abstract 


Unsupervised marketing strategies of alternative smoke have made the youth fall prey to herbal smoke in the form of herbal cigarettes and hookahs. The easy online access, exotic looks, and flavors; marketed as safer, healthy alternatives, as an aid to quit smoking has made global herbal cigarette and hookah market see soaring sales in the past decade. Various studies have proven their popularity among the youth and minors with perceptions of being safer and smart alternatives. The scientific studies have shown that herbal smoke is as harmful as tobacco smoke. The marketing strategies of smoke industry to capture the minors and young adults could result in another stronger lobby besides tobacco to be dealt with in coming years. This creates an urgent need for the laws to be reviewed and amended keeping in view the changing scenario.

Keywords: Herbal cigarettes, herbal hookah, herbal smoke


How to cite this article:
Agnihotri A, Sood P, Kaur A. Herbal smoke: Next hurricane on horizon. Indian J Public Health 2021;65:76-81

How to cite this URL:
Agnihotri A, Sood P, Kaur A. Herbal smoke: Next hurricane on horizon. Indian J Public Health [serial online] 2021 [cited 2021 Apr 13];65:76-81. Available from: https://www.ijph.in/text.asp?2021/65/1/76/311525




   Introduction Top


According to the World Health Organization (WHO), over 1.1 billion people in the world smoke tobacco.[1] Tobacco smoking products are multimillion-dollar industry. Every year it generates huge revenue not only for the companies but also for the governments and leading to economic dependence. According to a report by compound annual growth rate (2020–2023), they are expected to generate the revenue of US$58,828.4m in 2020. The market is expected to grow annually by 3.2%.[2] However, it adversely affects the health of present and future generations. It is one of the leading reasons for early death. According to the global burden of disease study published by Lancet, smoking resulted in more than 8 million premature deaths in 2017.[3]

This has prompted governments, national and international organizations, especially health organizations to direct efforts against smoking tobacco products. Various legislations and treaties such as Framework convention on tobacco, cigarettes, and other tobacco products act (COTPA, India), and tobacco control measures such as MPOWER have been implemented.[4],[5],[6] However, the tobacco lobby is very strong and coming up with newer ideas to counteract these strategies. According to the WHO, youth are now the new focus of tobacco companies.[7] With intensified efforts against tobacco smoking, the companies have now come up with nicotine free, tobacco-free herbal products such as herbal cigarettes, cigars, and hookahs. Herbal smoking products are a new rage among youth. These are also being promoted as an aid to quit tobacco smoking as they are thought to be nonhabit forming and do not produce any withdrawal symptoms.[8]

According to G-market of online distribution industry in Korea, this has led to increased sales volume of herbal cigarettes by 118% in 2014.[9] Many of these quit efforts are supported by tobacco companies with the underlying strategy that people continue to smoke. Studies have shown that people believe that such products are less harmful, less addictive, and healthy alternatives.[10] This leads to their increased consumption and other substance abuse and subsequently falling trap to conventional tobacco smoking products.

Herbal smoking products used in herbal cigarettes and hookahs mainly consist of mixture of herbs and other natural products. Various brands of herbal cigarettes and herbal hookahs are gaining market due to their various marketing strategies of advertising their proclaimed benefits mentioned on the outer packaging or information leaflets [Table 1] and [Table 2].
Table 1: Herbal cigarettes (Global brands and Health claims)

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Table 2: Herbal hookah brands and flavours

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These are easily available at many convenience stores and over the Internet. They do not come under the purview of much legislation and can be sold to anyone without age considerations leading to early smoking habits. The exciting and exotic packing and availability in different flavors make them appealing. Most of pubs, discotheques, restaurants, and bars are also offering so called “tobacco free” or “flavored” hookah to youth without any regulation.[11]


   Herbal Cigarettes Top


The business of alternative and herbal smoke is blooming. The global market analysis of herbal cigarettes for the past few years has shown a linear growth and is expected to grow further in the years to come. The biggest marketing strategy used by some of major manufacturers of herbal cigarettes for escalating the sale numbers is their health communication messages and labels on the packets such as healthy alternatives and “smoke smart.”[12]

Mathew Gold a staff attorney for Federal Trade Commission (FTC) in 2000 filed a case against Alternative Cigarettes, Inc. and the company was asked to display health warnings on its product packages as: “Herbal cigarettes are dangerous to your health. They produce tar and carbon monoxide.”[13]

Another FTC complaint against alternative cigarettes and Santa Fe natural tobacco company made the manufacturers to take down the advertising claims about their cigarettes as being safer and add a tag line “Don't light up. It's bad for your health, even when the product claims to be herbal or natural.”[14]

However, a telephonic survey conducted in 2003 on 2028 adult current cigarette smokers in the United States about their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes revealed that almost 39% of smokers were aware of these cigarettes and 27% of them could name a specific brand; of these numbers 25% believed such products were less harmful than traditional cigarettes.[10]

Richter et al. in a similar study observed that health communication messages on nontraditional products influence the risk perceptions of the population about the products.[15]

In India, these herbal or so-called alternative safer cigarettes manufactured by various herbal pharmacies are available at many stores and sold at famous online sites. This makes them easily accessible even to kids who are not old enough to buy tobacco products.[16]

Research has shown that alternative cigarettes are not safe as they deliver more tar nicotine, carbon monoxide [Table 3] and thus are worse than regular tobacco products and later may lead to tobacco smoking and addiction.[9],[17]
Table 3: Studies comparing herbal cigarettes/hookahs versus tobacco counterparts

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The COTPA, Section 5 states that “No person engaged in or purported to be engaged in the production, supply or distribution of cigarettes or any other tobacco products shall advertise and no person having control over a medium shall cause to be advertised cigarettes or any other tobacco products through that medium and no person shall take part in any advertisement which directly or indirectly suggests or promotes the use or consumption of cigarettes or any other tobacco products.”[5]

Although the ban on the advertising of herbal cigarettes comes under the purview of COTPA section 5, there is no stringent law as far as ban on availability to minors because of being tobacco less and nicotine free.

In 2017 FICCI organized an exhibition of wellness products by AYUSH, in collaboration with the Ministry of Commerce and Industry and the pharmaceuticals export promotion council. A stall selling and promoting herbal cigarettes were ordered to close by the state tobacco control cell and were also asked to explain as to why a stall was allotted to a company which sells cigarettes in the violation of COTPA.[20]


   Herbal Hookah Top


Rijhwani et al. in their study conducted a content analysis of online portals selling hookah products and their marketing strategies. It was found that 19.2% products were tobacco/nicotine-free, and only 6.5% had age/health-specific warnings on their products. The authors concluded that the accessibility of these products through online portals is reason behind their popularity amongst the youth, and there is an urgent need to raise the issue of hookah products parallel to other forms of tobacco.[21]

Anand et al. in their survey on high school students in an Indian city observed that the children had misperceptions regarding the safety of hookahs and believed that these are safer and a socially acceptable option. The present study also found the use of hookahs by under 18 years old. 85.5% of minors reported illegal visitation to a hookah lounge, which suggested widespread illegal hookah lounges among minors.[22]

Studies on hookahs have shown that the concentration of harmful substances (carbon monoxide, polyaromatic hydrocarbons, and volatile aldehydes) in the smoke emitted from “tobacco-free” hookah was equal to or greater than those from a tobacco-based hookah [Table 3].[18],[19] These toxicants have been found to be associated with cancer, lung disease, and cardiovascular disease.[23]

In India, there are no regulations and restrictions on the sale of smokable herbs in pharmacies and online sites which have made these herbs easily accessible and usable. All these activities also affect the tobacco control efforts in a negative way. An article by Yang mentioned that Chinese tobacco industry was using tactics to increase cigarette sales by promoting herbal cigarettes as low tar herbal alternative which was making tobacco control efforts in China really challenging.[24]

COTPA also bans to serve Hookah with tobacco products, but it is not applicable to tobacco-free herbal hookah. Mumbai high court allowed a number of restaurants in Mumbai and Pune to offer tobacco-free herbal hookah and also directed the police and other authorities not to take any action unless they serve tobacco hookah.[25] Media campaigns, particularly focus on the ban advertising of tobacco cigarettes and their sale to minors, whereas legality of sale of herbal cigarettes to minors seems to be nowhere under consideration. These campaigns should also include providing the information regarding ill effects of herbal hookahs and cigarettes to prevent this rising public health concern.


   Conclusion Top


It is imperative to take coordinated action on tobacco as well as any form of herbal smoke (cigarettes and hookahs) for improving the environment and protecting the health. Therefore, anti-tobacco community should re-assess the changing scenario, easily accessible herbal products, growing trend of using herbal products among youth at an early age because of easy access, considering it safer and being in-vogue. The Union Health Ministry should re-amend the Cigarettes and Other Tobacco Products Act by broadening its purview to encompass herbal smoke in any form under legislation before it becomes a pandemic and develops a strong lobby later hindering its control as we are witnessing for tobacco right now.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Prevalence of Tobacco Smoking (Global Health Observatory Data). Available from: https://www.who.int/gho/tobacco/use/en/. [Last accessed on 2018 May 31].  Back to cited text no. 1
    
2.
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Stanaway JD. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet 2018;392:1923-94.  Back to cited text no. 3
    
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WHO Framework Convention on Tobacco Control; 2005. Available from: https://www.who.int/tobacco/framework/WHO_FCTC_english.pdf. [Last accessed 06 Jun 2020].  Back to cited text no. 4
    
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Tobacco Free Initiative. Available from: https://www.who.int/tobacco/mpower/en/. [Last accessed on 2019 Jul 26].  Back to cited text no. 6
    
7.
World no Tobacco Day; 2020. Available from: https://www.who.int/campaigns/world-no-tobacco-day/world-no-tobacco-day-2020. [Last accessed on 2020 May 31].  Back to cited text no. 7
    
8.
Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, et al. Overview of electronic nicotine delivery systems: A systematic review. Am J Prev Med 2017;52:e33-66.  Back to cited text no. 8
    
9.
Bak JH, Lee SM, Lim HB. Safety assessment of mainstream smoke of herbal cigarette. Toxicol Res 2015;31:41-8.  Back to cited text no. 9
    
10.
O'Connor RJ, Hyland A, Giovino GA, Fong GT, Cummings KM. Smoker awareness of and beliefs about supposedly less-harmful tobacco products. Am J Prev Med 2005;29:85-90.  Back to cited text no. 10
    
11.
Pandey P. Rising popularity of “tobacco-free” hookah among youth: A burgeoning public health challenge for India. Int J Noncommun Dis 2017;2:30-5.  Back to cited text no. 11
    
12.
NirdoshNarayani Herbal Pharmacy Dhoompaan. Available from: https://www.amazon.in/Narayani-Pharmacy-Nirdosh-Dhoompan- Quality/dp/B07GRBSBZ6. [Last accessed on 2020 Jun 02].  Back to cited text no. 12
    
13.
Woolston C, Calhoun N. The hazards of herbal cigarettes. Available from: https://consumer.healthday.com/encyclopedia/smoking-and-tobacco-cessation-36/smoking-cessation-news-628/the-hazards-of-herbal-cigarettes-645340.html. [Last accessed on 2019 Dec 31].  Back to cited text no. 13
    
14.
Federal Trade Commission. FTC Accepts Settlements of Charges that “Alternative” Cigarette Ads are Deceptive. Available from: https://www.ftc.gov/news-events/press-releases/2000/04/ftc-accepts-settlements-charges-alternative-cigarette-ads-are. [Last accessed on 2000 Apr 27].  Back to cited text no. 14
    
15.
Richter PA, Pederson LL, O'Hegarty MM. Young adult smoker risk perceptions of traditional cigarettes and nontraditional tobacco products. Am J Health Behav 2006;30:302-12.  Back to cited text no. 15
    
16.
Royal Swag Ayurvedic Cigarette Herbal Cigarette FRUTTA Nicotine Free & Tobacco Free Cigarettes. Available from: https://www.amazon.in/dp/B07J5KY683/ref=sspa_dk_detail_3?psc=1&pd_rd_i=B07J5KY683&pd_rd_w=iIgqB&pf_. [Last accessed on 2020 Jun 02].  Back to cited text no. 16
    
17.
Gan Q, Yang J, Yang G, Goniewicz M, Benowitz NL, Glantz SA. Chinese “herbal” cigarettes are as carcinogenic and addictive as regular cigarettes. Cancer Epidemiol Biomarkers Prev 2009;18:3497-501.  Back to cited text no. 17
    
18.
Hammal F, Chappell A, Wild TC, Kindzierski W, Shihadeh A, Vanderhoek A, et al. 'Herbal' but potentially hazardous: An analysis of the constituents and smoke emissions of tobaccofree waterpipe products and the air quality in the cafés where they are served. Tob Control 2015;24:2907.  Back to cited text no. 18
    
19.
Shihadeh A, Salman R, Jaroudi E, Saliba N, Sepetdjian E, Blank MD, et al. 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 Chem Toxicol 2012;50:1494-8.  Back to cited text no. 19
    
20.
PTI. Government asks FICCI to Close Stall Selling Herbal Cigarettes at Wellness Fair. Available from: https://economictimes.indiatimes.com/industry/cons-products/tobacco/government-asks-ficci-to-close-stall-selling-herbal-cigarettes-at-wellness-fair/articleshow/61949990.cms?from=mdr. [Last accessed on 2017 Dec 06].  Back to cited text no. 20
    
21.
Rijhwani K, Hashmi S, Mohanty VR, Balappanavar AY, Kapoor S. Hookah products and online retail marketing strategies in India: A content analysis. Indian J Cancer 2018;55:261-4.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Anand NP, Vishal K, Anand NU, Sushma K, Nupur N. Hookah use among high school children in an Indian city. J Indian Soc Pedod Prev Dent 2013;31:180-3.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Al Rashidi M, Shihadeh A, Saliba NA. Volatile aldehydes in the mainstream smoke of the narghile waterpipe. Food Chem Toxicol 2008;46:3546-9.  Back to cited text no. 23
    
24.
Yang G. Marketing 'less harmful, low-tar' cigarettes is a key strategy of the industry to counter tobacco control in China. Tob Control 2014;23:167-72.  Back to cited text no. 24
    
25.
Deshapande S. Bombay High Court Allows 40 Restraunts to Offer Tobacco Free Hookah. Available from: http://timesofindia.indiatimes.com/articleshow/70793362.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst. [Last accessed on 2019 Aug 23].  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
    Abstract
   Introduction
   Herbal Cigarettes
   Herbal Hookah
   Conclusion
    References
    Article Tables

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