Pediatrics -- P3Rs for Prokhorov et al., 118 (3) 890-903

Dear Editor,

I wish to thank Dr Prokhorov and his colleagues for this important publication (1). It is timely because the hookah epidemic is spreading among young people all over the world although more in the USA and Europe than in the traditional �cradles� and this, for several reasons that I cannot detail here for space reasons (2).

An entire generation of researchers has been misled by a famous one-page paper bearing a� high-sounding title and published in a prestigious journal (3). Its author stated that hookahs originated in India. Unfortunately, they did not and this is not the only serious error to be found in the same paper (4). For this reason, and if we use the same playful language, not Arabs have been kept in Wonderland because of narghile smoking (3) but many of the researchers whose job was to study it (5).

Consequently, hookahs did not �quickly spread to Arab countries� from India but from Africa (2). Hookah �regained immense popularity� not only in Arab countries but also in non-Arab ones like Turkey, Iran, Pakistan, India, etc.; in other words, beyond what is technically called SANA (South-West Asia and North Africa) by some colleagues. Indeed, it spread to the entire world. It is now an �emerging epidemic� as pointed out by a paper published in this very journal (6).

In the above regions, hookah smoking has not become �a favourite pastime in coffee houses and restaurants�. It has always been so, at least in the caf�s.� The latter �are not proliferating on the streets of Amman, Jordan, Beirut, Lebanon, Damascus, Syria�. They have always been there (2). A young researcher may be right when he says that hookah smoking is �a threat never realized� (7). However, is not it amazing that it would have taken several centuries for the public health community to become fully aware of this plague ?�

As for the revival of hookah smoking, of course it �has been partly attributed to the belief that hookah smoking delivers less harmful substances to the smoker than do conventional cigarettes�. However, this is only one reason. Contrary to simplistic advertised scenarios, an early health-oriented anthropological research has identified almost 15 reasons for the unexpected upsurge (2).

I agree that research regarding this question (i.e. health effects) is scarce. However, I am not sure it has produced conflicting evidence, as stated by Prokhorov et al. The references given by the authors do not support the existence of a so-called debate. Actually, very few researchers specialising in this field have dared to put into question -in other words, discuss- the scientific truth about narghile smoking brought on a golden tray by experts. Fortunately, ice is now melting away for the benefit of the world public health (4). As an observer of the hookah scene over the past ten years, I can see that there are now excellent studies led in natural environments. They begin to shed a new light on this hot issue. Indeed, a new era is opening up. Let me cite only two encouraging examples: Waked�s and Al-Mutairi�s (8)(9). The former shows where the real problem lie �and with what categories of smokers- while the results of the latter establish that inhalation of �a significant amount of nicotine� is not always true. Finally, certainly �hookah smoke contains significant amounts of carbon monoxide� but this is perhaps, and sadly enough, the only consensus reached so far on this complex issue.

Kamal Chaouachi (kamchaAgmail.com)

Researcher in Socio-Anthropology and Tobaccology

Consultant in Tobacco Control (Paris)

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REFERENCES

(1) Prokhorov AV, Winickoff JP, Ahluwalia JS, Ossip-Klein D, Tanski S, Lando HA, Moolchan ET, Muramoto M, Klein JD, Weitzman M, Ford KH; Tobacco Consortium, American Academy of Pediatrics Center for Child Health Research.� Youth tobacco use: a global perspective for child health care clinicians. Pediatrics. 2006 Sep;118(3):e890-903

(2) Chaouachi K: Le narguil� : analyse socio-anthropologique. Culture, convivialit�, histoire et tabacologie d�un mode d�usage populaire du tabac. Doctoral thesis, Universit� Paris X (France). [Eng.: Narghile (hookah): a Socio-Anthropological Analysis. Culture, Conviviality, History and Tobaccology� of a Popular Tobacco Use Mode]. Published by ANRT (Lille), 420 pages.

(3) Kandela P. Nargile smoking keeps Arabs in Wonderland. The Lancet 2000; 356 (9236): 1175.

(4) Chaouachi K. A Critique of the WHO's TobReg "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. Journal of Negative Results in Biomedicine 2006 (17 Nov); 5:17.

www.jnrbm.com/content/5/1/17

(5) Chaouachi K. E-Letter to the Editor: Measuring Real Exposure to Narghile (Hookah, Shisha) Smoke and Other Concerns Related to Public Health. European Journal of Public Health 2006 (Jul 2), 4 pages.

http://eurpub.oxfordjournals.org/cgi/eletters/ckl043v1#18

(6) Knishkowy B, Amitai Y : Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior. Pediatrics 2005, 116(1): e113-119.

(7) Jawaid A, Aftab O. Water-pipe smoking: a threat never realized. J Pak Med Assoc. 2006 (Jul);56(7):341-2.

(8) Waked M. Le narguil� : quand la fum�e se dissipe [Eng.: Nargile : beyond the cloudy smoke]. La Lettre du pneumologue 2006; 9(5):177-9.

(9) Al-Mutairi SS, Shihab-Eldeen AA, Mojiminiyi OA, Anwar, AA. Comparative analysis of the effects of hubble-bubble (Sheesha) and cigarette smoking on respiratory and metabolic parameters in hubble-bubble and cigarette smokers. Respirology 2006; 11: 449-55

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