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 cafés.
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)
______________
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 narguilé : analyse socio-anthropologique. Culture,
convivialité, histoire et tabacologie d’un mode d’usage populaire du tabac.
Doctoral thesis, Université 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 narguilé : quand la fumée 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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