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Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences
. International Journal of Environmental Research and Public Health. 2009; 6(2):798-843.

Full text free from the above link.
Table of contents (useful)

 “-[ADDENDUM 2 mar 2010] After the claims about the supposedly high hazards of hookah Environmental Tobacco smoke. have been clarified, findings from antismoking researchers funded by powerful lobbies have been published. However, they were actually based on methodological tricks”

For more details, go to relevant KNOL (piece of KNOwLedge).




The Invention of Hookah (Shisha, Narghile) «Passive Smoking»

through Repeated Scientific Misconduct and Fraud


(A Necessary Step for the Tobacco-Free Earth Geo-Political Agenda)

by K. C. (Paris/Middle East, 26 March 2008)


Second-hand smoke from waterpipes […] poses a serious risk for non-smokers (8)

[(8) Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333]

> SOURCE: The WHO Erroneous report on ““waterpipe”” tobacco smoking” [1]


« Fî qahwé ‘a-l-mafraq ; Fî mawqidé u fî nâr ; Nebqâ ’enê w-hebîby ; Nefreshhâ b-’el-’asrâr... »

[There is a coffee-house there by the crossroad, with a brazier and some fire. I used to stay there with my love, carpetting its walls with secrets]

> Lebanese singer FEYROUZ (cited in doct. thesis on narghile, footnote 511)


-Hookah produces NO side-stream smoke

- Hookah smoke is 13.2 times LESS concentrated in CO (Carbon Monoxide) than cigarette smoke

- Hookah smoke is 6.4 times LESS concentrated in PM10 particles than cigarette smoke

- Hookah smoke is 3.5 times LESS concentrated in PM2.5 particles than cigarette smoke

- Hookah smoke 2.8 times LESS concentrated in ultra-fine particles than cigarette smoke

- CO in non-smokers exposed to hookah smoke does not change before and after a hookah session

- the first victim of “passive smoking” is the smoker her/him/self, not the non-smoker

CONCLUSION: Hookah “passive smoking” (ETS: Environmental Tobacco Smoke) is a scientific Fraud

IMPORTANT NOTE (added 28 March 2008) about another HUGE FRAUD: The cigarette used in the laboratory experiment was not an "ordinary" one but a Gauloise Light, said by the ETS "experts"  to be "the most common cigarette used by study subjects"… (sic)

Since ventilation holes in light cigarettes DECREASE UP TO 10 TIMES PARTICLE CONCENTRATION, ALL the above related figures should be multiplied by 10 !


"Second-hand tobacco smoke (SHS) refers to the smoke from BURNING tobacco products, generated by people smoking them." [SOURCE: WHO (World Health Organization) Report: Smoke-Free Inside. World No-Tobacco Day 2007 (page 3)]

Since the smoking product in the hookah bowl does NOT burn but is only heated (below 200°C) , these studies are, to start with, in blatant contradiction with WHO’s definitions…


Cigarette “passive smoking” has been willingly and widely exaggerated by the anti-tobacco organisations, both in the USA and Europe [2-5]. As for hookah (shisha, narghile) « passive smoking », more than a mere overstatement, it has actually been what a first communiqué described as a major fraud [6].

A recent study on CO levels among US students was led by Dr S. Katharine HAMMOND [7], one of the WHO (World Health Organisation) TobReg top-experts who “peer-reviewed” and validated the WHO Erroneous report on ““waterpipe”” tobacco smoking” , the first ever published by this UN organisation [1]. This new study was not empty of serious errors [8]. As in other studies on the same subject, the researchers found that CO levels in non-smokers exposed to hookah “passive smoking” (ETS: Environmental Tobacco Smoke) do not significantly vary between the beginning and the end of a hookah session. A previous communiqué showed that hookah smoke is up to 13 times less concentrated in CO than cigarette smoke [9]. Furthermore, scientists have established in the past that half of the inhaled CO is retained in the smoker’s respiratory tract. For non-smokers exposed to ETS, the inhalation rate was found to be even lower than 50%. In these conditions, one can understand why non-smokers are not so much affected by their exposure to the gas generated by the hookah.

A study on hydrocarbons was also carried on by a team of the US-American University of Beirut [10]. Although it has a direct connection with hookah “passive smoking”, it will not be criticised right now as its bias (particularly the smoking machine and the underlying smoking topography) have already been commented elsewhere [11].

Interestingly and expectedly, the joint US-Syrian Center for Tobacco Studies (chief investigators: Wasim MAZIAK, Kenneth WARD and Thomas EISSENBERG) has published two papers on ““waterpipe”” “passive smoking” [12][13]. The last one was published in NTR (Nicotine and Tobacco Research), a journal supposed to be “peer-reviewed” despite huge errors regularly published in its columns [14]. Its abstract concludes that “policymakers considering clean air regulations should include waterpipe tobacco smoking, and the public should be warned about this source of smoke exposure” [13]. Amazingly, Wasim MAZIAK and his colleagues insist that their study is the first to investigate hookah (narghile, shisha) second-hand smoke. Of course, this is not true. For instance, in France, Bertrand DAUTZENBERG, president of OFT (Office Français du Tabagisme) and Jean-Yves NAU (medical journalist with Le Monde) have dedicated a full book to this issue [15]. In Switzerland, a team led by Christian MONN has assessed CO and ultra-fine particles in hookah smoke [9].

It must be clear that the objective of all these studies is, in conformity with the WHO Tobacco-Free Earth geo-political agenda, to provide a ““scientific” “basis”” for policy makers which will allow them to implement prohibitive measures even when side-stream smoke is inexistent [6].

Beside the usual amount of errors (about the role of water and so on…) which can be found in any new publication signed by the US-Syrian Center for Tobacco Studies, we note that its investigators would have used “sensitive objective methods and strict international protocols to measure exposure to SHS” (sic)[12]. The reader may wonder whether it is scientifically rigorous to measure the reality of hookah “passive smoking” in a closed laboratory with almost no ventilation (door and window closed with a 100 cm2 outlet in the latter…). Is it also methodologically sound to assess and compare the concentrations of particles (size PM10 [< 10 microns] and PM2.5 [< 2.5 microns]) from the smoke of a ““waterpipe”” used over 35 minutes with the concentrations of the same kind of particles in the smoke of a single cigarette kept burning between 7 and 9 minutes ? Isn’t it in contradiction with the public statements by the head of the US-Syrian Centre who, on the eve of the Smoking Ban in the United Kingdom (July 2007), declared that 1 Hookah Equals 200 Cigarettes [16] ?

Anyway, the results are as follows:

PM 2.5 Mean concentration (µg/m3):  264 for “”waterpipe””  (35 minutes)

267 for 1 cigarette (c. 10 minutes)

PM 10 Mean concentration (µg/m3):   365 for “”waterpipe””  (35 minutes)

287 for 1 cigarette (c. 7 minutes)

Interestingly, the team members “realised” that, contrary to cigarettes, the hookah produces almost no sidestream smoke (during “smouldering”)… Safe potential flaws and assuming that the above given figures are exact, this means that:

a)  the concentration of hazardous PM2.5 particles in hookah smoke is : (264/267)*(35/10)=  3.5 times inferior to that of cigarette smoke. Let us remember that a similar ratio was found by MONN et al for ultrafine particles [9].

b)  the concentration of hazardous PM10 particles in hookah smoke is: (365/287)*(35/7)=  6.4 times inferior to that  of cigarette smoke.

IMPORTANT NOTE (added 28 March 2008) about another HUGE FRAUD: The cigarette used in the laboratory experiment was not an "ordinary" one but a Gauloise Light, said by the ETS "experts"  to be "the most common cigarette used by study subjects"… (sic)

Since ventilation holes in light cigarettes DECREASE UP TO 10 TIMES PARTICLE CONCENTRATION, ALL the above related figures should be multiplied by 10 !

. Strikingly, in a study on hookah “passive smoking”, no information is given on the very composition of the smoke when all hookah users know that, unlike cigarette, it is made up mainly of water (around 40%) and a similar amount of glycerol [HOCH2(HO)CHCH2OH]. Differences in concentrations, texture (coarse for cigarette and almost transparent, for shisha) and chemical composition are obvious, aren’t they ?


The interpretation of the world anti-tobacco official “waterpipe” team’s experience shows that there is no side-stream smoke and that exhaled hookah smoke is, between 3 and 6 times less concentrated than cigarette smoke. This is not all. The most dangerous aspect of the fraud is that the “study” has compared:

-a single cigarette producing, for c. 7 minutes, side-stream smoke + exhaled smoke with:

-a hookah producing only exhaled smoke, for 35 minutes.

In both cases, the exhaled smoke is very different from the smoke inhaled by the hookah user. Studies on cigarette show that only 20 % of the inhaled smoke is exhaled by the smoker. In the case of the hookah, the exhaled smoke has also been filtered at the level of the bowl (where temperatures are up to 700 hundreds degrees Celsius below that of a cigarette tip) and at the level of the vase, where most of the irritants (including notorious carcinogens) and other toxicants are watered down. Finally, all studies show that, as far as carbon monoxide is concerned, there is no such thing as hookah “passive smoking”. This is because the first victim of “passive smoking” is the smoker her/him/self, not the non-smoker. A good ventilation is the best piece of advice we can give to all hookah smokers of the world who do cannot refrain from smoking. May they just keep in mind that breathe is life and everything will be fine…

Dr Kamal T. Chaouachi (includes declaration of competing interests, direct or indirect, vis-à-vis the Pharmaceutical and Tobacco Industries)



[1] 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. 

[2] Enstrom JE. Defending legitimate epidemiologic research: combating Lysenko pseudoscience. Epidemiologic Perspectives & Innovations 2007 (10 Oct);4:11

[3] Enstrom JE, Kabat GC. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98 BMJ 2003; 326: 1057

[4] Appel: Alcool, tabac.  Gare au pavé de l'ours. Hygiénisme moral, puritanisme d'Etat, ou lobbies industriels ? Un appel à réagir (19 nov 2007) [Two Prominent Public Health Scholars Warn on Alcohol & Tobacco Policies: Moral Hygienism, State Puritanism or Industrial Lobbies ?] 

[5] Entrevue:

Verbatim transcription: English Translation/ (original in French)

[6] Communiqué : Le « tabagisme passif » du narguilé est un leurre [The Invention of Hookah (shisha, narghile) Passive Smoking] (17 Feb 2008). (incl. English translation)

[7] El-Nachef WN, Hammond SK. Exhaled carbon monoxide with waterpipe use in US students. JAMA 2008 (Jan 2);299(1):36-8.

[8] Chaouachi K. Serious Errors in Measuring Exhaled Carbon Monoxide with Waterpipe Use in US Students. Journalreview 2008 (10 Mar).

[9] Communiqué: Seven Thousand Billions of Ultra Fine Smoke Particles in a Single Hookah (Narghile, Shisha) Session and Yet their Users are Still Alive… (1 Dec 2007). A critical analysis of the following study: Monn C, Kindler P, Meile A, Brandli O. Ultrafine particle emissions from waterpipes. Tob Control 2007;16: 390-3.

[10] Sepetdjian E, Shihadeh A, Saliba NA. Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke. Food Chem Toxicol 2008 May;46(5):1582-90

[11] Chaouachi K. The narghile (hookah, shisha, goza) epidemic and the need for clearing up confusion and solving problems related with model building of social situations. TheScientificWorldJOURNAL: TSW Holistic Health &Medicine 207 (7): 1691–6.

[12] Maziak W, Ali RA, Fouad MF, Rastam S, Wipfli H, Travers MJ, Ward KD, Eissenberg T. Exposure to secondhand smoke at home and in public places in Syria: a developing country's perspective.Inhal Toxicol. 2008 Jan;20(1):17-24.

[13] Maziak W, Rastam S, Ibrahim I, Ward KD, Eissenberg T. Waterpipe-associated particulate matter emissions. Nicotine Tob Res. 2008 Mar;10(3):519-23.

[14] Letter (17 Jan 2008) to David Balfour, Editor in Chief of the Nicotine and Tobacco Research journal, about serious scientific error in: Ward KD, Eissenberg T, Gray JN, Srinivas V, Wilson N, Maziak W. Characteristics of U.S. waterpipe users: A preliminary report. Nicotine Tob Res. 2007 Dec;9(12):1339-46.

[15] Communique : Tout ce que vous ne pouviez pas savoir sur le livre de Bertrand DAUTZENBERG (président de l’OFT [Office Français du Tabagisme]) et Jean-Yves NAU (journaliste au journal Le Monde): «Tout ce que vous ne savez pas sur la chicha» (Ed Margaux-orange/OFT, mai 2007)(8 juin 2007).  

[16] Communiqué : One Hookah Would Equal 200 Cigarettes and European “Colonialism” (sic!) Would Now Be the Cause of the Hookah (Shisha, Narghile) Catastrophe ? (22-25 April 2007)




> Dr Wasim MAZIAK is the UNDECLARED author of the WHO report:

To the Editor of Journal of Negative Results in Biomedicine. Critique of comment by declared (and non-declared) authors of WHO erroneous report (Thomas Eissenberg, Wasim Maziak, Alan Shihadeh, Alan Ward) on the critique published in Journal of Negative Results in BioMedicine)(7 Nov 2007)

> Dr Thomas EISSENBERG is author or co-author of a certain number of studies (5 at least published in Nicotine and Tobacco Research) [*] in which he has made use of a smoking topography system called CReSS [Clinical Research Support System]. He has personally contributed to its development, through direct funding (2000 to 2002) from PLOWSHARE Technologies, Inc. , an industrial firm strongly linked to the Tobacco Industry. PLOWSHARE has recently been acquired by BORGWALDT (13 Nov. 2007), a company which sells, on a large scale, flavours and other products to the Tobacco Industry. One of PLOWSHARE's more famous customers was, at least in 2002, Philip MORRIS.

Dr EISSENBERG's work on a smoking topography device has had in fact a direct impact on studies on ""waterpipe"" smoking. For instance: the device is said to be "critical in the assessment of nicotine dependence in smokers […] Moreover, there is a similar need for a smoking topography measurement device capable of measuring any substance, which can be inhaled through the mouth [...]". See: LIKNESS MA, WESSEL RM. Apparatus for Measuring Smoking Topography. US Patent, 6,814,083 B2; 2004 (9 Nov). This work obviously paved the way to the development of the “waterpipe smoking” machine by the US American University of Beirut (and all the related pseudo-scientific comments in the literature citing the related experiments) which was based on a “smoking topography”. in fact, the latter violated the very principles established by WHO TobReg itself and the topography was biased [11].

(*) A sample of some studies (co)-authored by Thomas EISSENBERG and having a relation to the smoking topography device:

Breland, A.B., Buchhalter, A.R., Evans, S.E., and Eissenberg, T. (2002) Evaluating acute effects of potential reduced exposure products for smokers: clinical laboratory methodology. Nicotine & Tobacco Research. 4 (Suppl 2), S131-S140.

Buchhalter A.R., Schrinel, L., and Eissenberg, T. (2001) Withdrawal Suppressing Effects of a Novel Smoking System: Comparison with Own Brand, Not Own Brand, and Denicotinized Cigarettes. Nicotine & Tobacco Research. 3, 111-118.

Buchhalter, A.R. and Eissenberg, T. (2000). Preliminary evaluation of a novel smoking system: effects on subjective and physiological measures and on smoking behavior. Nicotine & Tobacco Research. 2, 39-43.

Eissenberg, T., Adams, C., Riggins, E.C.R. III, and Likness, M. (1999). Smoker' sex and the effects of tobacco cigarettes: subject-rated and physiological measures. Nicotine & Tobacco Research. 1, 317-324.

Breland, A.B., Kleykamp, B.A., and Eissenberg, T. (2006) Clinical laboratory evaluation of potential reduced exposure products for smokers. Nicotine & Tobacco Research, 8, 727-738.

Eissenberg, T., Riggins, E.C.R. III, Harkins, S.W., and Weaver, M.F. (2000). A clinical laboratory model for direct assessment of medication-induced antihyperalgesia and subjective effects: initial validation studies. Experimental and Clinical Psychopharmacology. 8, 47-60.

Zack, M., Belsito, L., Scher, R., Eissenberg, T., and Corrigall, W.A. (2001). Effects of abstinence and smoking on information processing in adolescent smokers. Psychopharmacology. 153, 249-257.

Kassel, J.D., Greenstein, J.E., Evatt, D.P., Wardle, M.C., Yates, M.C., Veilleux, J.C., and Eissenberg, T. (2007) Smoking in the absence of nicotine: behavioral, subjective and physiological effects over 11 days. Journal of Adolescent Health. 40, 54-60.


> Dr S. Katharine HAMMOND has not declared her conflicting interest in the study she supervised:

El-Nachef WN, Hammond SK. Exhaled carbon monoxide with waterpipe use in US students. JAMA 2008 (Jan 2);299(1):36-8.

“The FAMRI Bland Lane Center of Excellence on Second Hand Smoke at UCSF is supported by the National Flight Attendant Medical Research Institute (FAMRI) program. FAMRI is funded through a settlement from a class action lawsuit against tobacco companies on behalf of flight attendants who sustained health problems due to exposure to second hand smoke in their job”.



> The so-called “Initiative for Cardiovascular Health Research in Developing Countries”

is a funding party. Investigation on its potentially non-declared sources and contributors is pending.



NOTE : because it contains several electronic links to online documents, this communiqué is also made available at:



VOIR l'affiche à gauche (dont l'origine est l'OMS) préparée par les associations anti-tabac, l'INPES et la MILDT à l'occasion de la Journée Mondiale Sans Tabac 2006.  Elles fabriquent littéralement le "tabagisme passif" du narguilé, tout comme celle de l'Association états-unienne de pneumplogie (US-American Lung Association]: 

inpes2006 americanlungassociation